Making sense of distress

: how meanings are shaped through socio-cultural narratives across everyday and therapeutic contexts

Abstract

Section A
Background. Narrative theory proposes that individuals make sense of experience by drawing on socio-cultural discourses. In Western contexts, dominant narratives often conceptualise distress as failure or illness, shaping identity, agency and hope. Talking therapy can provide alternative narrative resources for understanding distress and a context for reinterpretation. However, no synthesis has examined how narrative analyses depict meaning making
of distress within talking therapy or how dominant discourses shape these meanings.
Aim. To explore how narrative analyses of first-person accounts of talking therapy depict the concepts individuals draw upon to understand distress.
Design. A systematic search identified 14 qualitative or mixed methods studies using narrative analysis. Studies were appraised for methodological quality, and participant quotes and study author’s interpretations were synthesised using thematic synthesis.
Results. Distress was interpreted through moral or medicalised narratives, positioning it as evidence of failure or illness and contributing to shame and identity threat. Talking therapy expanded conceptual resources, supporting reinterpretation and self-compassionate understandings. Embodied metaphors also conveyed the felt experience of distress.
Discussion & Implications. Meanings of distress were shaped by available narrative resources. Clinically, exploring narrative frameworks and attending to embodied descriptions may support collaborative meaning-making. Future research is needed in Global South and public populations.

Section B
The Power Threat Meaning Framework (PTMF) conceptualises distress as a response to power disparities and adversity, offering a non-blaming and non-pathologising alternative to medicalised and moral narratives. However, little is known about how members of the public engage with PTMF concepts to understand distress. This qualitative study explored what stories members of the public told about engaging with PTMF concepts when making sense of distressing life experiences. Six adults participated in two narrative interviews. Data were analysed using narrative analysis, attending to story content, structure and relation to wider socio-cultural discourses. Participants drew on coexisting psychosocial, moral and medicalised narratives, creating tension between understanding distress and ways of coping as understandable responses to adversity and as evidence of failure or illness, conflicting with
valued social roles and identities. Participants selectively drew on PTMF concepts to contextualise these meanings within wider socio-cultural narratives and re-author ways of coping as responses to threat, supporting alternative narrative positions and story plots. However, appropriation was conditional where coping conflicted with perceived responsibilities towards others. Findings highlight how ideological power may shape meanings of distress and suggest that the PTMF could benefit from greater attention to moral identity and responsibility in meaning-making.

Date of Award	2026
Original language	English
Awarding Institution	Canterbury Christ Church University