Once upon a time:In what ways does the use of metaphor and story in counselling sessions help those with PTSD to reframe their trauma narratives?

隐喻是一种将一件事物视为另一件事物的方式（Grady, 1997a&b），允许我们推理和交流抽象概念。长期以来，它一直被用于心理治疗，并被证明可以增强概念化、情感表达和意义转化（Lakoff和Johnson, 1999; Mathieson et al., 2018）。现有的研究表明，“披露”，即通过表达性写作、隐喻和创造性活动来揭示创伤，可以改善生理和心理健康（Pennebaker和Beall, 1986； Connolly Baker和Mazza, 2004; Brewin,2005）。但到目前为止，还没有研究调查这些特征是如何结合起来的。本研究的主要目的是测试在写作和创造性活动中使用隐喻和故事的心理干预的有效性，以帮助重新构建客户的创伤叙事，特别是对那些患有创伤后应激障碍的人。我们将分析将隐喻和故事融入创造性活动的不同方法，看看哪种方法对PTSD最有效。本研究还将探讨隐喻的有效性是取决于活动还是取决于治疗师或工作坊领导者如何体现活动。该项目将是跨学科的，以认知语言学为基础，借鉴心理学、隐喻、写作和创伤理论。创造性活动将由两组设计和运行，以比较和分析活动中的哪些部分对PTSD患者更有效。一组的参与者将从英语和咨询/心理学专业的本科生中招募。该讲习班将作为一项缓解压力的活动加以推广。根据创伤知情筛选测试改编的初步问卷将用于测试PTSD。另一组将是伯明翰和索利赫尔心理健康NHS基金会信托基金（BSMHFT）饮食失调诊所的客户。临床工作人员会筛选病人是否患有创伤后应激障碍。工作坊为期六周，每班6-8人。实验活动将在两组中进行，其有效性将与Pennebaker和Beall（1986）关于创伤性事件写作的研究中使用的表达性写作范式中的活动进行比较。这项研究将集中在包括隐喻和故事的不同组合的活动上，例如，像童话故事中的人物一样写作。参与者将被邀请在他们的日记中反思，并将通过问卷评估他们在活动之前，期间和之后的感受。两个月后，他们将被要求完成一项简短的表达性写作任务，并回答一份调查问卷，以确定他们的叙述是否有变化。分析的重点将放在他们使用的词语上，这些词语表明了认知的变化，这些词语连接了想法，以及这些词语显示了对事件更深入或更深思熟虑的理解。一个单词情绪图表将被用来记录情绪的变化。护理人员将根据饮食失调患者的态度和行为报告饮食失调患者群体的任何重构证据。主要的研究问题是：涉及隐喻和故事的干预措施在帮助客户重新构建创伤叙事方面有多有效？次要问题包括：隐喻和讲故事的结合方法是否有助于人们在群体环境中安全地重新构建他们的创伤？当来访者和治疗师使用隐喻和讲故事来获取和重新构建他们的创伤叙述时，他们的认知会发生什么变化？语言还需要什么？该项目将产生广泛的影响，通过对隐喻和故事如何帮助重新构建创伤叙事的理论理解，使学术界和实践者受益。希望这些发现将影响和改进创造性隐喻干预心理项目的设计和实施。

Metaphor is a way to see or experience one thing as something else (Grady, 1997a&b) allowing us to reason and communicate abstract concepts. It has long been used in psychotherapy where it has shown to enhance conceptualisation, expression of emotion and transforming meaning (Lakoff and Johnson, 1999: Mathieson et al., 2018). Existing research has shown that 'disclosure', that is revealing a trauma, using expressive writing, metaphor and creative activities, results in improvement in physiological and psychological health (Pennebaker and Beall, 1986; Connolly Baker & Mazza, 2004; Brewin,2005). But no studies to date have investigated how these features work in combination.The primary aim of the study is to test the effectiveness of psychological interventions using metaphor and story in writing and creative activities, to help reframe the trauma narrative of clients, especially for those suffering from PTSD. Different ways of incorporating metaphor and story into creative activities will be analysed to see which work best with PTSD. The study will also explore whether the effectiveness of the metaphor is dependent on the activity or on how the therapist or workshop leader embodies the activity. The project will be interdisciplinary, based on cognitive linguistics drawing on psychology, metaphor, writing and trauma theories. Creative activities will be designed and run with two groups to compare and analyse what components in the activities are more effective for people with PTSD. Participants for one group will be recruited from English and Counselling/Psychology undergraduates. The workshop will be promoted as a stress relieving activity. A preliminary questionnaire adapted from trauma-informed screening tests will be used to test for PTSD. The other group will be clients from an eating disorder clinic at The Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT). The clinical staff triage will screen the clients for PTSD. The workshops will be held over six weeks, with 6-8 people. The experimental activities will be conducted with both groups and their effectiveness will be compared with activities within the expressive writing paradigm used in Pennebaker and Beall's (1986) research on writing about traumatic events. This study will focus on activities which include different combinations of metaphor and story, for example, writing as if a character from a fairy tale. Participants will be invited to reflect in their journals and will be assessed by questionnaires on how they felt before, during, and after the activities. After two months they will be asked to complete a short expressive writing task and to answer a questionnaire to identify any changes in their narratives. The focus of the analysis will be in their use of words that indicate changes in cognition, words that connect ideas and words that show a deeper or more considered understanding of an event. A word emotion chart will be used to register changes in emotions. Evidence of any reframing from the eating disorder client group will be reported from the nurse staff based on their attitudes and behaviour. The primary research question is:How effective are interventions involving metaphor and story in helping clients reframe their trauma narrative?Secondary questions include:Does the combined approach of metaphor and storytelling help people reframe their trauma safely within a group setting?What cognitive changes are provoked in clients when they and the therapist use metaphor and storytelling, to access and reframe their trauma narratives? What else is required with language?The project will have a wide- reaching impact, benefiting academics and practitioners by contributing to theoretical understanding in how metaphor and story can help reframe the trauma narrative. The hope is that the findings will influence and improve the design and implementation of psychological programmes with creative metaphor interventions.