Trauma-Related Altered States of Consciousness: Exploring the 4-D Model

Figures & data

FIGURE 1 The 4D-model of the traumatized self. Notes. Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are differentiated in so far as they present in trauma-related altered states of consciousness (TRASC) form (red, top) versus in normal waking conscious (NWC) form (blue, bottom). The background coloring of the two states, however, is illustrated as blending into one another in order to represent that it is presently not known whether the difference between the TRASC and NWC forms is a qualitative (categorical) or only quantitative (dimensional) one. The arrow that is increasing in infrequency from bottom (NWC) to top (TRASC) represents the first hypothesis that symptom endorsements of TRASC are expected to be less frequent than symptom endorsements of NWC distress. The arcs connecting the four dimensions are drawn with greater weight when referring to NWC distress versus TRASC in order to represent the second hypothesis that the experience of forms of NWC will be more intercorrelated when compared with the experience of forms of TRASC. The arrow labeled “dissociative” that is increasing from bottom (NWC) to top (TRASC) is intended to illustrate the third hypothesis that the four dimensions in TRASC form, while being distinct in concept from the measurement of dissociation as a disintegration and/or compartmentalization of psychological functions (e.g., Holmes et al., 2005; Steele et al., 2009), will nevertheless be more often observed in people who also experience dissociative disintegration and/or compartmentalization of psychological functions. Finally, the arrow labeled “Developmental TE [Trauma Exposure],” oriented in the same direction, is intended to illustrate the hypothesis that the etiology of TRASC may often be developmental in origin, that is to say, typically requires repeated trauma exposure at an early age of onset, when a child’s brain is naturally more vulnerable to deviations from NWC such as is normally exhibited through age-appropriate imaginary play.©W. W. Norton and Company. Reproduced with the permission of W. W. Norton and Company. Permission to reuse must be obtained from the rightsholder.

TABLE 1  Operational Measures of Posttraumatic Symptomatology Exemplary of Nondissociative Distress (NWC) versus Dissociative Distress (TRASC) Referring to the 4-D Model Dimensions Time, Thought, Body, and Emotion in Study 1

Dimension	NWC distress	TRASC
Time	CAPS (Blake et al., 1995) frequency ratings for PTSD symptoms B1 and B4 measuring intrusive recollections and emotional distress at reminders of traumatic events	CAPS frequency ratings for PTSD symptom B3 measuring dissociative flashbacks (“reliving”) of traumatic events
Thought	Cognitive Distortion Scales (Briere, 2000) subscale measuring self-critical thinking experienced in first-person perspective (e.g., “calling yourself stupid or ugly,” “calling yourself names”)^a	Frequency ratings for the Multiscale Dissociation Inventory (Briere, 2002) subscale measure of Identity Dissociation (partly reflecting the experience of voice hearing; e.g., “having different people inside of you with different names,” “feeling like two or more people were fighting or arguing inside of yourself”)^b
Body	CAPS (Blake et al., 1995) frequency ratings for PTSD symptoms D1–D5 measuring symptoms of hyperarousal	CAPS (Blake et al., 1995) frequency ratings for Item 30 measuring the experience of depersonalization (i.e., “feeling as if you were outside of your body, watching yourself as if you were another person”)
Emotion	Participants were asked how often in the past month they had experienced the following six affective states, intended as a measure of nonspecific negative emotionality created for the present study: “sadness, misery, and despair,” “fear, terror, and panic,” “anxiety (nervous agitation, worrying),” “irritability or anger,” “guilt,” “humiliation and shame” (α = .81 this sample)	Four items measuring the feeling of being emotionally numb (Frewen, Dozois, et al., 2012; e.g., “You’ve felt emotionally ‘numb,’ as if you can’t experience emotions or feelings”; α = .94 this sample)

Notes: NWC = normal waking consciousness; TRASC = trauma-related altered states of consciousness; CAPS = Clinician-Administered PTSD Scale; PTSD = posttraumatic stress disorder.

^aAlthough the item content of the Cognitive Distortion Scales Self-Criticism subscale was considered to fit the 4-D model best, similar results to those reported herein accrue if any of the other five subscales are selected from the Cognitive Distortion Scales. ^bIt is acknowledged that the Multiscale Dissociation Inventory Identity Dissociation subscale, at face value, includes items additional to those merely descriptive of voice hearing, with the scale intended to assess “the perception or experience of having different identities, ego states, or perspectives within oneself” (Briere, 2002, p. 13). Such complexity represents a limitation of the present study’s use of the scale as a measure of voice hearing.

FIGURE 2 Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are endorsed less frequently in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue) (data from Study 1). Notes. Please see Table 1 for survey items used to operationalize each symptom dimension. Error bars denote SD which is also reported in brackets. Differing degrees of freedom due to missing data.

FIGURE 3 Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are less intercorrelated in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue). Notes. Please see Tables 1 and 2 for survey items used to operationalize each symptom dimension. Results from Study 1 below diagonal, and results from Study 2 above the diagonal.

FIGURE 4 Trait dissociation (Dissociative Experiences Scale; DES) is more strongly correlated with posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue) (data from Study 1). Notes. Please see Table 1 for survey items used to operationalize each symptom dimension. Error bars denote SD which is also reported in brackets. Differing degrees of freedom due to missing data.

TABLE 2  Operational Measures of Posttraumatic Symptomatology Exemplary of Nondissociative Distress (NWC) versus Dissociative Distress (TRASC) Referring to the 4-D Model Dimensions Time, Thought, Body, and Emotion in Study 2

Dimension	NWC distress	TRASC
Time	Average response to two items: (a) “Intrusive Memories of a Traumatic Event: Unwanted memories about a traumatic event that you have experienced, which may be in the form of thoughts, mental images, and/or perceptions” and (b) “Emotional Upset at Reminder of a Traumatic Event: Becoming very distressed and/or emotionally upset when you are reminded about a traumatic event that you have experienced”	Response to “Flashbacks of a Traumatic Event: Acting or feeling as if a traumatic event that you have experienced in the past is happening in the present. Having the sense that you are actually ‘reliving’ the event in the present, rather than only remembering the event as it happened in the past”
Thought	Average response to two items: (a) “Anxious Worrying: Intense anxiety and worrying, about bad/stressful things happening, that is difficult to control/stop” and (b) “Feeling Worthless: Extreme negative thoughts about yourself, so much so that you feel worthless (that you have no value, are useless, are not good for anything at all)”	Response to “Hearing Voices Inside Your Head: Hearing voices inside your head that seem to be different from your own voice and/or different from your own thoughts”
Body	Response to “Panic Attacks: Suddenly feeling very fearful/anxious and developing a lot of physical symptoms, for example, heart racing/pounding, sweating, trouble breathing, nausea, dizziness”	Response to “Depersonalization: A change in the way you perceive or experience yourself, so that you feel detached or separated from (or an outside observer of) yourself, your thoughts, and/or your body”
Emotion	Average response to three items: (a) “Depressed Mood: Feeling very depressed or down, such as feeling extremely sad or hopeless,” (b) “Irritability/Anger: Feeling extremely irritable or showing strong outbursts of anger toward others (verbally or physically or both),” and (c) “Guilt and/or Shame: Extreme guilt and/or shame about things that you have done, failed to do, or have happened to you (feeling at fault, to blame, having a strong sense of shame)”	Response to “Emotional Numbness: Significantly reduced ability to feel emotions; feeling like you are emotionally numb”

Notes: NWC = normal waking consciousness; TRASC = trauma-related altered states of consciousness.

FIGURE 5 Posttraumatic symptom dimensions of the consciousness of time, thought, body, and emotion are endorsed less frequently in trauma-related altered states of consciousness (TRASC) form (red) than in normal waking consciousness (NWC) form (blue) (data from Study 2). Notes. Please see Table 2 for survey items used to operationalize each symptom dimension. Error bars denote SD which is also reported in brackets. Differing degrees of freedom due to missing data.

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