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Thierrée S, Richa S, Brunet A, Egreteau L, Roig Q, Clarys D, El-Hage W. Trauma reactivation under propranolol among traumatized Syrian refugee children: preliminary evidence regarding efficacy. Eur J Psychotraumatol 2020; 11:1733248. [PMID: 32194925 PMCID: PMC7067198 DOI: 10.1080/20008198.2020.1733248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/08/2023] Open
Abstract
Background: There is a dearth of therapeutic solutions for traumatized young patients. Trauma reactivation conducted under the influence of the reconsolidation blocker propranolol (Reconsolidation Therapy) is a simple, cost-effective treatment option that has some promising initial results in adults suffering from posttraumatic stress disorder (PTSD). Objective: To explore the usefulness of this novel treatment in children. The primary outcome was the reduction of PTSD symptoms at the end of treatment, while secondary outcomes included reduction in anxiety and in depressive symptoms. Method: An open-label clinical trial was conducted in a refugee camp in Syria, investigating the safety and efficacy of this therapeutic strategy in 117 children suffering from enduring PTSD symptoms. Participants received propranolol 90 minutes before briefly recalling (i.e. reactivating) a single personal traumatic memory, for 5 consecutive days. Self-reported anxiety, depressive, and PTSD symptoms were assessed at baseline, as well as 4 and 13 weeks after treatment. Results: A significant, clinically meaningful symptom reduction was observed at all post-treatment measurement times vs. baseline. More specifically, between baseline and the 13-week follow-up we observed a 64% PTSD symptoms reduction (d = 2.71). In a similar vein, we obtained a 39% symptoms reduction for depressive symptoms (d = 1.01). The general anxiety symptoms improved, but eventually returned to prior level, probably because of the deteriorating living conditions in the camp. Conclusions: This therapy appeared as a potentially safe and useful treatment strategy for children suffering from PTSD symptoms, warranting replication studies using stronger study designs. The social acceptability and ease of implementation of the treatment should also be noted.
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Affiliation(s)
- Sarah Thierrée
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,No Lost Generation, Tours, France
| | - Sami Richa
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Alain Brunet
- Douglas Institute Research Center, and the Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Laurine Egreteau
- Centre de Psychotraumatologie CVL, Pôle de Psychiatrie, CHRU de Tours, Tours, France
| | | | - David Clarys
- UMR CNRS 7295, Centre de Recherches sur la Cognition et l'Apprentissage, Université de Poitiers, Poitiers, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,No Lost Generation, Tours, France.,Centre de Psychotraumatologie CVL, Pôle de Psychiatrie, CHRU de Tours, Tours, France
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Feinstein A, Osmann J, Patel V. Symptoms of PTSD in Frontline Journalists: A Retrospective Examination of 18 Years of War and Conflict. Can J Psychiatry 2018; 63:629-635. [PMID: 29792077 PMCID: PMC6109887 DOI: 10.1177/0706743718777396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the current study was to determine the frequency and severity of symptoms of posttraumatic stress disorder (PTSD) in journalists covering conflict. METHODS PTSD data (Impact of Event Scale-Revised) collected over an 18-year period from 684 conflict journalists were analyzed retrospectively for frequency and severity of reexperiencing, avoidance, and arousal symptoms. Conflicts covered were civil wars in the Balkans ( n = 140 journalists), 9/11 attack in New York City ( n = 46), Iraq war ( n = 84), Mexico drug wars ( n = 104), civil war in Syria ( n = 59), Kenya election violence/Al-Shabab terror ( n = 57), state-sanctioned media intimidation in Iran ( n = 114), and the current migration crisis in Europe ( n = 80). RESULTS The mean age of the sample was 38.59 (SD = 8.35) years, 461 (67%) journalists were men, and the mean duration of conflict work was 13.42 (SD = 7.74) years. The 5 most frequently endorsed symptoms were in the reexperiencing/intrusion category. Mean intrusion (1.31, SD = 0.97), avoidance (1.08, SD = 0.89), and arousal (1.07, SD = 0.96) scores for the entire sample were in the mild range. Being female and less educated independently predicted PTSD symptoms. CONCLUSIONS PTSD phenomenology in a group of conflict journalists with well over a decade of frontline experience is dominated by reexperiencing symptoms. While symptom severity is for the most part mild, group means can obscure those individuals with significantly more severe difficulties.
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Affiliation(s)
- Anthony Feinstein
- 1 Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, Ontario.,2 University of Toronto, Ontario
| | - Jonas Osmann
- 1 Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, Ontario.,2 University of Toronto, Ontario
| | - Viral Patel
- 1 Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, Ontario
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Abstract
Eye movement desensitisation and reprocessing (EMDR) was described by Shapiro (1989a,b) as a new method for treating post-traumatic stress disorder (PTSD). In May 1987, while walking in the park, Shapiro noticed that her own disturbing thoughts changed then disappeared “without any conscious effort” (Shapiro, 1995) when they had been temporally paired with diagonal upward to and fro eye movements. Over the next six months Shapiro worked with approximately 70 people to develop a procedure based on the temporal pairing of distressing images and thoughts with various eye movements. Shapiro began to develop strategies to unblock stalled emotional processing, which was initiated by EMDR in non-patients. She successfully tried the method on a Vietnam veteran suffering from severe PTSD and then embarked upon a trial of EMDR on a mixed group of victims of rape, molestation and Vietnam combat trauma. Initially, EMDR achieved wide recognition as a new breakthrough treatment for PTSD. This was, in part, because of very positive early reports (e.g. Wolpe & Abrams, 1991), but also because the EMDR effect appeared to occur with unprecedented speed, often in cases of PTSD that had previously resisted treatment by many other methods over a long period.
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McDiarmid TA, Bernardos AC, Rankin CH. Habituation is altered in neuropsychiatric disorders-A comprehensive review with recommendations for experimental design and analysis. Neurosci Biobehav Rev 2017; 80:286-305. [PMID: 28579490 DOI: 10.1016/j.neubiorev.2017.05.028] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/29/2017] [Indexed: 02/03/2023]
Abstract
Abnormalities in the simplest form of learning, habituation, have been reported in a variety of neuropsychiatric disorders as etiologically diverse as Autism Spectrum Disorder, Fragile X syndrome, Schizophrenia, Parkinson's Disease, Huntington's Disease, Attention Deficit Hyperactivity Disorder, Tourette's Syndrome, and Migraine. Here we provide the first comprehensive review of what is known about alterations in this form of non-associative learning in each disorder. Across several disorders, abnormal habituation is predictive of symptom severity, highlighting the clinical significance of habituation and its importance to normal cognitive function. Abnormal habituation is discussed within the greater framework of learning theory and how it may relate to disease phenotype either as a cause, symptom, or therapy. Important considerations for the design and interpretation of habituation experiments are outlined with the hope that these will aid both clinicians and basic researchers investigating how this simple form of learning is altered in disease.
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Affiliation(s)
- Troy A McDiarmid
- Graduate Program in Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Rm F221, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Aram C Bernardos
- Graduate Program in Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Rm F221, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Catharine H Rankin
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Rm F221, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada.
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Price M, Spinazzola J, Musicaro R, Turner J, Suvak M, Emerson D, van der Kolk B. Effectiveness of an Extended Yoga Treatment for Women with Chronic Posttraumatic Stress Disorder. J Altern Complement Med 2017; 23:300-309. [PMID: 28121466 DOI: 10.1089/acm.2015.0266] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Yoga has been found to be an effective posttraumatic stress disorder (PTSD) treatment for a variety of trauma survivors, including females with chronic PTSD. Aim/Purpose: The current study builds on extant research by examining an extended trauma-sensitive yoga treatment for women with chronic PTSD. The study sought to optimize the results of a treatment protocol examined in a recent randomized controlled trial with a shorter duration and without assignment or monitoring of home practice. MATERIALS AND METHODS The authors examined a 20-week trauma-sensitive yoga treatment in a non-randomized single-group treatment feasibility study for women with chronic treatment-resistant PTSD (N = 9). The authors examined PTSD and dissociation symptom reduction over several assessment periods. RESULTS The results indicate that participants experienced significant reductions in PTSD and dissociative symptomatology above and beyond similar treatments of a shorter duration. CONCLUSIONS The findings suggest that more intensive trauma-sensitive yoga treatment characterized by longer duration and intentional assignment and monitoring of home practice may be more advantageous for individuals with severe and chronic PTSD. The implications of the findings for the potentially more substantial role of yoga as an intervention for a subset of adults with chronic treatment-resistant PTSD are discussed.
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Affiliation(s)
- Maggi Price
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,2 Department of Counseling, Developmental, and Educational Psychology, Boston College , Newton, MA
| | - Joseph Spinazzola
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,3 Department of Psychology, Suffolk University , Boston, MA
| | - Regina Musicaro
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,3 Department of Psychology, Suffolk University , Boston, MA
| | - Jennifer Turner
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA
| | - Michael Suvak
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,3 Department of Psychology, Suffolk University , Boston, MA
| | - David Emerson
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA
| | - Bessel van der Kolk
- 1 The Trauma Center at Justice Resource Institute , Brookline, MA.,4 Department of Psychiatry, Boston University School of Medicine , Boston, MA
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Coubard OA. An Integrative Model for the Neural Mechanism of Eye Movement Desensitization and Reprocessing (EMDR). Front Behav Neurosci 2016; 10:52. [PMID: 27092064 PMCID: PMC4820440 DOI: 10.3389/fnbeh.2016.00052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 03/03/2016] [Indexed: 01/25/2023] Open
Abstract
Since the seminal report by Shapiro that bilateral stimulation induces cognitive and emotional changes, 26 years of basic and clinical research have examined the effects of Eye Movement Desensitization and Reprocessing (EMDR) in anxiety disorders, particularly in post-traumatic stress disorder (PTSD). The present article aims at better understanding EMDR neural mechanism. I first review procedural aspects of EMDR protocol and theoretical hypothesis about EMDR effects, and develop the reasons why the scientific community is still divided about EMDR. I then slide from psychology to physiology describing eye movements/emotion interaction from the physiological viewpoint, and introduce theoretical and technical tools used in movement research to re-examine EMDR neural mechanism. Using a recent physiological model for the neuropsychological architecture of motor and cognitive control, the Threshold Interval Modulation with Early Release-Rate of rIse Deviation with Early Release (TIMER-RIDER)-model, I explore how attentional control and bilateral stimulation may participate to EMDR effects. These effects may be obtained by two processes acting in parallel: (i) activity level enhancement of attentional control component; and (ii) bilateral stimulation in any sensorimotor modality, both resulting in lower inhibition enabling dysfunctional information to be processed and anxiety to be reduced. The TIMER-RIDER model offers quantitative predictions about EMDR effects for future research about its underlying physiological mechanisms.
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Erford BT, Gunther C, Duncan K, Bardhoshi G, Dummett B, Kraft J, Deferio K, Falco M, Ross M. Meta-Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder. Journal of Counseling & Development 2016. [DOI: 10.1002/jcad.12058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Chelsea Gunther
- Education Specialties Department; Loyola University Maryland
| | - Kelly Duncan
- Division of Counseling and Psychology; University of South Dakota
- Now at School of Education; Northern University
| | - Gerta Bardhoshi
- Division of Counseling and Psychology; University of South Dakota
- Now at Department of Rehabilitation and Counselor Education; University of Iowa
| | - Beth Dummett
- Education Specialties Department; Loyola University Maryland
| | - Jennifer Kraft
- Education Specialties Department; Loyola University Maryland
| | - Katie Deferio
- Education Specialties Department; Loyola University Maryland
| | - Michelle Falco
- Education Specialties Department; Loyola University Maryland
| | - Margaret Ross
- Education Specialties Department; Loyola University Maryland
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Foa EB, Gillihan SJ, Bryant RA. Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD. Psychol Sci Public Interest 2015; 14:65-111. [PMID: 25722657 DOI: 10.1177/1529100612468841] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.
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Affiliation(s)
- Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Seth J Gillihan
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
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Bluett EJ, Zoellner LA, Feeny NC. Does change in distress matter? Mechanisms of change in prolonged exposure for PTSD. J Behav Ther Exp Psychiatry 2014; 45:97-104. [PMID: 24091202 PMCID: PMC3883671 DOI: 10.1016/j.jbtep.2013.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinically, many individuals persist in prolonged exposure therapy (PE) for chronic PTSD despite continuing distress during recounting of the trauma memory (imaginal exposure). Theorists suggest that distress reduction is necessary for successful treatment outcome (e.g., Foa & Kozak, 1986), while others suggest otherwise (e.g., Craske et al., 2008). This study examined clinically reliable changes in distress, relations to broad clinical outcomes, and whether homework adherence affected this relationship. METHOD In 116 patients with PTSD, first to last imaginal exposure sessions' peak and average distress was examined, calculating reliable change in distress. Homework adherence and helpfulness were examined. At post-treatment, PTSD symptoms (re-experiencing, avoidance, hyperarousal), depression, and functioning were examined. RESULTS Patients exhibited a lack of reliable change in distress (64.7%) more than a reliable change in distress (35.3%). Although no difference in post-treatment PTSD diagnostic status, individuals experiencing a reliable change in distress reported lower PTSD severity (re-experiencing, hyperarousal), depression, and better functioning. Further, perceived helpfulness of imaginal homework had an indirect effect on this relationship. LIMITATIONS This study did not utilize a distress tolerance self-report measure; however, examined self-reported distress during imaginal exposure. CONCLUSIONS Results are encouraging for clinicians treating PTSD with PE, arguing that lack of reliable change in distress to the trauma memory does not result in treatment failure. Patient "buy in" to homework, rather than amount completed, was related to the process of distress reduction. Results suggest that distress reduction in imaginal exposure is not a key mechanism underlying therapeutic change in PE.
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Affiliation(s)
- Ellen J. Bluett
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Psychology, Utah State University, Logan, UT, USA 84322-2810
| | - Lori A. Zoellner
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Norah C. Feeny
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio, USA.
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van Dam D, Vedel E, Ehring T, Emmelkamp PMG. Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: a systematic review. Clin Psychol Rev 2012; 32:202-14. [PMID: 22406920 DOI: 10.1016/j.cpr.2012.01.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/21/2011] [Accepted: 01/30/2012] [Indexed: 11/16/2022]
Abstract
This article gives an overview of research into psychological treatments for concurrent posttraumatic stress disorder (PTSD) and substance used disorder (SUD), with a special focus on the effectiveness of treatments addressing both disorders compared to treatments addressing one of the disorders alone. In addition, a distinction is made between trauma-focused versus non-trauma-focused therapies for concurrent PTSD and SUD. The databases Embase, Psychinfo, Medline and Web of science were searched for relevant articles. In total, seventeen studies were identified evaluating ten treatments protocols (six trauma-focused and four non-trauma-focused treatment approaches). In general, the studies showed pre-post reductions for PTSD and/or SUD symptoms. Although most treatments for concurrent PTSD and SUD did not prove to be superior to regular SUD treatments, there are some promising preliminary results suggesting that some patients might benefit from trauma-focused interventions. However, the lack of methodologically sound treatment trials makes it difficult to draw firm conclusions. Methodological limitations are discussed, along with recommendations for future research.
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Affiliation(s)
- Debora van Dam
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Tarrier N. The cognitive and behavioral treatment of PTSD, what is known and what is known to be unknown: How not to fall into the practice gap. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1468-2850.2010.01203.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sharpe L, Tarrier N, Rotundo N. Treatment of Delayed Post-Traumatic Stress Disorder Following Sexual Abuse: A Case Example. Behav Cogn Psychother 1994; 22:233-42. [DOI: 10.1017/s1352465800013096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recent advances have been made in the treatment of post-traumatic stress disorder (PTSD). Cognitive behavioural techniques have been reported in controlled trials to be very effective in reducing arousal symptoms associated with post-traumatic stress disorder, such as sleep disturbance, hypervigilance, intrusive thoughts and flashbacks. It remains unclear from the literature, however, how well these treatment modalities can alleviate post-traumatic stress disorder where the predominant clinical features are associated with depersonalization and dissociative states. Depersonalization is evident in a significant proportion of individuals presenting with PTSD and yet does not appear to be amenable to exposure based therapies. A case study presented suggests methods through which depersonalization may be addressed within the therapeutic context.
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Dunmore E, Clark DM, Ehlers A. Cognitive Factors in Persistent versus Recovered Post-Traumatic Stress Disorder after Physical or Sexual Assault: A Pilot Study. Behav Cogn Psychother 1997; 25:147-59. [DOI: 10.1017/s135246580001835x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cognitive models have linked individual differences in the appraisal of traumatic events and their sequelae to the persistence of post-traumatic stress disorder (PTSD). A pilot study investigated this proposal with victims of assault. Eleven assault victims suffering from persistent PTSD and 9 victims who had recovered from PTSD were interviewed retrospectively and compared on potentially relevant cognitive factors. Groups were comparable in terms of characteristics of the assault, gender, age, and initial PTSD severity. Participants with persistent PTSD were less likely than those who had recovered to have engaged in mental planning during the assault and more likely to have experienced mental defeat, and to indicate negative appraisals of their actions during the assault, of others' reactions after the assault, and of their initial PTSD symptoms. They were also more likely to indicate global negative beliefs concerning their perception of themselves, their world or their future. These cognitive factors may maintain PTSD symptoms either directly or by motivating the individual to engage in behaviour that prevents change.
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Kneebone II, Hull SL. Cognitive behaviour therapy for post-traumatic stress symptoms in the context of hydrocephalus: A single case. Neuropsychol Rehabil 2009; 19:86-97. [DOI: 10.1080/09602010802009623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Izquierdo I, Bevilaqua LRM, Lima RH, Clarke JR, Costa da Costa J, Cammarota M. Extinction learning: neurological features, therapeutic applications and the effect of aging. Future Neurology 2008. [DOI: 10.2217/14796708.3.2.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Extinction learning consists of the usually gradual inhibition of the retrieval of a previously learned response or behavior. It is widely used for the treatment of syndromes of learned fear, such as phobias and post-traumatic stress disorder. It relies on well-identified molecular processes in the hippocampus, basolateral amygdala, ventromedial prefrontal cortex (vmPFC) and entorhinal cortex. In humans, thickness of the orbital cortex, vmPFC and the anterior cingulate cortex correlates with the capacity to extinguish. The three regions are functionally inter-related (see below). The development of learned fear syndromes in humans is viewed by many as being due to a deficit of extinction, and so of the capacity to deal with fear. Blockade of NMDA receptors, inhibition of protein synthesis in the vmPFC or blockade of protein synthesis or of various molecular signaling cascades in the hippocampus, amygdala or entorhinal cortex impairs extinction. d-cycloserine, a partial agonist at NMDA receptors, enhances extinction in animals and humans and may help extinction to exert its therapeutic effect. Cannabinoids also enhance extinction, acting through CB1 receptors, but their therapeutic use is not warranted.
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Affiliation(s)
- Ivan Izquierdo
- Pontifical Catholic University of Rio Grande do Sul, Center for Memory Research, Biomedical Research Institute, Av. Ipiranga 6690, 2nd Floor, 90610-000 Porto Alegre, RS, Brazil
| | - Lia RM Bevilaqua
- Pontifical Catholic University of Rio Grande do Sul, Center for Memory Research, Biomedical Research Institute, Av. Ipiranga 6690, 2nd Floor, 90610-000 Porto Alegre, RS, Brazil
| | - Ramón H Lima
- Pontifical Catholic University of Rio Grande do Sul, Center for Memory Research, Biomedical Research Institute, Av. Ipiranga 6690, 2nd Floor, 90610-000 Porto Alegre, RS, Brazil
| | - Julia R Clarke
- Pontifical Catholic University of Rio Grande do Sul, Center for Memory Research, Biomedical Research Institute, Av. Ipiranga 6690, 2nd Floor, 90610-000 Porto Alegre, RS, Brazil
| | - Jaderson Costa da Costa
- Pontifical Catholic University of Rio Grande do Sul, Center for Memory Research, Biomedical Research Institute, Av. Ipiranga 6690, 2nd Floor, 90610-000 Porto Alegre, RS, Brazil
| | - Martín Cammarota
- Pontifical Catholic University of Rio Grande do Sul, Center for Memory Research, Biomedical Research Institute, Av. Ipiranga 6690, 2nd Floor, 90610-000 Porto Alegre, RS, Brazil
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Abstract
The scientist-practitioner model has long been espoused within cognitive behavioural psychotherapy. The study includes an evaluation of the efficacy of cognitive therapy for driving phobia. Assessment, formulation and practical treatment of this common problem are also reported. Self-report measures evaluated results. Eight of the 10 consecutive cases improved significantly and reported that the intervention was acceptable. A reflexive analysis of the research findings and the influences on the first author's practice as a researcher and practitioner are also explored. Recommendations for future research are also made.
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Affiliation(s)
- M Townend
- Unit for Psychotherapeutic Practice and Research and Prevention of Domestic Abuse (UPPR) University of Derby, Derby, UK.
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Abstract
Tritonia diomedea is one of several gastropod molluscs used to study cellular mechanisms of learning and memory. Previous studies in this organism have focused on short-term habituation and sensitization. This report presents the first detailed description of long-term habituation in Tritonia. Experimental animals were given 11 swim sessions, each consisting of 10 trials, over 6 days, during which they typically displayed an initial sensitization, followed by short-term, within-session habituation. Responses were compared to controls, which were given a single stimulus per day. Cycle number habituation steadily accumulated over the days of training, and then persisted for at least 2 days after the end of training. These findings will permit comparative studies of the cellular mechanisms of short- and long-term memory in this highly tractable model system.
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Affiliation(s)
- William N Frost
- Department of Cell Biology and Anatomy, The Chicago Medical School, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, Illinois 60064, USA.
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Abstract
This paper describes the theoretical background and procedures (including psycho-education, screening, treatment protocol and outcome measurement) involved in a protocol-driven internet treatment of post-traumatic stress and grief in a group of people who have suffered from mild to relatively severe trauma. The paper examines the results of 3 outcome and process studies, which were carried out initially in a student population and subsequently in the general population of highly traumatized people. In the latter study, participants in the experimental condition (n = 69) improved significantly more than participants in the waiting list control condition (n = 32), with respect to trauma-related symptoms and general psychopathology. The effect sizes were large. More than 50% of the participants treated showed reliable change and clinically significant improvement after treatment for avoidance and depression. Treatment proved most beneficial for participants who had suffered from intentional trauma and those who had not previously discussed the traumatic events with significant others. Content analysis of the publications indicates a remarkable increase in cognitive coping during treatment. The possibilities for future research into internet-driven treatment of post-traumatic stress symptomatology are discussed, including the proposal to study the effects of sending a final written letter to a significant other person.
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Affiliation(s)
- Alfred Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Bisson JI, Shepherd JP, Joy D, Probert R, Newcombe RG. Early cognitive-behavioural therapy for post-traumatic stress symptoms after physical injury. Randomised controlled trial. Br J Psychiatry 2004; 184:63-9. [PMID: 14702229 DOI: 10.1192/bjp.184.1.63] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early single-session psychological interventions, including psychological debriefing following trauma, have not been shown to reduce psychological distress. Longer early psychological interventions have shown some promise. AIMS To examine the efficacy of a four-session cognitive-behavioural intervention following physical injury. METHOD A total of 152 patients attending an accident and emergency department displaying psychological distress following physical injury were randomised 1-3 weeks post-injury to a four-session cognitive-behavioural intervention that started 5-10 weeks after the injury or to no intervention and then followed up for 13 months. RESULTS At 13 months, the total Impact of Event Scale score was significantly more reduced in the intervention group (adjusted mean difference=8.4,95% CI 2.4-14.36). Other differences were not statistically significant. CONCLUSIONS A brief cognitive-behavioural intervention reduces symptoms of post-traumatic stress disorder in individuals with physical injury who display initial distress.
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Affiliation(s)
- Jonathan I Bisson
- Department of Liaison Psychiatry, Cardiff and Vale NHS Trust, University Hospital of Wales, Cardiff, UK.
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Abstract
Following considerable empirical scrutiny, cognitive behaviour therapy (CBT) has proven to be a safe and effective treatment for posttraumatic stress disorder (PTSD). This article overviews the general principles of treatment and describes the components that comprise CBT for PTSD. We then move on to review the efficacy of CBT for the treatment of PTSD caused by various traumas, including assault, road traffic accident (RTA), combat, and terrorism. Recent advances in early intervention and in the treatment of disorders that are comorbid with PTSD are reviewed. Finally, future directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be conducted with enhanced methodological rigour and public health relevance.
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Affiliation(s)
- Allison G Harvey
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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Abstract
The present study investigated predictors of treatment outcome and dropout in two samples of PTSD-patients with mixed traumas treated using prolonged imaginal exposure. Possible predictors were analysed in both samples separately, in order to replicate in one sample findings found in the other. The only stable finding across the two groups was that patients who showed more PTSD-symptoms at pre-treatment, showed more PTSD-symptoms at post-treatment and follow-up. Indications were found that benzodiazepine use was related to both treatment outcome and dropout, and alcohol use to dropout. Demographic variables, depression and general anxiety, personality, trauma characteristics, feelings of anger, guilt, and shame and nonspecific variables regarding therapy were not related to either treatment outcome or dropout, disconfirming generally held beliefs about these factors as contra-indications for exposure therapy. It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout. Clinically seen, it is therefore argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre-treatment characteristics is not justified.
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Affiliation(s)
- A van Minnen
- Department of Clinical Psychology, University of Nijmegen, Netherlands.
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Back SE, Dansky BS, Carroll KM, Foa EB, Brady KT. Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: description of procedures. J Subst Abuse Treat 2001; 21:35-45. [PMID: 11516925 DOI: 10.1016/s0740-5472(01)00181-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime PTSD. This comorbidity has detrimental effects on clinical presentation, and treatment course and outcome. Cocaine dependence is associated with increased rates of exposure to trauma, more severe symptoms, higher rates of treatment attrition and retraumatization, and greater vulnerability to PTSD when compared to other substance use disorders. These associations underscore the need for effective treatments that address issues particular to PTSD in a manner tolerable to cocaine-dependent individuals. This article describes a manualized psychotherapy developed specifically for individuals with PTSD and cocaine dependence. Concurrent Treatment of PTSD and Cocaine Dependence (CTPCD) provides coping skills training, cognitive restructuring techniques, and relapse prevention strategies to reduce cocaine use. In-vivo and imaginal exposure therapy techniques are incorporated to reduce PTSD symptom severity. Primary treatment goals include psychoeducation specific to the interrelationship between PTSD and cocaine dependence, and clinically meaningful reductions in cocaine use and PTSD symptomatology. Secondary goals include a reduction in HIV high-risk behaviors and improved functioning in associated areas, such as anger and negative affect management.
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Affiliation(s)
- S E Back
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Center for Drug and Alcohol Programs, Charleston, SC, USA.
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Abstract
Individuals (n = 39) participated in an outpatient, 16-session individual, manual-guided psychotherapy designed to treat concurrent PTSD and cocaine dependence. Therapy consisted of a combination of imaginal and in-vivo exposure therapy techniques to treat PTSD symptoms and cognitive-behavioral techniques to treat cocaine dependence. Although the dropout rate was high, treatment completers (i.e., patients who attended at least 10 sessions; n = 15) demonstrated significant reductions in all PTSD symptom clusters and cocaine use from baseline to end of treatment. Significant reductions in depressive symptomatology, as measured by the Beck Depression Inventory, and psychiatric and cocaine use severity, as measured by the Addiction Severity Index, were also observed. These improvements in PTSD symptoms and cocaine use were maintained over a 6-month follow-up period among completers. The average pre- to posttreatment effect size was 1.80 for PTSD symptoms and 1.26 for drug and alcohol use severity. Baseline comparisons between treatment completers and noncompleters revealed significantly higher avoidance symptoms, as measured by the Impact of Events Scale, and fewer years of education among treatment noncompleters as compared to completers. This study provides preliminary evidence to suggest that exposure therapy can be used safely and may be effective in the treatment of PTSD in some individuals with cocaine dependence. However, the study is limited by the uncontrolled nature of the study design, small number of subjects, and high dropout rate.
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Affiliation(s)
- K T Brady
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Center for Drug and Alcohol Programs, Charleston, SC, USA
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Abstract
Post Traumatic Stress disorder (PTSD) is a condition where the individual suffers re-experiencing phenomena, avoidance behaviour or emotional numbing and hyperarousal following a major traumatic event. Psychological treatments, primarily behavioural, and psychopharmacological interventions have been shown to be of considerable benefit. This case report describes an individual suffering from PTSD who experienced almost complete remission of her symptoms following the prescription of a centrally acting stimulant for unrelated reasons. The actions of centrally acting stimulants and the current knowledge about the neurophysiology of PTSD may help to explain the patient's recovery. Further investigation of amphetamine-like substances and related compounds in PTSD is required. Copyright 2000 John Wiley & Sons, Ltd.
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Affiliation(s)
- Oscar E Daly
- Department of Psychiatry, Lagan Valley Hospital, Hillsborough Road, Lisburn BT28 1JP, UK
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Dunmore E, Clark DM, Ehlers A. Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behav Res Ther 1999; 37:809-29. [PMID: 10458046 DOI: 10.1016/s0005-7967(98)00181-8] [Citation(s) in RCA: 266] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cognitive factors hypothesised to influence the development and maintenance of PTSD were investigated. 92 assault victims completed questionnaires assessing a range of cognitive variables. Factors relating to onset of PTSD were investigated by comparing victims who did and who did not suffer PTSD. Factors relating to maintenance of PTSD were investigated by comparing victims who had recovered from PTSD with victims who had persistent PTSD. Cognitive factors associated with both onset and maintenance of PTSD were: appraisal of aspects of the assault itself (mental defeat, mental confusion, appraisal of emotions); appraisal of the sequelae of the assault (appraisal of symptoms, perceived negative responses of others, permanent change); dysfunctional strategies (avoidance/safety seeking) and global beliefs impacted by assault. Cognitive factors that were associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between the cognitive variables and PTSD remained significant when variations in perceived and objective assault severity were statistically controlled. The cognitive factors identified in the study may contribute to PTSD directly, by generating a sense of ongoing threat, or indirectly, by motivating cognitive and behavioural strategies that prevent recovery, or by affecting the nature of the traumatic memory.
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Affiliation(s)
- E Dunmore
- Department of Psychology, University of Surrey, Guildford, UK.
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Abstract
Research on Eye Movement Desensitization and Reprocessing therapy (EMDR) was reviewed to answer the questions "Does EMDR work?" and "If so, Why?" This first question was further subdivided on the basis of the control group: (a) no-treatment (or wait list control), (b) nonvalidated treatments, and (c) other validated treatments. The evidence supports the following general conclusions: First, EMDR appears to be effective in reducing at least some indices of distress relative to no-treatment in a number of anxiety conditions, including posttraumatic stress disorder, panic disorder, and public-speaking anxiety. Second, EMDR appears at least as effective or more effective than several nonvalidated treatments (e.g., relaxation, active listening) for posttraumatic stress reactions. Third, despite statements implying the contrary, no previously published study has directly compared EMDR with an independently validated treatment for posttraumatic stress disorder (e.g., therapist-directed flooding). In the treatment of simple phobia, participant modeling has been found to be more effective than EMDR. Fourth, our review of dismantling studies reveals there is no convincing evidence that eye movements significantly contribute to treatment outcome. Recommendations regarding further research directions are provided.
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Affiliation(s)
- S P Cahill
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston 29425-0742, USA.
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Abstract
Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during relieving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.
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Affiliation(s)
- A Ehlers
- Department of Psychiatry, University of Oxford, U.K.
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Abstract
BACKGROUND AND PURPOSE Psychological reactions after stroke have been recognized for some time. The present study examined whether psychological symptoms consistent with post-traumatic stress disorder (PTSD) could occur after stroke as a consequence of the sudden and unpredictable occurrence of a life-threatening internal stressor. METHODS Sixty-one patients who had experienced a first-ever stroke or transient ischaemic attack were assessed using standard self-report clinical measures for anxiety, depression and PTSD. Those patients who fulfilled criteria on at least one PTSD self-report measure were subsequently assessed using a structured clinical interview for PTSD. RESULTS Six (9.8%) patients fulfilled criteria for PTSD. No significant differences were found between the post-stroke PTSD group and the non-PTSD group in terms of premorbid health and lifestyle, or experiences of adverse life events. Significant differences were noted with respect to self-reported post-stroke mental health and premorbid neuroticism. The post-stroke PTSD group also scored consistently higher on measures of anxiety, depression and psychiatric caseness. CONCLUSIONS The results of this study demonstrate a number of close similarities between post-stroke PTSD and classical PTSD. We therefore conclude that PTSD or a PTSD-like syndrome can occur after stroke.
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Affiliation(s)
- S Sembi
- Department of Clinical Psychology, North Manchester General Hospital NHS Trust, UK
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Abstract
Sexual abuse in childhood is increasingly recognized as an important etiologic component in a number of psychiatric disorders. One-quarter to one-third of all female children suffer sexual abuse before their eighteenth birthday, and at least one half of women with severe mental illness acknowledge such events. An even higher percentage of a particularly vulnerable group, dually diagnosed homeless women, appear to have a premorbid history of childhood victimization. In this paper, we review the emergent literature on childhood abuse, its sequelae and treatment; and discuss the implications of these data for the development of new approaches to trauma recovery in people with severe mental illness.
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Affiliation(s)
- S D Rosenberg
- Department of Psychiatry, Dartmouth Medical School, Lebanon, NH 03756-0001, USA
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de Jongh A, Broeke ET. Eye Movement Desensitization and Reprocessing (EMDR): een procedure voor de behandeling van aan trauma gerelateerde angst. ACTA ACUST UNITED AC 1996; 22:53-64. [DOI: 10.1007/bf03079287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
This article analyzes the literature on the treatment of posttraumatic stress disorder (PTSD). It briefly exposes the theoretical basis for each treatment modality and extensively examines pharmacological, behavioral, cognitive, and psychodynamic therapies, as well as group and family therapies, hypnosis, inpatient treatment, and rehabilitation. Articles were identified by scanning Medline and PsychLit for all papers in English reporting treatment of PTSD. Anecdotal case reports were, then, excluded. Eighty one articles were identified and categorized as either biological or psychological, with the latter category further divided into behavioral, cognitive, psychodynamic, and other treatment modalities. Information regarding the type of trauma, the sample studied, the treatment method, and the results of the treatment has been extracted from each article and is presented briefly. A synthesis of findings in each area is provided. Most studies explored a single treatment modality (e.g., pharmacological, behavioral). The cumulated evidence from these studies suggests that several treatment protocols reduce PTSD symptoms and improve the patient's quality of life. The magnitude of the results, however, is often limited, and remission is rarely achieved. Given the shortcoming of unidimensional treatment of PTSD, it is suggested that combining biological, psychological, and psychosocial treatment may yield better results. It is further argued that rehabilitative goals should replace curative techniques in those patients with chronic PTSD. A framework for identifying targets for each treatment modality is presented.
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Affiliation(s)
- A Y Shalev
- Center for Traumatic Stress, Hadassah University Hospital, Jerusalem, Israel
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Abstract
Dyck's (Journal of Behavior Therapy and Experimental Psychiatry, 1993) conditioning model of EMD provides a useful description of failure of habituation in post-traumatic stress disorder, but may not account for some common EMD phenomena. An alternative model proposes that the therapist's waving hand--in the presence of a trauma-related cortical set--triggers an intense orienting response (OR). Intrinsic effects of the OR facilitate continuing attention to the memory without avoidance, and provide for effective input of new trauma-related information. The person's neuronal model of the trauma alters to reflect his survival and current safety--as true outcome of the trauma--and associated conditioned responses extinguish. Proposals for experimental evaluation of the model are described.
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Affiliation(s)
- M S Armstrong
- Department of Psychiatry, University of Sydney, NSW, Australia
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Abstract
The published reports of the clinical application of eye movement desensitization and reprocessing (EMDR) are reviewed in terms of empirical validity. Case studies, single-subject experiments and group design experiments on clinical problems are evaluated for the effectiveness of the protocol, component effects, comparative effects and treatment fidelity. Classification of disorders and measurement issues are addressed. The protocol frequently reduces verbal report and independent observer ratings of distress--strikingly in some instances. Psychophysiologic measures show little effect of treatment. There is little empirical evidence to indicate the effect of treatment on motoric or behavioral indices. Eye movements do not appear to be an essential component of treatment, and there have been no substantial comparisons with other treatments. No studies have adequately controlled for nonspecific (placebo) effects of treatment. Suggestions are made for applying improved methodological controls for future applications of EMDR to clinical disorders.
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Affiliation(s)
- J M Lohr
- Department of Psychology, University of Arkansas, Fayetteville 72701, USA
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Thompson J, Chung MC, Jackson G, Rosser R. A comparative trial of psychotherapy in the treatment of post-trauma stress reactions. Clin Psychol Psychother 1995. [DOI: 10.1002/cpp.5640020304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.
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Abstract
The efficacy of taped imaginal exposure as a treatment for Post-Traumatic Stress Reactions (PTSR) was assessed in eighteen consecutive outpatients, including Gulf War veterans. Detailed present-tense scripts of their personal traumatic experiences were prepared and in all but two cases audio-taped and listened to regularly. The severity of PTSR and standard questionnaire scores (including the IES, BDI, GHQ8 and the SCL 90) all showed statistically significant improvements post treatment and at three month follow-up. This case series confirms the potential efficacy of taped imaginal exposure in the treatment of full and partial forms of Post-Traumatic Stress Disorder (PTSD). The simplicity of its administration and acceptability to the individual suggest that it is worthy of more thorough research.
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Abstract
Recent research has shown that people who have gone through war experiences in one way or the other tend to manifest reactions classified as post-traumatic stress disorder. Viktor Frankl, the founder of logotherapy, manifested PTSD reactions when he was in a concentration camp. This paper attempts to sketch how he lived through his traumatic experiences by relying on the principle of Will to Meaning as his survival mechanism. Two implications will be outlined derived from this principle for psychotherapies dealing with disaster survivors.
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Affiliation(s)
- M C Chung
- Department of Psychiatry, University of Birmingham
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Vaughan K, Armstrong MS, Gold R, O'Connor N, Jenneke W, Tarrier N. A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. J Behav Ther Exp Psychiatry 1994; 25:283-91. [PMID: 7706505 DOI: 10.1016/0005-7916(94)90036-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Thirty-six patients with PTSD were randomly allocated to individual treatment with imaginal exposure (image habituation training -- IHT), or applied muscle relaxation (AMR) or eye movement desensitization (EMD). Assessment by a blind independent rater and self-report instruments applied pre and posttreatment and at 3-month follow-up indicated that all groups improved significantly compared with a waiting list and that treatment benefits were maintained at follow-up. Despite a failure to demonstrate differences among groups, there was some suggestion that immediately after treatment EMD was superior for intrusive memories.
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Affiliation(s)
- B C Bende
- Department of Psychogeriatrics, Mossley Hill Hospital, Liverpool
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48
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Abstract
A novel approach is described for the treatment of post-traumatic stress disorder (PTSD). Eye-movement desensitisation (EMD) requires the patient to generate images of the trauma in the mind and define physiological and emotional arousal states. While concentrating on these states, lateral multisaccardic eye movements are induced. Ten consecutive cases are reported who presented with symptoms originating from a range of traumas. The effectiveness of EMD in reducing symptoms outlined by DSM-III-R is described. An independent rater indicated that eight of the ten cases showed considerable improvement in PTSD symptoms following EMD, which was maintained at follow-up. Particular reference is given to the 'specificity' of EMD in treating symptoms and the changing pattern of effect at follow-up.
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Affiliation(s)
- K Vaughan
- PTSD Clinic, Hornsby Ku-Ring-Gai Hospital, Sydney, NSW, Australia
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