Dissociation-focused Victim Support and Coping with Traumatic Memory: an Empirical Search for...

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DISSOCIATION-FOCUSED VICTIM SUPPORT AND COPING WITH TRAUMATIC MEMORY: AN EMPIRICAL SEARCH FOR EVIDENCE SUSTAINING THE EFFECTIVENESS OF DOWNWARD COMPARISON BASED INTERVENTIONS1

FRANS WILLEM WINKEL*, ERIC BLAAUWt and FRANCIEN WISMAN*

• Kurt Lewin Institute, Department of Social Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam

tDepartment of Clinical Psychology, Vrije Universiteit Amsterdam, Vander Boechorststraat 1, 1081 BT Amsterdam

ABSTRACT

Some victims are highly susceptible to develop traumatic memories. A basic model of traumatic memory and its theoretical implications for coping assistance offered by victim support is outlined. The main focus of victim support from this perspective is to initiate and facilitate a process of dissociation, of disengaging episodic and negative affective memory. Downward comparison based intervention-a subtype of techniques of cognitive restructuring and psychological distancing-is suggested here as a potential facilitative vehicle. Various basic hypotheses underlying this potential were tested empirically, utilising data from the VU A -longitudinal study on criminal victimization. Analyses suggested that downward comparisons were associated with more successful adjustment, that they are vital in controlling fear responses, and that these processes are linked with relatively lower levels of reported trauma symptoms, such as anxiety, agoraphobia, depression, and somatic complaints. Downward comparison based interventions thus in principle appear to constitute effective, quality enhancing components of victim support. The actual impact of such interventions should be examined in more detail in future studies.

COPING WITH TRAUMATIC MEMORY: A SUPPORT PERSPECTIVE

Only a minority of victims involved in a criminal incident or a traffic accident develop traumatic memories. Traumatisation is thus not a necessary consequence of victimization. In circles of victim support such (empirically strongly corrobor-ated) statements often elicit sceptical reactions, and they are easily interpreted as signs of disrespect for victims. There is indeed an extensive literature on the psychological consequences of victimisation (Denkers and Winkel, 1998; Frieze et al., 1987; Janoff-Bulman, 1992; Lurigio and Resick, 1990; Norris and Ka-niasty, 1994). However, the picture emerging in that literature on the 'victimis-ation-traumatisation' interface is rather confusing. There is strong evidence suggesting that traumatisation is a highly likely consequence, and there is strong counter-evidence. This appears to be a contradiction; however, the sources

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underlying the evidence are rather different. As to crime victims, Janoff-Bulman (1992; p. 170) for example concludes:

'victims probably fare better than has generally been assumed. Most of what we presently know about survivors of traumatic life events is based on clinical samples. These are victims that have sought professional help in the aftermath of their victimization, and those having the greater difficulties are apt to be overrepresented in this population. It is likely that trauma victims who have had the fewest problems are those who have been studied least. Not surprisingly, clinical studies have tended to emphasize survivors' long-term psychological difficulties. Yet research with community samples has begun to paint a more positive picture, one that highlights the psycho-logical adjustment and well-being of survivors. The evidence for resilience2

is far more ubiquitous a phenomenon than mental health personnel ever realized, largely because of their long-term attention to behaviour patho-logy'.

The simultaneous presence of evidence for resilience or ubiquitous healthy functioning, and evidence indicating serious symptomatology in response to a criminal victimisation, points at the vital role of individual difference variables in further studying the formation of (and recovery from) traumatic memories. That is why various more recent models very explicitly include a 'trauma susceptibility' component (Bowman, 1997; Dohrenwend, 1998). The strain-pain model for example (Winkel, 1995) specifies a particular pre-victimisation psy-chological susceptibility-profile (consisting of intrapersonal risk/vulnerability factors; Winkel and Vrij, 1993; Winkel eta/., 1994; Winkel, 1997; see Figure 1) for victims who tend to be at risk in developing traumatic memories in response to particular types of life stressors, e.g. incidents that are far beyond 'normal human experience', or that are subjectively experienced as threatening one's physical and psychological integrity. The basic assumption underlying these models is that the formation of traumatic memory always is under the dual control of internal and external inputs (see Figure 1).3

A traumatic memory in our view basically consists of a powerful association between episodic and (negative) affective memory (see Figure 2).4 The episode as a stimulus, and negative affect as a response, become integrated in an associ-ative network (see Figure 2). Over time the salience and vividness of the episode tend to fade away, while affective intensity tends to level off and to extinguish (Crombag and Merckelbach, 1996; Wickelgren, 1972). These processes together thus result in a disengagement of the association: the link tends to get blurred and to evaporate. Time (proverbially healing all wounds) is a pre-eminent therapeutic device: it literally creates distance from the episode and the original affective response. However, sometimes, inter alia in chronic cases in which traumatic memory remains hyper-accessible over extensive periods of time, time appears

Traumatic Memory

i Internal Factors X

{Interaction)

Profile

0 External Control 0 Low Self-Efficacy 0 Low Hardiness 0 High Prior Life Stress 0 Prior Victimisation-Residues 0 Dispositional Pessimism 0 Anxious Style of Information-

Processing 0 Feelings of Unique Vulnerability 0 Low Psychological Wellbeing 0 Character Attributions

Figure I. Traumatic Memory and the Susceptibility Profile

External Factors

Stressor-Related

Crimininall Victimization

Threat Appraisai_j

to need an extra hand: external victim support is needed to initiate and stimulate the dissociation-process.

Dissociation-focused support, aimed at facilitating successful coping with a traumatic memory, should in a sense duplicate these properties of time. Ultimate-ly, the general goal is to provide victims with an opportunity to distance them-selves psychologically from the 'affective episode'. We assume that psychological distancing can be accomplished in various ways, inter alia through cognitive (verbal) restructuring and through 'nonverbal distraction' (see Figure 2).

Nonverbal distraction, in our view, is one of the working ingredients of Eye Movement Desensitization and Reprocessing (EMDR), a relatively recently developed trauma-focused intervention (Shapiro, 1996). The EMD-component consists of a particular application of the exposure principle:5 clients are re-ex-posed to images of the distressing episode (task 1) while making distracting eye movements (task 2). Dual tasking appears to result in relatively rapid desensiti-zation or affective discharging. The hypothesis that concurrent eye movements

Traumatic Memory

Personal/ Helper Induced Coping Attempts

De-victimization (Coping)

L, Episodic Memory

Affective Memory

ｾｔｩｲｮ･ｬｮ､ｵｯ･､＠

Association T ( 1)

<3radual 1r(2) Disengagement

Support Induced

l ｛］ｾ］ｲｩｮｾ＠(Downward

Comparison)

and/or

ｾｯｮｶ･ｲ｢｡ｬ＠ J

Restructuring Eyemovement esensitization

-Dissociation T (3) <1111'41-------'

Figure 2. Coping with Traumatic Memory: Personal and helper induced 'dissociation', decay, and extinction

reduce the emotional intensity associated with a negative image was experimen-tally tested by Andrade et al. (1997).

Andrade et al. asked non PTSD participants (students) to form images of neutral and negative pictures under dual task conditions: participants were also involved in an eye movement task, or in a spatial tapping task. In the first three experiments (which all relate to in vivo exposure to photographs of war, death, and disaster as negative stimuli) these distracting tasks did not consistently affect participants' emotional responses to the images. However, the fourth experiment (relating to imaginal exposure) which used personal recollections as stimuli for the imagery task, demonstrated a significant reduction in emotional response under the same dual task conditions. The impact of dual tasking followed by positive re-labeling of the episode on more common measures of trauma symp-toms was examined by Renssen in two samples of victims involved in a traffic accident. These victims participated in two or three EMDR sessions, each lasting about 1.5 hours (Renssen and Winkel, 1999). During these sessions, clients engage in imaginal recall of the disturbing event, while performing rapid tracking eye movements by following the repetitive motion of the helper's hand. Cycles of dual tasking are continued until the client reports feeling comfortable. At this

Trauma Symptoms

t Traumatic Memory

Response lncompatability

+ Response

th+gh Nonverbal/Cognitive

Restructuring

ｾ＠De-Victimization

Coping

Figure 3. Coping with Traumatic Memory: Support as a learning-process of incompatible responses

point a positive cognition is paired with the episode by having the client imagine the original scene and rehearse the positive statement covertly, while simulta-neously engaging in eye movements (Renssen, 1997; Feske, 1998). Analyses revealed clinically significant reductions of trauma symptoms (measured via the Symptom Checklist 90 and the Impact of Event Scale). These outcomes further substantiate the hypothesis that nonverbal distraction and cognitive restructuring facilitate the process of trauma-resolution. Theoretically, such a beneficial effect can also be understood in terms of a process of learning incompatible responses (see Figure 3).

The concept of response-incompatibility entails that opposite (cognitive or affective) reactions cannot occur simultaneously in response to a given stimulus

(Baron and Richardson, 1993). Joy and sadness, anger and fear, or more gener-ally positive and negative affect are incompatible in this sense. The repeated sets of helper initiated eye movements might, in our view, be construed as powerful nonverbal dis tractors (distracting from negative affect), inducing, at least, neutral affect. As trials proceed the victim is actually learning to associate neutral affect with the episode, thereby breaking the original association. Obviously, this speculation needs independent empirical support (Dyck, 1993; Shapiro, 1996). Techniques of cognitive restructuring (Beck, 1970; Ellis, 1962; Meichenbaum, 1979) might well work in a similar way. Traumatic memories typically appear to rest on a victim's rather 'pessimistic' construction of the episode (Winkel and Denkers, 1995; Winkel et al., 1994 ). Building a more optimistic perspective from which to appraise the original episode may then be considered learning an incompatible cognition, thereby providing an opportunity for dissociation.

COGNITIVE RESTRUCTURING: 'DOWNWARD COMPARISON' THEORY

Downward comparison theory suggests a set of cognitive mechanisms which facilitate recovery. In the psychological literature these mechanisms are dis-cussed under different labels, such as techniques of neutralisation (Agnew, 1985: e.g. denial of emotional injury, or denial of vulnerability), strategies of selective evaluation (Taylor et al., 1983), processes of social comparison (Wills, 1981), and mechanisms of adaptation and re-adjustment to criminal victimisation (Win-kel and Steinmetz, 1990; Winkel and Denkers, 1996).

Winkel and Steinmetz ( 1990), building on prior fear of crime studies (Winkel, 1981, 1983), suggest five cognitive mechanisms to control the perceived serious-ness of consequences emanating from, and the negative affective responses associated with the episode, namely:

1) downward social comparison;

2) downward dimensional comparison;

3) downward situational comparison;

4) beneficial framing; and

5) optimistic framing.

A very similar type of categorization, referred to as strategies of selective evaluation, was proposed by Taylor et al. (1993): (1) making social comparisons with less fortunate others; (2) selectively focusing on attributes that make one appear advantaged; (3) creating hypothetical worse worlds; (4) construing benefit from the victimizing episode I making sense of the incident; and (5) manufacturing normative standards of adjustment that make one's own adjust-ment appear exceptional.

A formal theory of downward comparison was introduced by Wills ( 1981, 1991). He argues that downward comparison theory encompasses principles of describing the process of upward comparison (i.e., comparing oneself with a person who is better off than the self), and of downward comparison (i.e., comparing oneself with a person who is worse off than the self). Its basic principle is that persons can increase their subjective wellbeing through compari-son with a less fortunate other. The 1991-version of the theory moreover suggests that wellbeing may be enhanced by comparison with a person who is also experiencing problems, but is at essentially the same level as the self (lateral comparison). Major corollaries flowing from these principles are: that downward comparison exists; that it is evoked by a decrease in subjective wellbeing; that it is likely to occur in situations where a person's self-esteem or wellbeing is threatened; that it constitutes a mechanism of self-enhancement, and that down-ward comparisons may take the form of 'constructive processes'. Wood (1996) draws attention to the fact that comparison targets may be the products of one's own imagination, and that imaginary comparison-others have a 'psychological reality'. Wood (1989) also notes that there is substantial empirical evidence suggesting that people construct social realities that serve their comparison purposes.

Various boundary conditions on the impact and consequences of downward comparisons were suggested. One of these relates to the size of the comparison-differential (the other being worse off to a small, moderate or large degree). The emotional benefit extracted from a downward comparison is hypothesized to be small, if the comparison differential is small; it tends to be moderate to large, if the differential is moderate to large, while negative outcomes might occur, if the differential exceeds a certain point and becomes too large (empathic concerns with the other are then hypothesized to override the comparison process). Another theoretical 'boundary condition' comprises the expectations about the future similarity between oneself and the comparison-target. Wills ( 1991) hypo-thesizes the emotional benefits resulting from downward comparison to be determined by fate similarity and future similarity. This hypothesis is represented in Figure 4.

In our view, these boundary conditions typically relate to processes of 'realis-tic comparisons', and may be less relevant for processes involving imaginary comparisons. However, Figure 4 explicitly suggests that downward comparison processes may conditionally backfire, and result in negative rather than positive changes in psychological wellbeing. Figure 4 thus highlights the necessity to study further comparison processes in crime victims. Various other points also highlight this necessity.

(1) As to types of stressors examined, crime victims are heavily understudied. Most studies relate to other trauma populations (Buunk, 1992; Taylor et al., 1993; Helgeson and Taylor, 1993; Wood et al., 1985; Wood, 1989).

FATE SIMILARITY (current state)

WORSE OFF (other)

MUCH WORSE OFF (other)

FUTURE SIMILARITY

ww I HIGH

(Symbols indicate net change in subjective wellbeing; + indicates positive change in wellbeing; - a negative change in wellbeing; + + larger postive and -- larger negative change in wellbeing)

Figure 4. Emotional Outcomes of Downward Comparison (Wills, 1991)

(2) As to crime victims Hale (1996) recently noted that there appears to be very limited support for the notion that they engage in 'techniques of neutralisation', as defined by Agnew (1985).

(3) Social comparison research has shown a recent resurgence in the area of health psychology (Buunk and Gibbons, 1997). This area is plagued by contra-dictory findings (which partly is due to differences in the way comparison processes are defmed; Taylor and Lobel, 1989). Aspinwall (1997; p. 133) for example concludes: 'consistent with Wills' (1981) analysis, there is now consid-erable evidence that people undergoing decreases in subjective wellbeing re-spond favorably to downward comparisons. In addition, studies employing either inductions of negative mood or naturally occurring dysphoria suggest that people in a negative mood respond favorably to downward comparison information'. However, in the same book Buunk et al. (1997; p. 12) note: 'there is also a substantial amount of evidence suggesting that individuals who are experiencing stress have a preference for upward comparisons .... ' In a series of field experi-ments Ybema and Buunk found that disabled individuals and individuals facing a loss of their job experienced a more positive mood after being confronted with an upward comparison rather than a downward comparison. Various social psychological studies employing an experimental design tend to be fatally flawed (Wood, 1996; Ybema, 1994). Ybema (1994) and Buunk (1992) claim to have documented enhanced negative affect due to downward social comparison. However, a careful inspection of their experimental designs and of the statistical analyses performed reveals that they are not documenting boomerang-effects due to comparison-processes, but merely that exposure to negative information (providing information about a target, who is not coping very well, or very unsuccessfully) results in increased negative affect. This is a common outcome of studies examining the impact of crime related information on the public's and

victims' fear-responses (see: Winkel and Vander Wurff, 1990, for an extensive review).

4) Central to the 'dissociation-potential' (see section 1) of downward compari-son as an effective coping strategy for crime victims is the 'internal focus' of the process(/ am doing better). An external focus (the comparison target is doing worse) might backfire, and thus increase negative affect. The imminent risk of the modal design used in social comparison studies is an unwanted, external perceptual focus.

5) Experimental social psychological studies tend to ignore the 'reconstructive nature' of downward comparison processes.

The 'Vrije Universiteit Amsterdam' (VUA) Prospective and Longitudinal Study on the Psychological Impact of Criminal Victimisation offers various opportunities to further examine the dissociation potential of reconstructive downward comparison processes in crime victims. In line with the original theory, introduced by Wills (1981), the following hypotheses were tested: (1) Engaging in downward comparison is positively associated with more successful coping with a criminal victimisation; (2) Downward comparison results in more optimistic appraisals of the damaging impact emanating from the victimising episode, which in tum, neutralise fear-responses (e.g., crime victims' fear levels and controls are basically at the same level), and (3) Downward comparison is associated with reporting fewer long term trauma symptoms, and thus with less psychological distress.

METHOD

The VUA-study was conducted from September 1992 until January 1996. It basically consists of a series of measurements among crime victims and a matched (age, sex, degree of urbanisation, and household composition) sample of control subjects/non-victims over time, namely at T(o) or pre-victimisation measures, and various post-victimisation measures, at To>• or within 2 weeks after the victimisation, at T(2). or 1 month after, at T<3>, or 2 months after, at T<4>, or 4 months after, at T(S)• or 8 months after, and at T<6>, or 10 months after the incident. All T(o)-measures relate to 5,218 subjects, belonging to the 'Telepanel Foundation', comprising a sample representative of the Dutch population. This Foundation operates with a computerized method of data-gathering: question-naires are sent out, each week, from the central computer via a modem to personal household-computers. Participants tend to respond during the week-ends, at a time convenient to them. After the T<orquestionnaire, each week respondents were asked if they had been victimized. In case of an affirmative answer these respondents (after considering factors such as the type of victimis-

ation and its financial and physical consequences) were streamed in into our victims sample. Victimizations relate to household burglary, contact-robbery, threat, assault, and sex-related crime. Sampling continued until 200 victims of person-directed, and 200 victims of property-directed crimes were registered at T(la)· A matched sample of 200 non-victims served as controls.6

In the present context only a few measures are relevant, namely Downward Comparison (measured from T(l) up to T(s)); Fear of Crime (measured from T(o) up to T(s)), and the fear-related cognitions SVR (Subjective Victimization Risk; measured from To) up to T(s)), and NI (Perceived Negative Impact; measured from T(o) up to T(s)); Psychological Well-being (measured from T(o) to T(s)); and Trauma Symptoms or Long-term Psychological Distress (measured at T(6)). The current measure for Downward Comparison was similar to that reported by Winkel and Denkers (1996), comprising three items: 'in comparison to other victims I got off rather well', 'sometimes I think, it could have been worse', and 'in comparison to others I think I am coping rather well'. Answers were in terms of 7 point rating scales, ranging from 'total disagreement' to 'total agreement'. The scale turned out to be reliable: alpha= .70. All fear-scales were based on Winkel (1983). SVRs were assessed through asking 'how small or big do you think the chances are of personally becoming a victim of 'x' (for 'x' a series of crime labels were included). The reliability of this scale was .82 for victims, and .86 for controls. NI was assessed in a similar way through the question: "how serious do you think the consequences will be, if you are personally victimised by 'x'". This scale also was reliable: alpha was .83 for victims, and .90 for controls. Fear of Crime was directly measured via a series of bipolar semantic differentials (safe-unsafe, calm-tensed, etc), relating to the statement: 'if you think about the possibility of becoming a crime victim, to what extent are the following feelings currently elicited'. Answers were always in terms of 7 point rating scales. Reliabilities for fear of crime were .85 for victims, and .86 for controls.

Long term psychological distress ('trauma symptoms') was assessed via the 'SCL90' (Arrindell and Ettema, 1986). More specifically, ratings were requested for eight different symptom-groups; anxiety, agoraphobia, depression, somatic complaints, insufficiency of thinking and behavior, interpersonal sensitivity, hostility, and sleeping problems. Sample items illustrating the anxiety-dimension included: 'suddenly scared for no reason, feeling fearful, and feeling tense or keyed up'. Sample items relating to the agoraphobia-dimension included: 'feel-ing afraid in open spaces or in public, feeling afraid to get out of your house alone, feeling afraid to travel on buses, subways or trains'. Depression items included: 'thoughts of ending your life, feeling of being trapped or caught, and feeling no interest in things'. Somatic complaints included: 'headaches, pains in lower back, and heart pounding or racing'. Insufficiency of thinking and beha-vior: 'feeling that you are watched or talked about by others, other people being aware of your private thoughts, and hearing voices others don't hear'. Interper-sonal sensitivity: 'feeling others do not understand you or are unsympathetic,

others not giving you proper credit for achievements, feelings of worthlessness, and feeling inferior to others'. Hostility included: 'having urges to beat, harm, or injure someone, temper outbursts that you could not control, and the feeling that most people cannot be trusted'. Sleeping problems: 'having difficulty falling asleep, waking up too early, and uneasy or disturbed sleeping'. Finally, psycho-logical wellbeing was measured via the Diener et al. (1985) 'Satisfaction with Life scale', consisting of 5 items (sample item: 'in most ways my life is ideal'). This scale also turned out to be reliable (alpha= .85).

RESULTS

Coping success and downward comparison

Psychological wellbeing was assessed both prior to the incident, and at various post-victimisation points in time. These repeated measures provide us with an intriguing opportunity to examine coping at two specific levels, namely success-ful versus failing adjustment. Successful adjustment in our view typically emer-ges if post-victimization psychological wellbeing is similar or better than prior to victimisation wellbeing. The reverse (postvictimisation being lower than prior wellbeing) then represents failing adaptation, at least to some degree. Various analyses of variance were conducted on the basis of either an adjustment/coping (successfuVfailing) by type of subject status (victims versus controls), or a simple coping-design. To check the validity of our coping-measure a two-way analysis was conducted on a positive-negative affect profile. This analysis revealed two significant main effects for victimisation (Fo.46?) = 3.70, p < .05), and for coping (F0 .467) = 10.50, p < .001). Victims reported less positive affect than controls, while coping failure was associated with enhanced negative affect relative to successful adjustment (see Figure 5). Moreover a significant interaction emerged: F0.467) = 4.44, p < .03). Victims who were coping successfully were at the same level as controls. Victims exhibiting coping failure typically tended to report reduced positive affect. This reduction is visible both with regard to the pertinent controls, and regarding victims who were coping successfully. This interaction highlights the validity of our coping measure.

The second analysis - on downward comparison - resulted in a significant main-effect due to coping (F(1,201) = 16.16, p > .001). Victims who were coping successfully were more strongly engaged in downward comparisons: they tended to report that they got off relatively well, and that they were coping relatively well, in comparison to others. Moreover, they tended to agree more strongly with the idea that it could have been worse. These outcomes clearly support our first hypothesis.

Positive Affect

ｾ＠ Succesful Adjustment

D Coping Failure

Figure 5. Successful Adjustment and Coping Failure in Crime Victims: means on positive affect and downward comparison

Fear responses and downward comparison

Fear responses to criminal victimisations, according to our model (Winkel, 1981, 1983, 1991), are cognitively mediated, in particular by subjective victimisation risk (SVR) and perceived negative impact (NI). Contrary to common-sense expectations, (direct) criminal victimisations only tend to result in relatively marginal increases in fear of crime (Hale, 1996). There is even overwhelming empirical evidence suggesting that the fear-criminal victimisation relationship is generally weak (Box et al., 1988; Braungart et al., 1979; Garofalo, 1979; Hale, 1996; Hindelang et al., 1978; Sparks et al., 1977; Skogan and Maxfield, 1981), or even inexistent (Baker et al., 1983; Hill et al., 1985; Winkel, 1985). In terms of our model, these outcomes can be easily explained through the notion of 'compensation': if increases in SVR as a typical response to a criminal victirnis-ation are compensated for by reductions in NI then the model predicts only very slight increases in fear of crime. It is very likely that such NI-reductions are a direct manifestation of underlying downward comparison process (Winkel and Steimetz, 1990). Empirical support for these notions becomes available if it can be documented that victims, relative to controls, associate less serious conse-quences with a victimisation, or if victims' post-victimisation assessments of these consequences are more optimistic than their pre-victimisation expectations.

To explore the compensation-phenomenon a series of multi-variate analyses of variance were conducted, on the basis of a single factor- design (victimis-ation: yes/no). Pre-victimisation differences in fear of crime between victims and non-victims did not emerge (F < 1; n.s.). However, multivariate main effects due

to victimisation emerged at all post-victimisation points in time: at To> Fm (3,543) = 8.86 (p < .001), at T(2) Fm (3,522) = 8.56 (p < .05), at T(3) Fm (3,467) = 4.98 (p < .01), at T(4) Fm (3,425) = 3.14 (p < .05), and at T(5) Fm (3,313) = 3.86 (p < .05). Univariate analyses revealed that in none of these analyses (these multivariate) differences were related to differences in fear of crime: thus victims and non-vic-tims generally tended to report the same level of 'post-victimisation' fear of crime, supporting the general trend in the literature. The T(l)-main effect was particularly related to differences in SVR: F = 16.31 (p < .001), and slightly related to differences in NI (F = 2.57; p = .10). At this point in time mean SVR for controls was: M = 2.37 compared toM= 2.80 for victims. Victimisation thus appeared to affect SVR negatively; victims tended to assess their chances of future victimisation to be higher than controls. This effect however is rather shortlived, and tends to dissipate rather quickly: after T(l) no significant SVR-differences between victims and controls emerged. Thus all other multivariate effects appeared to be due to univariate differences in NI: at T(2) F = 5.01 (p < .05); at T(3) F = 6.00 (p < .05), at T(4) F = 4.05 (p < .05), and at T(5) F = 10.09 (p < .01). The effects on NI appeared to be rather consistent over time: at all measurement points in time mean Nls had more favorable values for victims than for controls. Controls thus tended to associate more negative consequences with victimisation than victims. Together these outcomes provide strong empirical support for the notion of compensation (see Figure 6), in which higher levels of SVR are cancelled out by lower levels of Nl.

To further explore the observed Nl-differences among victims, pre-victimis-ation expectancies relating toNI were compared with post-victimisation assess-ments of NI at To>· A simple comparison of means suggested a significant difference between pre-and post-victimisation assessments: t = 5.16 (p < .001). An inspection of the means suggested that post-victimisation assessments were significantly more optimistic than pre-victimisation assessments. After their victimisation subjects tended to associate less serious consequences with a future victimisation. This finding directly supports our hypothesis relating compensa-tion to downward comparison processes. In comparing their pre-and post-victi-misation situation, victims appear to be saying 'I expected the victimisation to be worse', thereby exhibiting a particular form of downward comparison.

Downward comparison and long term trauma symptoms

An analysis of variance, representing a single 'comparison-factor' (downward versus lateral and upward comparison), was fmally conducted on long term trauma symptoms (SCL90), reported ten months after the victimisation. The downward level of this factor consisted of victims reporting more 'optimistic' post-victimisation negative impacts (thus: post-victimisation NI < pre-victimis-ation NI), while the upward/lateral level comprised victims reporting relatively 'pessimistic' negative impacts (thus: post-victimisation NI is either > or =

high 2,8

Subjective Victimization

Ftislc 2,4

tl t2 t3

ｾ＠ victims D controls

Negative Impact

Figure 6. SVR-NI Compensation: Enhanced SVR and reduced NI in victims relative to controls

ﾷｾ＠ victims

D controls

...... \0 N

pre-victimisation NI). An overall analysis suggests that victims engaging in downward comparison reported significantly fewer trauma symptoms (F(1,259) = 5.35; p < .05). The pertinent means are summarised in Table 1.

TABLE 1

The Relation of Downward (Negative Impact) Comparison versus Upward/wteral (Negative Impact) Comparison on wng Term (after 10 months) Post-victimisation Psychological Distress

wng Term Psychological Distress Downward NI- Upward/wteral An ova (SCL90:Trauma Symptoms) Comparison NI -Comparison

M M Fo.259)

Symptom Checklist 90 (overall) 111.27 121.93 5.36** Agoraphobia 7.50 8.03 4.33** Anxiety 11.85 13.18 5.20** Depression 20.34 22.83 5.19** Somatic Complaints 14.96 16.43 4.56**

Insufficiency of Thinking and 11.93 13.36 5.28** Behavior

Interpersonal Sensitivity 22.91 24.85 3.20*

Hostility 6.96 7.51 2.56* Sleeping Problems 4.27 4.53 < 1 ns

**: p < .05; *: p < .10

According to Table 1 the overall comparison-effect on trauma symptom-in-tensity was particularly due to significant differences in agoraphobia, anxiety, depressive symptoms, somatic complaints, insufficiency of thinking and beha-viour, interpersonal sensitivity, and in hostility symptoms. In all of these cases victims engaging in downward comparisons reported trauma symptoms at a much lower level than victims exhibiting upward or lateral comparisons. Only with regard to sleeping problems did no significant differences emerge. Both the overall pattern, and the pattern of means for separate symptom groups, clearly substantiate our third hypothesis.

APPLICATION AND DISCUSSION

The basic principle underlying our theoretical conception of traumatic memory is that it consists of a S-0-R-scheme, an organism-bound (see: susceptibility profile) relation between the episodeS (the victimisation) and negative affective Responses. The resulting association of episodic and negative-affective memory

comprises the heart of a traumatic memory. The basic aim of coping assistance through victim support is to provide the victim with opportunities for dissoci-ation, and to provide the resources enabling the victim to initiate and further develop this process of disengaging the pertinent memories. The focus of the present article was on potential cognitive resources empowering the victim gradually to build a more optimistic perspective from which to look at the episode. Stimulating downward comparison was here introduced as one of the potential devices for paving the way to dissociation. Obviously, this potential needs further direct empirical scrutiny: the various analyses reported here sug-gest that this potential appeared to have a firm empirical basis, emerging in (1) a clear association between coping success and downward comparison, (2) the apparent role of downward comparison-processes in controlling fear of further victimisation, and (3) a clear relation between downward comparison tendencies and the reporting of long term trauma symptoms at a significantly lower level.

Support workers who are providing coping-assistance are generally involved in a delicate and complex transaction-process. Initiatives permanently tend to shift back and forth, from the victim to the helper, and from the helper to the client. Techniques used by the helper to facilitate the victim's coping attempts with his or her traumatic memory tend to be multi-faceted, and inter alia include: providing opportunities for emotional ventilation (Pennebaker, 1995), engaging in techniques of cognitive restructuring, applying eye movement desensitization (Shapiro, 1996), and attempting to induce a state of hypersuggestibility in the victim (Barber, 1996). Moreover, to be effective, these techniques should be applied in an orderly fashion. It is beyond the scope of this article to discuss in more detail the efficient use of these techniques, and particularly the ways of integrating them properly (see Figure 7). However, given the present focus on techniques of cognitive restructuring, we feel that a few words of caution are needed regarding the practical application of downward comparison based inter-ventions.

It is obvious that unskilled or uncritical application will very easily result in a secondary victimization, in psychologically wounding the client again. A helper starting the intervention by implicitly, or even more serious, explicitly suggesting to the victim that his or her suffering is more or less relative compared to others with a similar fate is merely blaming the victim in a rather drastic way. It is not appropriate for a Victim Support worker, neither during the initial phases, nor during the further phases of the intervention, to express value judgments about the seriousness of the victim's pain and suffering. Obviously this is not what we are suggesting when talking about downward comparison interventions. In con-densed form, what we argue for is briefly summarized in Figure 7.

Various parts of this model and related concerns were discussed in more detail elsewhere (Winkel and Koppelaar, 1988; Winkel, 1991; Winkel and Renssen, 1998). As to downward comparison, the underlying idea is not to be confronta-tional, but in various ways to be responsive to downward signals emitted by the victim. Such a responsiveness includes providing a platform for emotional

( 1 ). NEUTRAL OPENING

( 2 ). ESTABLISHING RAPPORT

( 3 ). CREATING SPACE FOR EMOTIONAL

EXPRESSION I VENTILATION I and DISCLOSURE ( 4 ).

UNOBTRUSIVELY MONITORING FOR DOWNWARD SIGNALS (downward comparison; creating hypothetical, worse worlds; construing benefit from

or making sense of the event, etc.) ( 5 ).

PREPARATORY ACI10N FOR INITITATING THE PROCESS OF COGNITIVE RESTRUCTURING

5 (A): RE-ROUTING under the condition of 'IDGH AFFECTIVE INTENSITY':

(extensive) INTERMEDIATE STEPS, including - eyemovement desensitization, and I or

- inducing hyper-suggestibility 5 (B):

DIRECT TRANSmON TO (6). under the condition of 'WW AFFECTIVE INTENSITY'

( 6 ). PROVIDING EMOTIONAL SUPPORT

(including positive reinforcement of downward signals, if present) ( 7 ).

SUBJECTIVE AND OBJECTIVE ASSESSMENT OF CLffiNT'S CURRENT COPING-POTENTIAL AND PSYCHOLOGICAL STATE

(via administering the SOCIAL COMPARISON CHECKLIST (SCC)) ( 8 ).

INTERPRETATION, GUIDANCE, AND (PROVISIONAL) CLOSURE

8(A): Utilize prevailing Downward Signals to further enhance perceptions of control and

recovery; S(B):

An emerging 'SCC-Upward Profile' (presenting a coping-deficit) is indicative of a need for a 2nd appointment I active referral

Figure 7. A (partial) model of support integrated downward comparison interventions

disclosure, carefully 'following' the victim's narrative, and being on the ｾ･ｲｴ＠ for downward signals. The more active role of the support worker durmg the interaction with victim is, inter alia, to provide emotional support and to rein-

force emerging downward signals. In many cases, emotional ventilation as such provides sufficient ground for the victim successfully to initiate the process of cognitively building a more optimistic way of looking at the victirnising episode. However, ventilation, although being always necessary, is probably not a suffi-cient condition for victims exhibiting hyper-affective traumatic memory (Penne-baker, 1995). In these cases, downward comparison based interventions should be preceded by affect-focused interventions, such as eye movement desensitiza-tion. Finally, closure of the interaction always involves an appraisal of the victim's current psychological functioning and future coping potential. In our view, the emergence of an abund1mce of upward signals provides a diagnostic cue for continued support, in one form or another. Equally, we consider a clear pattern of downward signals to present a positive prognostic cue. Obviously, these ideas and the utility of the model in designing and conducting training in downward comparison interventions need further empi1ical validation. The Ach-mea Foundation 'Quality of Victim Support' research-and training-develop-ment-program that we are currently involved in aims at meeting this demand.

This study forms part of the 'Quality of Victim Assistance' Research-and Training-Develop-ment Program, which is conducted by a multi-disciplinary team of psychologists working at the Department of Social Psychology ofVrije Universiteit Amsterdam, in cooperation with the Netherlands Victim Support. The program is financially supported by the ACHMEA Founda-tion Victim and Society (Stichting A CHMEA Sla.chtoffer en Samenleving).

2 Such conclusions were already drawn in the seventies.In their review of the life events literature Kessler et al. (1985; p. 532) conclude: 'it has become increasingly clear that the vast majority of people who are exposed to stressful life events do not develop emotioaal disorder. There are two different life events literatures, one grounded in epidemiology and the other in clinical practice. lJntil the mid-1 ｾＷＰｳ＠ (the first type of &tudy) focused on the task of demonstrating that exposure to such events car1, in fact, lead to illness. Yet the relations that have been documented are extremely small. Rabkin and Struening (1976) estimated that no more than 9% of the variance in health outcomes is explained by life events. TI1e same predictive power is found when mental health outcomes are the focus of analysis'. These relationshios were generally seen as 'disappointingly weak' (1985; p. 534).

3 Dual controi implies that minor stressors may result in serious symptomatology, i:!nd that major stressors may result in mild symptomatology (See B;ewin eta[., 1996).

4 A more fine-grained distinction within traumatic memory is that between hypercognitive (hypo-affective) and oyperaffective (hypocognitive) traumatic memories. In the tirst type of trauma memory the affective responses are appraisal-based: cognition is assumed to precede emotion. In the second type of memory affective ｲ･ｳｰｯｲＮｳ･ｾ＠ are ｾｳｳｵｭ･､＠ to precede cognitive r0sponses: the affective response5 are directly due to ･ｰｩｳｯ､･Ｍｩｮ､ｵｾ･､＠ hyper-arousal. This latter type is thus characterisl·d by a primary affective response, while cognitions/appraisals are secondary responses. Tne reverse is true for hypo-affective traumatic memories. From a neuro-psychological perspective the hyper-affective type of memory is based on non-cortical processing, resulting in a 'direct' activation of the amygdala (Winkel, 1999). See also Brewin et al. (1996) fo;- u similar type of distinction in verbally and situationally accessible trauma memories.

5 Most psychosocial treatments for post-traumatic stress disorder involve exposure procedures: the common feature is that victims are re-exposed to the distressing episode. Foa and Meadows (1997) note that exposure varies on 'the dimensions of exposure medium (imaginal versus in vivo), exposure length (short vs long), and arousal level during exposure (low versus high)'. EMDR is at the extreme of imaginal, brief, and maximally arousing exposure. In contrast to standard procedure EMDR offers two new elements, namely (1) 'flexible exposure' and (2) 'dual tasking', engaging in a concurrent secondary task (making eye movements). Exposure is flexible in the sense that the client is not 'forced' to stay with one particular episode, but that he or she can freely move to other episodes (e.g., prior victimizations; see Figure 1).

6 For a systematic analysis of drop-out rates we refer to Denkers (1996). Drop-out rates for victims were higher than for non-victims. On the basis of an analysis of all T(otmeasures there are no indications for a selective drop-out among victims. Drop-out was mainly related to the non-serious nature of the crime. Moreover a number of victims were excluded from the analyses because of errors in self-classification.

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