Logotherapy: A Useful Treatment for Trauma and Bipolar Disorder?

This is the second in a two-part series of reflections on trauma, bipolar disorder (BD) and Logotherapy and Existential Analysis (LTEA).

The first blog post explored the connection between trauma and BD, as well as defining some key terms. This article sets out the key tenets of LTEA, what it is used for, how it works, and an overview of the scientific literature, primarily as it pertains to trauma.

What Is LTEA?

LTEA is an existential-phenomenological approach developed by the Psychiatrist and Holocaust Survivor, Viktor Frankl. Sometimes known as the Third Viennese School of Psychotherapy it is increasingly recognized in scientific literature as an effective adjunct treatment for trauma, but also BD.  

It emphasizes freedom of will, responsibility, and the ‘will to meaning’ as primary human drivers, rather than pleasure or power. 

Key aspects include:

• Core Premise: Founded on the belief that the primary human motivation is to find meaning in life, as described in Viktor Frankl's "Man's Search for Meaning".

• Existential Analysis (The Foundation): This is the philosophical and anthropological foundation that focuses on the person and their capacity to live according to their values, making authentic, responsible decisions.

• Logotherapy (The Method): This is the practical, application-oriented therapy that uses a range of approaches to help clients discover meaning and purpose in their unique situations.

Clinical Indications

Szabó, K. & Baji, I. (2025). The current status and applications of logotherapy and existential analysis: a narrative review. Developments in Health Sciences, 18 Dec. pp82-100.

LTEA is transdiagnostic, that is it is focused on underlying and shared mechanisms, not specific diagnoses. However, according to this review of the scientific literature, LTEA has been shown to be relevant in:

• Depression, anxiety, and existential distress in patients with chronic or terminal illnesses.

• Supporting meaning-centred post-traumatic growth and meaning-making after trauma or loss.

• Enhancing life purpose and spiritual well-being among individuals experiencing burnout or occupational stress.

• Tackling grief, suicidal ideation, and identity crises within high-risk populations.

• Complementing psychiatric care and behavioural interventions in substance use and personality disorders.

Role of LTEA in Managing BD

Medication is the cornerstone of BD treatment. LTEA but helps patients cope with symptoms and ongoing challenges by focusing on realising meaning and purpose during their illness. It is often integrated with other treatments to: 

• Reduce Existential Suffering: Addresses the ‘existential vacuum’ or feelings of meaninglessness that often accompany depressive episodes.

• Build Resilience: Encourages a proactive attitude toward suffering, helping patients maintain psychological stability during mood swings.

• Combat Self-Stigma: Helps individuals recognize that their condition does not define their inherent value. It emphasises the dignity of the person.

Therapeutic Mechanisms

LTEA is not solely about specific techniques, rather it is expansive and holistic, engaging the client/patient in their unique perspective on the world. However, current research validates four primary techniques in LTEA that enhances trauma processing: 

• Dereflection: Redirecting attention from trauma symptoms to external goals to prevent pathological rumination.

• Socratic Dialogue: Using directed questioning to help individuals uncover unconscious attitudes and hidden personal meaning.

• Attitude Modulation: Helping individuals adopt 'tragic optimism'— the ability to find meaning despite unavoidable suffering.

• Paradoxical Intention: Breaking the cycle of anticipatory anxiety and avoidance commonly found in individuals that have experienced trauma. 

Below are key scientific references and findings regarding LTEA’s application for trauma (Note: I have included combat-related PTSD as this may be of interest):

Treatment for Combat-Related PTSD

Research highlights logotherapy as a potent adjunctive treatment for veterans, focusing on existential issues like survivor guilt and loss of purpose. 

• Meaning-based interventions derived from logotherapy effectively address the "existential vacuum" in combat veterans.

• Short-term group LTEA intervention significantly reduced PTSD symptoms, including emotional arousal and avoidance behaviours in war veterans.

• LTEA exercises led to significant decreases in stress, anxiety, and depression in combat-related PTSD case studies. 

Application in Medical & Chronic Trauma

LTEA is used to mitigate the traumatic impact of life-threatening illnesses, such as cancer and diabetes. 

• LTEA decreases post-traumatic stress and improves Post-Traumatic Growth (PTG) in women with breast and gynaecological cancer.

• LTEA regulates chronic stress by fostering resilience and transformation after trauma and personal crises.

Conclusion

There is clinical and empirical evidence that meaning is a central factor in resilience and growth across various trauma settings. Given the bi-directional linkage between trauma and BD, LTEA has a clear role in enhancing wellbeing and encouraging growth focused ways of thinking.

Disclaimer: this post does not in any way constitute medical advice; it is solely for information purposes. Please consult a relevant mental health professional if you feel that any of the issues raised are pertinent to you - further details are provided at the end of this article.  

Where to find help - If you live in the UK, the first step (if you are not currently under the care of a mental health team), is to reach out to your GP.  If you are in crisis, call 999, go to your nearest Emergency Department, or call your mental health crisis team. Further information is provided on the NHS website. Listening and support is available 24/7 from the Samaritans – call 116 123 or email jo@samaritans.org.uk