What is the nature of the alteration of temporality in Trauma-Related Altered States of Consciousness? A neuro-phenomenological analysis

Abstract

According to the 4-D model of Frewen and Lanius, trauma-related altered states of consciousness (TRASC) involve an alteration of the dimension of time and memory which divides the symptoms of post traumatic stress disorder (PTSD) into those which occur in “Normal Waking Consciousness” (NWC) and those which present dissociative experiences as part of TRASC. The present report addresses the temporal dimension of TRASC from a neurophenomenological approach. Initially, we generate an updated model of the structure of normal temporality. From there, we derive a model of altered temporality in TRASC, which at the same time indicates, from a theoretical point of view, which specific points of the structure of temporality would be altered in PTSD with TRASC. We pose two theoretical questions to guide our analysis: 1) What logical consequences can we derive from a graphic model of temporality in TRASC based on neurophenomenological analysis? and 2) Can altered chronesthesia be proposed as a phenomenon related with the dissociative disorders that affect how time is experienced in TRASC? Material and methods: To answer these questions, we carried out a systematic review of the literature up to May 2019, as well as a review of the classic philosophical texts that offer a view of temporality, with special emphasis on works in the field of phenomenology and neurophenomenology which offer graphic models of temporality. Results: We found 2671 articles associated with the keywords used in the search. Of these, 2603 articles were discarded based on a review of the titles and abstracts, leaving 68 reports that were reviewed in full text. We also reviewed classic philosophical texts dealing with the problem of temporality. From the results obtained we designed a scheme of normal temporality from which we derived a hypothesis as to how this variable would be altered in TRASC. The central point of the analysis explains under which hypothetical mechanisms the patient would lose his or her normal capacity to remember a past event or anticipate a future event, with the perspective that this would occur FROM the present moment. This would be an essential aspect of the alteration of temporality in PTSD with TRASC. Discussion and conclusions: We discuss the possible implications of our model for clinical practice, including non-pharmacological treatments. We then draw a correlation between the logical consequences of our model and the neurofunctional findings described in the literature. Finally, we offer answers to the two questions proposed, and to the central question of this report, stressing how altered chronesthesia could account for the alterations of temporality observed in PTSD with TRASC.