A remarkable amount of writing and research has been done since the early 1990s on psychological trauma—its etiology, biopsychological effects, and forms of therapy. Because this intense focus on trauma is relatively new, it isn’t a surprise that we don’t yet have a generally agreed upon framework to guide our understanding of what trauma is (or how to treat it).

Porges (2011), for example, who prefers a strict biological view rather than psychological constructs, states that trauma resides in the unmyelinated vagus nerve, unrestrained by the myelinated vagal brake. Resick, Monson, and Chard (2017) propose that trauma is a problem of maladaptive cognitive schemas. Zimbardo, Sword, and Sword (2012) argue that trauma is rooted in a skewed time-perspective that focuses on a dark past and dark present. These are just three of at least 17 different ways of making sense of trauma.

This variety of explanations has also led, in part, to what McNally (2006) labels “conceptual bracket creep” (p. 9), his complaint that the definition of trauma is ever-expanding. In the past, we used to assume a traumatic event was horrific, terrifying, and usually life-threatening. Today, however, as McNally points out, “The disorder is … being diagnosed among people whose stressful events range from exposure to crude jokes in the workplace, to giving birth to a healthy baby, and much else in between” (p. 9).

Integrating these different ideas is difficult, mainly because the experts operate on different assumptions. Some rely, for instance, on cognitive neuroscience to guide them, while others are convinced that affective neuroscience is the proper foundation because, they argue, the affective system can conscript the thinking part of the brain for its own purposes. Some experts rely on behaviorist principles for explanation, while others look to cognitive psychology.

Among the handful of psychologists who have attempted to find common ground among the different theories, Ed Tronick proposes a model that is rooted in our meaning-making processes. According to Tronick (2009), trauma is a failure of these processes.

Almost everyone agrees that we derive meaning from our thoughts (representations, symbols), but Tronick points out that we also derive meaning from our bodies and emotions, even when what is happening biologically or emotionally is not available to verbal examination. This situation occurs, for instance, when a person suffering from posttraumatic stress disorder (PTSD) experiences a flight/fight/freeze reaction and its accompanying emotion of fear. The fact that a person’s biology or emotions is reacting to a perceived threat, and is unavailable to the thinking part of our brains, does not mean that the person cannot make sense of it. According to Tronick, meaning is holistic, not merely the conscious intellectual examination of a situation. In fact, Tronick suggests that meaning is fluid as a person makes sense first of biological reactions, then emotional responses, and, finally, cognitive examinations. For Tronick, each of these sources—biology, affect, cognitions—is a state of consciousness, which creates qualitatively different forms of meaning, each influencing the others. He also suggests that meaning comes from fluid and ongoing relationships as each person in the relationship co-creates meaning for themselves.

The result of these meaning processes is increased complexity and coherence in making sense of experience. For Tronick, trauma keeps the person stuck in old ways of making sense of experience: “When meaning making fails to increase complexity, it is generally because the meaning-making processes have been saddled with the aim of maintaining current levels of complexity and staving off dissipation” (p. 102). Maintaining the current state of complexity does not allow for new meanings to develop, leading to feelings of constriction, immobilization, and fear.

The implications of Tronick’s ideas for therapy reflect his holistic approach. He proposes that therapy meet the client where the client is at in the meaning-making processes. A trauma client overwhelmed by fear, for example, would benefit from emotion-focused therapies. A client trapped by bodily experience (aroused sympathetic nervous system) would likely benefit from somatic therapies: “Emotions may most effectively change emotions, bodily processes change bodily processes” (p 104).

Another implication of Tronick’s ideas for clinicians is that the therapeutic focus changes over time. Thus, a therapist may begin with somatic therapy, move to emotion-focused therapy, and then to cognitive-based therapy, as clients are able to make better sense of what trauma means to them. Each step brings with it an increase in complexity and coherence.

We can see Tronick’s model at work in the reports of many trauma survivors. Here’s an example from a rape survivor:

I saw images every time I closed my eyes. I lost all ability to concentrate or even complete simple tasks. Normally social, I stopped trying to make friends or get involved in my community. I often felt disoriented, forgetting where, or who, I was. I would panic on the freeway and became unable to drive, again ending a career. I felt as if I had completely lost my mind.

This short excerpt highlights the somatic complaints, emotional turmoil, and confusion that are characteristic of PTSD. But her words—reflections on her experience of what it’s like to suffer from trauma—also show that she has moved beyond bodily and emotional states. From the woman who couldn’t concentrate, isolated herself, and panicked while driving, she is making sense of her suffering through reflection. As Tronick suggests, her meaning processes have helped her gain a more complex and coherent way of making sense of experiences.

References

McNalley, R. J. (2006). The expanding empire of posttraumatic stress disorder. Medscape General Medicine, 8(2), 9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785189/

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communications, self-regulation. New York, NY: Norton.

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. New York, NY: Guilford Press.

Tronick, E. (2009). Multilevel meaning making and dyadic expansion of consciousness theory: The emotional and the polymorphic polysemic flow of meaning. In D. Fosha, D. J. Siegel, & M. F. Solomon (Eds.), The healing power of emotion: Affective neuroscience, development and clinical practice (pp. 86-111). New York, NY: Norton.

Zimbardo, P., Sword, R., & Sword, R. (2012). Time cure: Overcoming PTSD with the new psychology of time perspective therapy. San Francisco, CA: Jossey-Bass.