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Research Library

Revising the Script: Mixed‑Method Study of Trauma Drama for Complex Trauma‑Exposed Youth in Residential Treatment

    • Published: 2021
    • Mimi Sullivan
    • Dissertation, Doctor of Philosophy, Center for Social Work Education, Widener University, Chester, PA, USA, June, 2021.
    • Download the complete paper, click here.


Creative-arts interventions have historically been used to treat people exposed to complex trauma. In the United States, however, such interventions have failed to achieve widespread use, perhaps because of obstacles to systematic study, which have prevented development of a sufficient evidence base. This may be attributable in part to the challenges of measuring drama’s differential impact on the unique psychophysiological system of the individual, as well as the complications related to having no legitimized complex trauma diagnosis around which to organize a research agenda until publication of the complex post-traumatic stress (CPTSD) diagnostic classification of 2018 (ICD 11; World Health Organization). In order to simplify future field research and data aggregation across settings, the current study of Trauma Drama (TD; Spinazzola, 2019) made a first attempt to identify a core matrix of variables that might imply an increased flexibility in the underlying constituents that bind heterogeneous symptoms (Insel, 2014). The TD study, as described in this dissertation, is an embedded, combined, concurrent, and sequential mixed-method investigation in a complex-trauma-exposed population of 47 youth in residential treatment in the northeastern United States (treatment condition [n = 27] and a semi-matched comparison condition [n = 20]).

Longitudinal pattern analysis of the subtracted distance between resting and maximum capacity heart rate variability (HRV) was used to calculate the novel high frequency HRV (HF HRV) variable, an index of parasympathetic nervous system balance at pre- vs. posttest. My analysis suggested the presence of three physiological subgroups across the treatment and comparison groups. The treatment condition of one of the subgroups appeared to account for improved depression symptoms in the overall treatment group as contrasted with the comparison group. Therefore, it appears that in this study, response to the TD intervention may be, at least partially, moderated by electrophysiological subtype. I used Interpretive Phenomenological Analysis (IPA; Smith & Osborn, 2008) to analyze interviews of treatment group participants (n = 29) and intervention-facilitators (n = 12). The superordinate theme of the qualitative arm of the study was the shift that occurs from a state of Absence (a survival state of fight, flight, and/or freeze that dissociates people from being in the now) to a state of greater Presence (being rooted in the now) via the Modification of Associations Process (MAP). The MAP reorganizes and expands associations undergirding subjective experience of self, others, and the world.

Taken together, triangulated data imply that the treatment group experienced a decrease in dissociation (a central symptom in the network of the Post-Traumatic Stress Disorder [PTSD] cluster of the CPTSD diagnosis [Knefel & Lueger-Schuster, 2013]), as well as a decrease in depression (a central symptom in the network of the Disturbances of Self Organization [DSO] cluster of the diagnosis [Haselgruber et al., 2020]). These findings suggest that TD may work to diminish complex trauma pathology in this population, and as a result, further study of TD is indicated. The data also suggest that the stabilization phase of TD is essential to engagement in the intervention and for the consequent reduction of DSO symptoms in particular; therefore further study of TD may offer an opportunity to use the intervention as an exemplar through which the general characteristics, effect, and value of the stabilization phase of component-based treatments for CPTSD may be examined.