Cochrane Database of Systematic Reviews recognizes several trauma-focused therapies as evidence-based and thus recommended treatments for posttraumatic stress disorder (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013). However, there is no consensus on the definition of trauma, and controversy persists about its meaning, which brings into question the specificity and the target of trauma-focused treatments. The construct of trauma is often linked to posttraumatic stress disorder and Criterion A of trauma-related disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013). In other instances, it is understood as a broader phenomenon covering much if not most of human suffering. In this report, I address the dichotomy between the narrow and broad views of trauma and review considerations for a tighter definition of trauma on the grounds of clinical philosophy, methodology, and practice. I suggest that the construct of trauma should be grounded in the general theory of stress, where trauma is considered a particular kind of stress response alongside with adversity and normative stress. Following such conceptualization, I formulate a working definition of what trauma is and, more importantly, is not.

We describe an original protocol Treating Depression Downhill (TDD) that was designed as a specific therapy for depression. Evolutionary theories of depression served as a basis for its development. We discuss the rationale for using evolutionary theory and describe the structure and integrative nature of TDD. We then present an observation on TDD's application to group therapy of active duty military personnel. In the described sample, TDD demonstrated effectiveness and specificity for depression, differentiating it from anxiety and personality disorders.

The notion of psychological trauma has been liberally used both in clinical literature and general discourse. However, no consensus exists on its exact meaning and definition. Whereas traditionally trauma has been mostly associated with criterion A of acute and posttraumatic stress disorders (PTSDs) as defined in the Diagnostic and Statistical Manual of Mental Disorders , many researchers find this definition too constraining and not accounting for the complexity and many aspects of trauma. This touched off a quest for a broader more accommodating trauma concept, and a dimensional view of trauma with PTSD as its extreme manifestation has been suggested. The dimensional view also has its detractors arguing that “conceptual bracket creep” may undermine the category’s utility. Both categorical and dimensional views mostly rely on trauma’s clinical phenomenology and lack a unified theoretical basis. In an attempt to reconcile this contradiction, a hybrid categorical–dimensional model of trauma based on the general theory of stress has been recently proposed ( Krupnik, 2019 ). Herein, I explore the categorical boundary of the trauma concept, as posited by the model, within the predictive processing framework (PPF). I integrate the PPF view with the theory of stress. In conclusion, I briefly discuss how the proposed model of trauma may guide clinical practice.

Key Clinical MessageWe present an intervention in a case of major depression, where eye movement desensitization and reprocessing (EMDR) therapy was integrated into an evolutionary-based psychotherapy for depression. At the end of the treatment and at follow up assessment we observed a more accepting disposition and decreased depressive but not anxiety symptoms.

Depression is one of the most common psychiatric disorders. Postpartum depression affects about 9% of women who give birth. Despite significant advances in research and in pharmacotherapy and psychotherapy, depressive disorders remain difficult to treat. The application of eye movement desensitization and reprocessing (EMDR) therapy to depression has lagged behind its applications to trauma-related and anxiety disorders. I present 2 cases of postpartum depression successfully treated with a combined therapy, where EMDR is integrated into a novel therapeutic framework developed specifically for depressive disorders and based on evolutionary theory of depression, treating depression downhill (TDD). In the integrated TDD-EMDR therapy, I have made adjustments to the standard EMDR protocol such that the choice and nature of targets, the cognitive frame, and the objective for change in affect are determined by TDD framework. The described cases demonstrate the treatment process, including the modifications made to the standard EMDR procedures, and the treatment’s outcome. I identify and discuss the differences between theories of EMDR and TDD.