Abstracts
Abstract
In this paper, an integrated existential framework for trauma theory is presented. The framework is based on the clustering of current trauma theories into physical, relational, and intrapersonal categories, and the relation of these three clusters to Irvine Yalom’s ultimate existential concerns of life/death, connection/isolation, and freedom/responsibility. Recent research has revealed an interplay between the physiological and psychosocial aspects of traumatic experiences, suggesting that a theoretical integration which includes consideration of physiological change, fear conditioning, and relational impacts is required to fully address the impacts of trauma. The fourth existential concern, meaning/meaninglessness, is argued to underlie all of the aspects of trauma, forming a common connection between all theories. This paper undertakes a brief review of current theories in traumatology to illustrate the validity of the three theoretical clusters, explores the current application of existential theory to the conceptualization of trauma, and presents a unifying organizational framework for trauma theory based in existentialism. Critiques of theory integration and existentialism are explored, followed by an analysis of risks for existential theory in the application of this framework. Implications for future research and social work practice based on the existential framework are also presented.
Keywords:
- trauma,
- existential,
- PTSD,
- theoretical,
- integration,
- framework
Résumé
Dans cet article, un cadre existentiel intégré pour la théorie du traumatisme est présenté. Ce cadre est basé sur le regroupement des théories du traumatisme actuelles en catégories physique, relationnelle et intrapersonnelle, et sur la relation de ces trois catégories avec les préoccupations existentielles ultimes d’Irvine Yalom, de vie/mort, de connexion/isolement, et de liberté/responsabilité. Des recherches récentes ont révélé une interaction entre les aspects physiologiques et psychosociaux de l’expérience traumatique, suggérant qu’une intégration théorique incluant la prise en compte du changement physiologique, du conditionnement de la peur, et des impacts relationnels est nécessaire pour traiter pleinement les impacts du traumatisme. La quatrième préoccupation existentielle, la signification/absence de signification, sous-tend tous les aspects du traumatisme, formant un lien commun entre toutes les théories. Ce document passe brièvement en revue les théories actuelles en traumatologie pour illustrer la validité des trois regroupements théoriques, explore l’application actuelle de la théorie existentielle à la conceptualisation du traumatisme et présente un cadre organisationnel unificateur pour la théorie du traumatisme basée sur l’existentialisme. Les critiques de l’intégration des théories et de l’existentialisme sont explorées, suivies d’une analyse des risques pour la théorie existentielle dans l’application de ce cadre. Les implications pour des recherches futures et la pratique du travail social basé sur le cadre existentiel sont également présentées.
Mots-clés :
- trauma,
- existential,
- TSPT,
- intégration,
- cadre théorique
Appendices
Bibliography
- Admon, R., Milad, M. R., & Hendler, T. (2013). A causal model of post-traumatic stress disorder: Disentangling predisposed from acquired neural abnormalities. Trends in Cognitive Sciences, 17(7), 337–347. https://doi.org/10.1016/j.tics.2013.05.005
- Arikan, G., Stopa, L., Carnelley, K. B., & Karl, A. (2016). The associations between adult attachment, posttraumatic symptoms, and posttraumatic growth. Anxiety, Stress & Coping, 29(1), 1–20. https://doi.org/10.1080/10615806.2015.1009833
- Bauman, S., & Waldon, M. (1998). Existential theory and mental health counseling: If it were a snake, it would have bitten! Journal of Mental Health Counseling, 20(1), 13–28.
- Benoit, M., Bouthillier, D., Moss, E., Rousseau, C., & Brunet, A. (2010). Emotion regulation strategies as mediators of the association between level of attachment security and PTSD symptoms following trauma in adulthood. Anxiety, Stress & Coping, 23(1), 101–118. https://doi.org/10.1080/10615800802638279
- Bering, J. M. (2003). Towards a cognitive theory of existential meaning. New Ideas in Psychology, 21(2), 101–120. https://doi.org/10.1016/S0732-118X(03)00014-X
- Berry-Smith, S. (2012). Death, freedom, isolation and meaninglessness, and the existential psychotherapy of Irvin D. Yalom (Masters dissertation Auckland University of Technology).
- Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23(3), 339–376. https://doi.org/10.1016/S0272-7358(03)00033-3
- Briere, J., & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd ed.). SAGE.
- Brousse, G., Arnaud, B., Durand-Roger, J., Geneste, J., Zaplana, F., Bourguet, D., & Blanc, O. (2011). Management of traumatic events: Influence of emotion-centered coping strategies on the occurrence of dissociation and post-traumatic stress disorder. Neuropsychiatric Disease and Treatment, 7, 127–133. https://doi.org/10.2147/NDT.S17130
- Bryant, R. A. (2016). Social attachments and traumatic stress. European Journal of Psychotraumatology, 7. https://doi.org/10.3402/ejpt.v7.29065
- Corrie, S., & Milton, M. (2000). The relationship between existential-phenomenological and cognitive-behaviour therapies. European Journal of Psychotherapy, Counselling & Health, 3(1), 7–24. https://doi.org/10.1080/13642530050078538
- Das, S., Pramanik, S., Ray, D., & Banerjee, M. (2016). The process of meaning making from trauma generated out of sexual abuse in childhood. Indian Journal of Positive Psychology, 7(3), 366–370.
- Day, K. W. (2009). Violence survivors with posttraumatic stress disorder: Treatment by integrating existential and narrative therapies. Adultspan Journal, 8(2), 81–91.
- Dewey, D., Schuldberg, D., & Madathil, R. (2014). Do peritraumatic emotions differentially predict PTSD symptom clusters? Initial evidence for emotion specificity. Psychological Reports, 115(1), 1–12. https://doi.org/10.2466/16.02.PR0.115c11z7
- Dick, A. M., Niles, B. L., Street, A. E., DiMartino, D. M., & Mitchell, K. S. (2014). Examining mechanisms of change in a yoga intervention for women: The influence of mindfulness, psychological flexibility, and emotion regulation on PTSD symptoms. Journal of Clinical Psychology, 70(12), 1170–1182. https://doi.org/10.1002/jclp.22104
- Du Toit, K. (2017). Existential contributions to the problematization of trauma: An expression of the bewildering ambiguity of human existence. Existential Analysis, 28(1), 166–175.
- Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0
- Fernando, D. M. (2007). Existential theory and solution-focused strategies: Integration and application. Journal of Mental Health Counseling, 29(3), 226–241.
- Floyd, M., Coulon, C., Yanez, A. P., & Lasota, M. T. (2005). The existential effects of traumatic experiences: A survey of young adults. Death Studies, 29(1), 55–63. https://doi.org/10.1080/07481180490483463
- Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. https://doi.org/10.1037/0033-2909.99.1.20
- Frankl, V. E. (1959). Man’s search for meaning. Beacon Press.
- Gupta, M. A. (2013). Review of somatic symptoms in post-traumatic stress disorder. International Review of Psychiatry, 25(1), 86–99. https://doi.org/10.3109/09540261.2012.736367
- Harris, W. (2013). Mindfulness-based existential therapy: Connecting mindfulness and existential therapy. Journal of Creativity in Mental Health, 8(4), 349–362. https://doi.org/10.1080/15401383.2013.844655
- Herold, B., Stanley, A., Oltrogge, K., Alberto, T., Shackelford, P., Hunter, E., & Hughes, J. (2016). Post-traumatic stress disorder, sensory integration, and aquatic therapy: A scoping review. Occupational Therapy in Mental Health, 32(4), 392–399. https://doi.org/10.1080/0164212X.2016.1166355
- Hoffman, L., Cleare-Hoffman, H. P., & Vallejos, L. (2013). Existential issues in trauma: Implications for assessment and treatment. Paper presented at Developing Resiliency: Compassion Fatigue and Regeneration, 121st Annual Convention of the American Psychological Association, Honolulu, HI. https://doi.org/10.13140/rg.2.1.5166.2881
- Johanson, G. J. (2010). Response to: “Existential theory and our search for spirituality” by Eliason, Samide, Williams and Lepore. Journal of Spirituality in Mental Health, 12(2), 112–117. https://doi.org/10.1080/19349631003730100
- Johnson, D., & Lubin, H. (2010). Principles and techniques of trauma-centered psychotherapy (1st ed.). American Psychiatric Publishing.
- Kidd, T., Hamer, M., & Steptoe, A. (2013). Adult attachment style and cortisol responses across the day in older adults: Attachment and day cortisol in older adults. Psychophysiology, 50(9), 841–847. https://doi.org/10.1111/psyp.12075
- Kindt, M., & Engelhard, I. M. (2005). Trauma processing and the development of posttraumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 36(1), 69–76. https://doi.org/10.1016/j.jbtep.2004.11.007
- Kwapis, J. L., & Wood, M. A. (2014). Epigenetic mechanisms in fear conditioning: Implications for treating post-traumatic stress disorder. Trends in Neurosciences, 37(12), 706–720. https://doi.org/10.1016/j.tins.2014.08.005
- Lantz, J. (2004). Research and evaluation issues in existential psychotherapy. Journal of Contemporary Psychotherapy, 34(4), 331–340. https://doi.org/10.1007/s10879-004-2527-5
- Leddick, K. H. (2018). Making good use of combined therapeutic modalities: Discussion of “Somatic Experiencing.” Psychoanalytic Dialogues, 28(5), 610–619. https://doi.org/10.1080/10481885.2018.1506223
- Lipov, E., & Kelzenberg, B. (2012). Sympathetic system modulation to treat post-traumatic stress disorder (PTSD): A review of clinical evidence and neurobiology. Journal of Affective Disorders, 142, 1–5. https://doi.org/10.1016/j.jad.2012.04.011
- MacNamara, A., Rabinak, C. A., Kennedy, A. E., Fitzgerald, D. A., Liberzon, I., Stein, M. B., & Phan, K. L. (2016). Emotion regulatory brain function and SSRI treatment in PTSD: Neural correlates and predictors of change. Neuropsychopharmacology, 41(2), 611–618. https://doi.org/10.1038/npp.2015.190
- Malarbi, S., Abu-Rayya, H. M., Muscara, F., & Stargatt, R. (2017). Neuropsychological functioning of childhood trauma and post-traumatic stress disorder: A meta-analysis. Neuroscience & Biobehavioral Reviews, 72, 68–86. https://doi.org/10.1016/j.neubiorev.2016.11.004
- Maunder, R., & Hunter, J. (2004). An integrated approach to the formulation and psychotherapy of medically unexplained symptoms: Meaning- and attachment-based intervention. American Journal of Psychotherapy, 58(1), 17–33.
- Mazloom, M., Yaghubi, H., & Mohammadkhani, S. (2016). Post-traumatic stress symptom, metacognition, emotional schema and emotion regulation: A structural equation model. Personality and Individual Differences, 88, 94–98. https://doi.org/10.1016/j.paid.2015.08.053
- Mikulincer, M., & Shaver, P. R. (2005). Attachment theory and emotions in close relationships: Exploring the attachment-related dynamics of emotional reactions to relational events. Personal Relationships, 12(2), 149–168. https://doi.org/10.1111/j.1350-4126.2005.00108.x
- Mitchell, K. S., Dick, A. M., DiMartino, D. M., Smith, B. N., Niles, B., Koenen, K. C., & Street, A. (2014). A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women: Yoga for PTSD in women. Journal of Traumatic Stress, 27(2), 121–128. https://doi.org/10.1002/jts.21903
- Nolan, C. R. (2016). Bending without breaking: A narrative review of trauma-sensitive yoga for women with PTSD. Complementary Therapies in Clinical Practice, 24, 32–40. https://doi.org/10.1016/j.ctcp.2016.05.006
- O’Connor, M., & Elklit, A. (2008). Attachment styles, traumatic events, and PTSD: A cross-sectional investigation of adult attachment and trauma. Attachment & Human Development, 10(1), 59–71. https://doi.org/10.1080/14616730701868597
- Porges, S.W. (2018). Polyvagal theory: A primer. In S.W. Porges, & D. Dana (Eds.), Clinical applications of the polyvagal theory: The emergence of polyvagal-informed therapies (1st ed., pp. 50–69). W.W. Norton & Company.
- Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015). Physical activity in the treatment of post-traumatic stress disorder: A systematic review and meta-analysis. Psychiatry Research, 230(2), 130–136. https://doi.org/10.1016/j.psychres.2015.10.017
- Rubinstein, T. (2015). Relational theory: A refuge and compass. Clinical Social Work Journal, 43(4), 398–406. https://doi.org/10.1007/s10615-015-0523-8
- Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., & Gray, S. H. (2008). Contributions of psychodynamic approaches to treatment of PTSD and trauma: A review of the empirical treatment and psychopathology literature. Psychiatry – Interpersonal and Biological Processes, 71(1), 13–34.
- Schuman, D. (2016). Veterans’ experiences using complementary and alternative medicine for posttraumatic stress: A qualitative interpretive meta-synthesis. Social Work in Public Health, 31(2), 83–97. https://doi.org/10.1080/19371918.2015.1087915
- Sotskova, A., & Dossett, K. (2017). Teaching integrative existential psychotherapy: Student and supervisor reflections on using an integrative approach early in clinical training. The Humanistic Psychologist, 45(2), 122–133. https://doi.org/10.1037/hum0000049
- Southwick, S. M., Gilmartin, R., Mcdonough, P., & Morrissey, P. (2006). Logotherapy as an adjunctive treatment for chronic combat-related PTSD: A meaning-based intervention. American Journal of Psychotherapy, 60(2), 161–174.
- Speer, K., Upton, D., Semple, S., & McKune, A. (2018). Systemic low-grade inflammation in post-traumatic stress disorder: A systematic review. Journal of Inflammation Research, 11, 111–121. https://doi.org/10.2147/JIR.S155903
- Thompson, N., & Walsh, M. (2010). The existential basis of trauma. Journal of Social Work Practice, 24(4), 377–389. https://doi.org/10.1080/02650531003638163
- Vachon, M., Bessette, P. C., & Goyette, C. (2016). “Growing from an invisible wound”: A humanistic-existential approach to PTSD. In G. El-Baalbaki, & C. Fortin (Eds.), A multidimensional approach to post-traumatic stress disorder—from theory to practice (pp. 179–203). Intech. http://dx.doi.org/10.5772/64290
- Wang, Q., Shelton, R. C., & Dwivedi, Y. (2018). Interaction between early-life stress and FKBP5 gene variants in major depressive disorder and post-traumatic stress disorder: A systematic review and meta-analysis. Journal of Affective Disorders, 225, 422–428. https://doi.org/10.1016/j.jad.2017.08.066
- Weems, C. F., Russell, J. D., Neill, E. L., Berman, S. L., & Scott, B. G. (2016). Existential anxiety among adolescents exposed to disaster: Linkages among level of exposure, PTSD, and depression symptoms. Journal of Traumatic Stress, 5, 466–473. https://doi.org/10.1002/jts.22128
- Willig, C., Berguno, G., Cooper, M., Milton, M., du Plock, S., & Spinelli, E. (2015). SEA conference – round table and open forum: “The challenge to theory in existential psychotherapy.” Existential Analysis. Journal of the Society for Existential Analysis, 26, 225–236.
- Woodhouse, S., Ayers, S., & Field, A. P. (2015). The relationship between adult attachment style and post-traumatic stress symptoms: A meta-analysis. Journal of Anxiety Disorders, 35, 103–117. https://doi.org/10.1016/j.janxdis.2015.07.002
- Yalom, I. D. (1980). Existential psychotherapy. Harper Collins Publishers.
- Zafirides, P., Markman, K. D., Proulx, T., & Lindberg, M. J. (2013). Psychotherapy and the restoration of meaning: Existential philosophy in clinical practice. In K. D. Markman, T. Proulx, & M. J. Lindberg (Eds.), The psychology of meaning (pp. 465–477). American Psychological Association. https://doi.org/10.1037/14040-023