Academic journal article American Journal of Psychotherapy

Logotherapy as an Adjunctive Treatment for Chronic Combat-Related PTSD: A Meaning-Based Intervention

Academic journal article American Journal of Psychotherapy

Logotherapy as an Adjunctive Treatment for Chronic Combat-Related PTSD: A Meaning-Based Intervention

Article excerpt

Combat-related Post-traumatic Stress Disorder (PTSD) is often highly debilitating and affects nearly all areas of psychosocial functioning. Veterans with PTSD re-experience their traumas in the form of haunting intrusive memories, nightmares and flashbacks, and have chronic difficulty modulating arousal. As a way to cope with these symptoms, many survivors live isolated and avoidant lives, self-medicate with alcohol and substances of abuse, and numb themselves to emotional experiences and relationships with family and friends. Additionally, many combat veterans report survivor guilt, depression, affect dysregulation, and an altered world view in which fate is seen as uncontrollable and life is viewed as devoid of meaning. In this report we describe the use of logotherapy (healing through meaning) for the treatment of combat-related PTSD

Chronic combat-related Post-traumatic Stress Disorder (PTSD) is notoriously difficult to treat. While numerous therapeutic approaches have been tried in this population, success rates generally have been modest to moderate. Published therapeutic trials have included treatment with exposure therapies, cognitive processing therapies, psychodynamic psychotherapy, eye movement desensitization and reprocessing (EMDR), hypnotherapy, and pharmacotherapy (Foa et al., 2000, Silver SM and Rogers S, 2002, Wilson, Friedman and Lindy 2001). These therapies have primarily focused on the alleviation of specific symptoms of PTSD and of symptoms accompanying co-morbid psychiatric disorders. However, even when DSM symptoms respond to treatment, many veterans with PTSD, who have experienced the darkest side of human nature, are left with profound existential questions related to the loss of meaning in life. While less symptomatic, they may remain tormented and in some cases feel hopeless.

In this report we describe the use of logotherapy for the treatment of combat-related PTSD. Logotherapy is a meaning-centered psychotherapy that draws from the tradition of existential philosophy and is grounded in the professional work and extraordinary life experiences of its originator, Viktor Frankl. The literal meaning of logotherapy is "healing through meaning." Logotherapy is sometimes referred to as the "third Viennese school of psychotherapy," following Freud's psychoanalysis and Adler's individual psychology. Frankl rejected Freud's notion of the pleasure principle and Adler's concept of inferiority as the primary mechanisms motivating behavior, and believed that man, at his core, is motivated by a need to find meaning in life and that this need is primary rather than a "secondary rationalization" to drives.

Viktor Frankl developed his meaning-centered psychotherapy prior to World War II, but found his convictions later "tested" in the harshest of circumstances as an inmate for three years in four different Nazi concentration camps. He first wrote about these experiences in his book, Man's Search for Meaning (Frankl 1959). Unlike the pessimism of other European existentialists and despite (or as Frankl might say, because of) his experiences, Frankl's understanding of man is decidedly hopeful. Logotherapy is future-oriented, focuses on personal strengths and places responsibility for change on the patient. It has in common with later "transpersonal" psychologies, an emphasis on the human spirit and the notion that self-transcendence represents the height of human potential.

Several of the main tenets of logotherapy are expressed in what Frankl termed "tragic optimism," optimism in the face of human suffering, guilt and even certain death. Tragic optimism encompasses the human potential to transform suffering into human achievement and guilt into meaningful action. Franklian psychotherapy directly addresses the dialectic of fate and freedom that may be expressed as follows: Even though we as human beings cannot often control the circumstances in our lives (fate), we can control our attitudes and responses to those circumstances. …

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