외상경험 강도와 복합외상후 증상의 관계: 감각기억 활성화, 내러티브 파편화의 매개효과 = The Relationship Between Trauma and Complex Post-Traumatic Stress Disorder: The Mediating Effect of Sensation-Based Memory Activation and Narrative Fragmentation

다국어 초록 (Multilingual Abstract)

The purpose of this study was to identify the effect of traumatic experience fragmentation on the relationship between the impact of traumatic experience and complex posttraumatic symptoms. Based on previous research, traumatic experience fragmentation was conceptualized in two dimensions: sensation-based memory, and narrative. Participants were 277 college students, and 180 reporting having had a traumatic experience. The results indicated that the activation of sensation-based memory and narrative fragmentation fully mediated the relationship between trauma and CPTSD. A multi-group analysis was used to investigate the path difference between the simple trauma group (n=82) and the complex trauma group (n=98). The results indicated that the path of trauma impact to the activation of sensation-based memory was significantly different between the two groups. The implications and limitations of this study, and recommendations for the further study are discussed.

국문 초록 (Abstract)

본 연구의 목적은 외상경험의 강도와 복합외상후 증상의 관계에서 외상경험 파편화가 미치는 영향을 확인하는데 있다. 선행연구를 바탕으로, 외상경험 파편화(통합실패)는 감각기억과 내러티브, 두 가지 차원에서 측정하였다. 본 연구를 위해 대학생 277명을 대상으로 설문을 실시하였고, 이 중 외상경험이 있다고 보고한 180부를 분석하였다. 구조방정식 모형 검증 결과, 외상경험 강도와 복합외상후 증상의 관계에서 감각기억 활성화와 내러티브 파편화가 매개함을 확인하였다. 감각기억 활성화와 내러티브 파편화의 순차적인 경로가 외상경험 강도와 복합외상후 증상 간의 관계를 완전 매개하는 것으로 나타났으며, 완전매개모형이 부분매개모형보다 더 적합한 것으로 나타났다. 외상경험의 유형에 따라 경로에 차이가 나는지 확인하기 위해, 단순외상 경험 집단과 복합외상 경험 집단으로 나누어 다집단 분석을 실시하였다. 그 결과, 단순외상(n=82)과 복합외상(n=98) 집단의 경로 중 외상경험 강도와 감각기억 활성화의 경로에서 집단 간 유의한 차이가 나타났다. 이는 강한 복합외상 경험일수록 외상관련 감각기억이 더 활성화할 수 있음을 의미한다. 본 연구의 의의를 논의하면서, 연구 결과가 상담 및 심리치료 현장에서 어떻게 활용 가능한지 언급하였으며, 연구의 제한점에 대해서도 논의하였다.

참고문헌 (Reference)

1 김소희, "한국판 복합외상질문지(CTI)의 타당화 연구" 한국재활심리학회 27 (27): 27-48, 2020

2 Allen, J. G., "트라우마의 치유" 학지사 2010

3 Ogden, P., "트라우마와 몸" 학지사 2019

4 Herman, J. L., "트라우마" 열린책들 2012

5 정지선, "청소년 학교폭력의 복합 외상(Complex Trauma)적 접근" 한국상담심리학회 20 (20): 145-160, 2008

6 장윤지, "유사 외상 상황에 의한 지각적 점화: 외상자극과 일반위협자극의 비교" 한국임상심리학회 36 (36): 165-176, 2017

7 장진이, "외상화된 자기체계 척도의 개발과 타당화" 한국상담심리학회 23 (23): 359-385, 2011

8 정희진, "여성의 복합외상경험이 자기역량의 변화와 우울에 미치는 영향" 이화여자대학교 대학원 2008

9 유정, "심리적 트라우마의 정보처리: 뇌생리학적 근거와 트라우마 내러티브" 인간환경미래연구원 (14) : 29-65, 2015

10 이지민, "성매매 여성들의 복합 외상 후 스트레스 장애" 한국상담심리학회 20 (20): 553-580, 2008

11 박철옥, "복합외상경험자의 상담을 통한 자기의 회복과정" 이화여자대학교 2015

12 최현정, "복합외상 후 정체성 변화와 통합 과정: 자기정의기억을 중심으로" 서울대학교 2014

13 장진이, "반복적 대인간 외상 경험자의 자기체계 손상과 심리적 특성" 이화여자대학교 대학원 2010

14 van der Kolk, B. A., "몸은 기억한다" 을유문화사 2016

15 홍세희, "구조방정식 모형의 적합도 지수 선정기준과 그 근거" 19 (19): 161-177, 2000

16 홍세희, "구조방정식 모형의 기초와 응용"

17 최현정, "고문 생존자의 외상기억표상의 특성과 외상후 심리적 증상과의 관계" 한국임상심리학회 33 (33): 459-479, 2014

18 Michael, T., "Unwanted memories of assault : what intrusion characteristics are associated with PTSD" 43 (43): 613-628, 2005

19 Neimeyer, R., "Trauma, healing, and the narrative employment of loss" 77 (77): 360-375, 1996

20 Meiser-Stedman, R., "Towards a cognitive–behavioral model of PTSD in children and adolescents" 5 (5): 217-232, 2002

21 van der Hart, O., "The treatment of traumatic memories : Synthesis, realization, and integration" 2 (2): 162-180, 1993

22 Guidano, V. F., "The self in process" Guilford 1991

23 Kelly, G. A., "The psychology of personal constructs" Routledge 1991

24 Jelinek, L., "The organization of autobiographical and nonautobiographical memory in posttraumatic stress disorder(PTSD)" 118 (118): 288-298, 2009

25 Jones, C., "The organisation and content of trauma memories in survivors of road traffic accidents" 45 (45): 151-162, 2007

26 Ehlers, A., "The nature of intrusive memories after trauma : The warning signal hypothesis" 40 (40): 995-1002, 2002

27 Brewin, C. R., "The nature and significance of memory disturbance in posttraumatic stress disorder" 7 : 203-227, 2011

28 Briere, J., "The inventory of altered self-capacities(IASC)a standardized measure of identity, affect regulation, and relationship disturbance" 9 (9): 230-239, 2002

29 van der Kolk, B. A., "The intrusive past : The flexibility of memory and the engraving of trauma" 48 (48): 425-454, 1991

30 Holland J. M., "The integration of stressful life experiences scale(ISLES): Development and initial validation of a new measure" 17 (17): 325-352, 2010

31 van der Hart, O., "The haunted self: Structural dissociation and the treatment of chronic traumatization" WW Norton & Company 2006

32 Litvin, J. M., "The complex Trauma Inventory : A self-report measure of posttraumatic stress disorder and complex posttraumatic stress disorder" 30 : 602-613, 2017

33 Berntsen, D., "The centrality of event scale : A measure of integrating a trauma into one’s identity and its relation to post-traumatic stress disorder symptoms" 44 (44): 219-231, 2006

34 Meiser-Stedman, R., "The Trauma Memory Quality Questionnaire : Preliminary development and validation of a measure of trauma memory characteristics for children and adolescents" 15 (15): 271-279, 2007

35 Berntsen, D., "Splintered memories or vivid landmarks? Qualities and organization of traumatic memories with and without PTSD" 17 (17): 675-693, 2003

36 Rubin, D. C., "Reliving, emotions, and fragmentation in the autobiographical memories of veterans diagnosed with PTSD" 18 (18): 17-35, 2004

37 Amir, N., "Relationship between trauma narratives and trauma pathology" 11 (11): 385-392, 1998

38 Halligan, S. L., "Posttraumatic stress disorder following assault : The role of cognitive processing, trauma memory, and appraisals" 71 (71): 419-431, 2003

39 Grey, N., "Peritraumatic emotional"hot spots"in memory" 29 (29): 367-372, 2001

40 Sündermann, O., "Perceptual processing during trauma, priming and the development of intrusive memories" 44 (44): 213-220, 2013

41 Bennett, H., "Metacognition, memory disorganization and rumination in posttraumatic stress symptoms" 24 (24): 318-325, 2010

42 Crepo, M., "Memory and narrative of traumatic events: A literature review" 8 (8): 149-156, 2016

43 Reisberg, D., "Memory and emotion" Oxford University Press 3-41, 2004

44 Currier, J. M., "Meaning made following deployment in Iraq or Afghanistan : Examining unique associations with posttraumatic stress and clinical outcomes" 24 (24): 691-698, 2011

45 Park, C. L., "Meaning in the context of stress and coping" 1 (1): 115-144, 1997

46 Park, C. L., "Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events" 136 (136): 257-301, 2010

47 Post, R. M., "Kindling versus quenching" 821 (821): 285-295, 1997

48 Briere, J., "Inventory of Altered Self-Capacities professional manual" Psychological Assessment Resources 2000

49 Brewin, C. R., "Intrusive images in psychological disorders : characteristics, neural mechanisms, and treatment implications" 117 (117): 210-232, 2010

50 O’Kearney, R., "Integration and organization of trauma memories and posttraumatic symptoms" 24 (24): 716-725, 2011

51 "Inernational Classification of Diseases(ICD)-11 Beta Draft"

52 Siegel, D. J., "Healing Trauma: Attachment, Mind, Body and Brain" Norton 2003

53 Neimeyer, R. A., "Fostering posttraumatic growth : A narrative elaboration" 15 (15): 53-59, 2004

54 Brewin, C. R., "Episodic memory, perceptual memory, and their interaction : foundations for a theory of posttraumatic stress disorder" 140 (140): 69-97, 2014

55 van der Kolk, B. A., "Developmental Trauma Disorder : Toward a rational diagnosis for children with complex trauma histories" 35 (35): 401-408, 2005

56 Pelcovitz, D., "Development of a criteria set and a structured interview for disorders of extreme stress(SIDES)" 10 (10): 3-16, 1997

57 McCann, I. L., "Constructivist self-development theory : A theoretical framework for assessing and treating traumatized college students" 40 (40): 189-196, 1992

58 Courtois, C. A., "Complex trauma, complex reactions: assessment and treatment" 41 (41): 412-425, 2004

59 Brewin, C. R., "Cognitive change processes in psychotherapy" 96 (96): 379-394, 1989

60 Foa, E. B., "Change in rape narratives during exposure therapy for posttraumatic stress disorder" 8 : 675-690, 1995

61 Sewell, K. W., "Broken narratives : Trauma, metaconstructive gaps, and the audience of psychotherapy" 15 (15): 205-218, 2002

62 Smeets, T., "Autobiographical integration of trauma memories and repressive coping predict post‐traumatic stress symptoms in undergraduate students" 17 (17): 211-218, 2010

63 배병렬, "Amos 24 구조방정식모델링" 청람 2017

64 Browne, M. W., "Alternative ways of assessing model fit" 154 : 136-136, 1993

65 Herman, H., "Advances in personal construct psychology" Praeger 3-38, 2002

66 Brewin, C. R., "A dual representation theory of posttraumatic stress disorder" 103 (103): 670-686, 1996

67 Ehlers, A., "A cognitive model of posttraumatic stress disorder" 38 (38): 319-345, 2000