Preliminary Findings from a Qualitative Study of Trauma Survivors in Treatment: Changes in Personal Narratives

This article seeks to document the characteristics and themes of later trauma recovery using a grounded theory analysis of interviews with trauma survivors enrolled in outpatient treatment. Little research exists that speaks to patients’ own accounts of the process of trauma recovery. Such accounts might elucidate how psychotherapy helps survivors make and remake meaning of their lives, their experience of traumatic events, and the resources they might call on in psychotherapy to secure recovery. This study examined narrative material gathered in a series of interviews with trauma survivors (n?=?14) who had been in treatment for an average of 8 months and could be described as in a later phase of the recovery process. Two significant themes emerged from the analysis: (a) greater coherence to the trauma narrative, and (b) the emergence of a more reflective and observational stance with respect to one's history. Implications for trauma-informed therapy are discussed.     

Individual and contextual predictors of involvement in twelve-step self-help groups after substance abuse treatment

Drawing on ecological and narrative theories of self-help groups, this study tests a multilevel model predicting self-help group involvement among male veterans who received inpatient substance abuse treatment. Following K. Maton (1993), the study moves beyond the individual-level of analysis to encompass variables in the treatment and post-treatment social ecology. Surveys administered to patients (N = 3,018) and treatment staff (N = 329) assessed these predictor domains and self-help group involvement 1 year after discharge. A hierarchical linear model fit to the data indicates that greater involvement in 12-step groups after discharge is predicted by the compatibility between personal and treatment belief systems. The implications of these findings for efforts to facilitate transitions between inpatient professional treatment and community-based self-help groups are discussed.     

A longitudinal investigation of the reliability of memories for trauma and other emotional experiences

This study examined the relative consistency and characteristics of memories for trauma and other non‐traumatic emotional experiences over time. A community sample of 52 participants who reported a recent traumatic event were asked to recall both the traumatic and a positive emotional experience in two interviews separated by approximately three months (M = 105.39 days). The recollections were elicited with either a free narrative, cognitive interview, guided imagery, or written narrative approach. Results indicated that traumatic experiences were recalled more reliably over time than other emotional experiences. Traumatic memory imagery tended to persist in memory (with no apparent impairment), whereas features of positive memories were subject to considerable distortion, regardless of interview style. The findings contribute to the understanding of the impact of trauma on memory with the passage of time. Copyright © 2004 John Wiley & Sons, Ltd.     

Linguistic correlates of self in deceptive oral autobiographical narratives

The current study collected orally-delivered autobiographical narratives from a sample of 44 undergraduate students. Participants were asked to produce both deceptive and non-deceptive versions of their narrative to two specific autobiographical question prompts while standing in front of a video camera. Narratives were then analyzed with Coh-Metrix software on 33 indices of linguistic cohesion. Following a Bonferroni correction for the large number of linguistic variables (p < .002), results indicated that the deceptive narratives contained more explicit action verbs, less linguistic complexity, and less referential coherence (sentences being cohesive with each other). The results support a theory that, in deceptive narratives, there is greater narrative distance between the self that narrates and the self that is narrated about. This suggests that narrative selves are constituted not as autonomous selves, but are subject to processes (e.g., psychological, linguistic, social) that are likely operating on a subconscious level.     

Characteristics and organization of the worst moment of trauma memories in posttraumatic stress disorder

It has been proposed that the organization of the worst moment in traumatic memories (“hotspots”) is of particular importance for the development of PTSD. However, current knowledge regarding the organization and content of worst moments is incomplete.In the present study, trauma survivors with (n = 25) and without PTSD (n = 54) were asked to indicate the worst moment of their trauma and to give a detailed narrative of the traumatic event. The worst moment and the remaining narrative were analyzed separately with regard to organization and emotional content.Results indicated that worst moments of trauma survivors with PTSD differed from the remaining narrative and from worst moments described by trauma survivors without PTSD in that they were characterized by more unfinished thoughts, more use of the present tense and lower levels of cognitive processing. However, hypotheses regarding differentiating emotional content were not supported. Implications for our theoretical understanding of PTSD and potential therapeutic interventions are discussed.     

Disequilibrium and Loss of Narrative Coherence in Identity Construction: A Piagetian Perspective on Trauma in Adolescent Victims of Sexual Abuse

Previous authors have presented contradictory views of trauma as either the over- or under-elaboration of experience. This article provides a new theoretical perspective on trauma by incorporating Piagetian constructivism. On a theoretical level, it argues that both forms of narrative disruption following a traumatic episode are not contradictory. Rather, both over- and under-elaboration indicate disequilibrium and loss of narrative coherence in the construction of personal identity. Results are presented from an empirical study of the autobiographies of 15 adolescent victims (between the ages of 12 and 17) of sexual assault. Participants were enrolled in the initial stage of a psychotherapeutic treatment program for abuse in Santiago, Chile, at the time of study. Analysis of participant autobiographies reveals multiple forms of disorganization. The majority of adolescent narratives referred to predominance of traumatic experiences, whereas a small number of cases excluded traumatic experiences altogether. Discussion of study results shows that both forms of narrative disorganization indicate disequilibrium and loss of narrative coherence. Piagetian constructivist theory provides insight into this phenomenon by supporting and advancing understandings of trauma from a constructivist perspective. Implications for therapeutic treatment of sexual abuse, which may help generate clinical guidelines, are presented.     

Gender and Changes in Trauma Narrative Following CBT for PTSD

Our study explored whether the characteristics of pretreatment trauma narratives could be used as indicators of posttraumatic stress disorder (PTSD) symptom severity before treatment. We also studied whether pretreatment characteristics could predict treatment efficacy. Although several studies suggest that fragmentation, proportion of internal events, and length in trauma narratives are associated with PTSD symptomatology, there are contradictions in the findings. Given the differences in trauma response between men and women, we considered the potential influence of gender. Before beginning a cognitive-behavioral therapy treatment, 66 participants verbally recounted their traumatic event during a diagnostic interview. After treatment, 48 participants once again provided a trauma narrative. PTSD symptom severity was assessed using the Clinician-Administered PTSD Scale. Linear regression analyses revealed that none of the pretreatment characteristics predicted treatment efficacy. Furthermore, the length of the trauma narrative was the only pretreatment characteristic that correlated with pretreatment PTSD symptomatology. This suggests that more severe symptomatology is associated with shorter narratives. We only found a significant gender difference in narrative length, which was longer in women than in men. Our findings not only highlight the need for additional research on the link between trauma narratives and PTSD symptomatology, but also stress the necessity of considering gender in this field of research. This could allow for enhanced treatments to target gender-specific needs, thus leading to more individualized care for PTSD patients.     

Intertraumatic Dissociative Attachment

SUMMARY

This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years.

This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.     

Surviving the Zombie Apocalypse: Trauma and Transformation in AMC’s The Walking Dead

ABSTRACT

The experience of massive psychic trauma has been all too common in human history, uprooting us from the safety of our homes and thrusting us into strange and dangerous environments. The combination of uncertainty and stress bears down on us emotionally, putting the integrity of self-experience at risk. The psychological disorders resulting from trauma (such as posttraumatic stress disorder, depression, and moral injury) can be disruptive, painful, and refractory. Among the many ways in which modern culture has reflected on these experiences, narrative media—such as novels, film, and television—have frequently dramatized the experience and aftermath of trauma. In this article I discuss the AMC television series The Walking Dead, which depicts the ongoing struggle of a group of survivors of a zombie apocalypse. The psychological and interpersonal impact of coping with the demands of a postapocalyptic world is the primary focus of the narrative of The Walking Dead. I examine of the series’ sustained depiction of trauma. I stress the central role of uncertainty, the disruption of our assumptive worlds, and the loss of trust in the foundations of our lives.     

The “Hero‐Protector Narrative”: Manufacturing Emotional Consent for the Use of Force

How do political leaders manufacture collective emotions to justify the use of force? This article introduces the “hero‐protector narrative” as a conceptual model to analyze how political leaders try to manufacture specific collective emotions to encourage their audience to perceive violence as the only morally acceptable course of action. In our model, we formalize a set of distinctive narrative structures (roles and sequences), which are combined to activate compassion and moral anger as well as identification with “heroic” behavior. Furthermore, we argue that the resonance of this narrative draws on values of hyper‐masculinity in patriarchal societies. As such this narrative is to be found across different types of actors (state/nonstate) and culturally diverse settings. To test our model, we use a computer‐assisted QDA approach. We compare systematically discourses produced by political actors legitimizing the use of force versus actors opposing the use of force. We find that discourses supporting the use of force, such as those produced by George W. Bush and Osama bin Laden in the context of the Iraq war, share the structural characteristics of the hero‐protector narrative. In this regard, they differ remarkably from violence‐opposing discourses, regardless of their cultural background.     

Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration

This study evaluated the differential effects of the Grief and Trauma Intervention (GTI) with coping skills and trauma narrative processing (CN) and coping skills only (C). Seventy African American children (6-12 years old) were randomly assigned to GTI-CN or GTI-C. Both treatments consisted of a manualized 11-session intervention and a parent meeting. Measures of trauma exposure, posttraumatic stress symptoms, depression, traumatic grief, global distress, social support, and parent reported behavioral problems were administered at pre, post, 3 and 12 months post intervention. In general, children in both treatment groups demonstrated significant improvements in distress related symptoms and social support, which, with the exception of externalizing symptoms for GTI-C, were maintained up to 12 months post intervention. Results suggest that building coping skills without the structured trauma narrative may be a viable intervention to achieve symptom relief in children experiencing trauma-related distress. However, it may be that highly distressed children experience more symptom relief with coping skills plus narrative processing than with coping skills alone. More research on the differential effects of coping skills and trauma narration on child distress and adaptive functioning outcomes is needed.     

Life story research: A relevant methodology for counsellors and psychotherapists

Aims: This paper introduces, describes and proposes life story research as an important, relevant and appropriate contribution to counselling and psychotherapy research. It shows how narrative knowledge is created and constructed through the stories people tell about their lived experiences and explores the concept of ‘narrative knowing’ (Bruner, 1986). Methods: Drawing on life story research with people who linked their history of problematic drug use with experiences of historic trauma/abuse, the paper contributes to the ongoing discussion related to the similarities/differences between therapy and research and what we might learn from each that informs the other. Implications for practice: The paper offers narrative ideas and practices as ways of researching matters of social and psychological importance. It suggests that therapists (and counselling researchers) could learn from what participants tell us about the therapeutic value of using life story methods which one participant described as helping him to face ‘out into the world, without unduly or specifically delving into, or focusing on [my] emotional state’. This learning may be particularly relevant for therapists working with traumatised clients.     

Evaluation of the evidence for the trauma and fantasy models of dissociation

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.     

Emplotting the traumatic self: Narrative revision and the construction of coherence

Abstract

In this article we provide a constructivist‐narrative conceptualization of the origins and psychotherapeutic methods for treating trauma. We believe that the experience of trauma ensues when lived events outpace peoples’ abilities to emplot or narrate these events from the perspective of dominant life narratives. The sights, sounds, and smells associated with traumatic events preclude such emplotment. The therapeutic objectives of narrative therapy include finding ways to develop meanings for the trauma and subsequently to integrate these with the dominant narrative. Two case studies are provided to illustrate our conceptualization and therapeutic approach.     

Redefining the Meaning of Negative History in Times of Sociopolitical Change: A Social Creativity Approach

This article explores the role negative history plays in political discourse on crisis management and how times of sociopolitical change in turn influence the strategies that can be employed to write a positive historical charter. Choosing Germany as a case study, we analyzed how political leaders negotiate Germany's narrative and political role during the European “refugee crisis” in speeches (n = 332) held between 2015 and 2018. Applying a combination of corpus-based and qualitative narrative analysis, we found that the context of a crisis is used to attach new meaning to Germany's role in World War II. By focusing on the lessons learned from history and pointing out the parallels between the current crisis and sociopolitical developments that took place 80 years ago, Germany is presented as the ideal advocate for a free and united Europe, a narrative that legitimizes its advancingly dominant role within the EU and beyond. The analysis demonstrates how times of change can facilitate social creativity strategies for nations whose past is dominated by negative history, with implications for the theory of identity management.     

Effectiveness of a trauma/grief-focused group intervention: a qualitative study with war-exposed Bosnian adolescents

The effectiveness and impacts of a school-based, trauma/grief-focused group treatment program for war-exposed youth in Bosnia and Herzegovina were investigated using semistructured focus groups, conducted separately for students and their school counselor group leaders. Overall, students' and leaders' evaluations of the groups were generally positive. General themes of outcomes and impacts perceived by students and group leaders include: acquisition of coping skills and attitudes, willingness to advocate for peers, improved interpersonal relationships, negative impacts, general positive impacts, impacts in the schools, impacts on the group and logistics of the program, and broader impacts on the perception of mental health in the community. The broad positive impacts of this program suggest that trauma/grief-focused group treatment intervention programs targeting trauma-exposed youth may be effective on multiple levels with war-exposed youth and their communities.     

Meta‐Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder

This meta‐analysis of 152 published posttraumatic stress disorder (PTSD) clinical trials from 1990 to 2012 concluded that counseling generally produced a small to large effect of treatment across all comparison conditions at termination (d+ = 0.30 to 0.89). These gains were maintained at longest follow‐up (d+ = 0.58 to 0.86) for the wait‐list, treatment‐as‐usual, and single‐group comparisons, but not for the follow‐up placebo comparison (d+ = 0.15), probably because of the low power (j = 3 placebo studies). Clinical trial findings were synthesized using a random‐effects model. No effects of publication bias or moderating variables were evident. No difference was found between trauma‐focused and non‐trauma‐focused approaches. Implications for counseling practice and future PTSD outcome research are addressed.     

Narratives of trauma,recovery, and growth: The complex role of sport following permanent acquired disability

ObjectivesThe purpose of this study was to explore how participation in sport may assist an individual in working through experiences of physical trauma.DesignAn instrumental, collective case study was used to illustrate the experiences of two men with acquired disabilities.MethodBoth men participated in sport at a high level and suggested that participation was a central feature of their recovery from trauma. Interviews invited participants to describe their lives pre-trauma, the trauma experience, and the recovery process. A narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results exemplify two narrative types: assimilation and positive accommodation. The narrative of positive accommodation demonstrates how sport provided mastery experiences, enhanced relationships, corporeal understanding and enhanced life philosophies. The alternative narrative of assimilation was associated with resilience to trauma. Our case illustrates that such a narrative may be focused on re-capturing previous life meanings and creating an athletic identity using past definitions of sport.ConclusionWhile the narrative of positive accommodation is most frequently associated with posttraumatic growth, our case outlines the occurrence of synchronous positive and negative experiences, even within the same dimensions of growth. The narrative of assimilation demonstrates the challenges presented by the rehabilitation and sporting environments for an individual who aimed to restore their pre-trauma self and pre-trauma beliefs.     

Source memory errors associated with reports of posttraumatic flashbacks: a proof of concept study

Flashbacks are involuntary, emotion-laden images experienced by individuals with posttraumatic stress disorder (PTSD). The qualities of flashbacks could under certain circumstances lead to source memory errors. Participants with PTSD wrote a trauma narrative and reported the experience of flashbacks. They were later presented with stimuli from flashback and non-flashback parts of their narrative, mixed with foils from the narrative of another participant, and judged whether they belonged to their own narrative. They also reported whether stimuli elicited a flashback during this recognition test. Overall reporting a flashback at test was associated with significantly better recognition performance. Flashbacks were occasionally reported to foil stimuli, which were then likely to be wrongly attributed to the person's own narrative. This provides proof of concept of a cognitive mechanism that could potentially account for some cases of false trauma memories.