Francine Shapiro Library - EMDR Bibliography Links
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1. Becker, C. B., Darius, E., & Schaumberg, K. (2007, December). An analog study of patient preferences for exposure versus alternative treatments for posttraumatic stress disorder. Behaviour Research and Therapy, 45(12), 2861-2873. doi:10.1016/j.brat.2007.05.006.
Language: English
Format: Journal
Abstract:
Although several efficacious treatments for PTSD exist, these treatments are currently underutilized in clinical practice. To address this issue, research must better identify barriers to dissemination of these treatments. This study investigated patient preferences for PTSD treatment given a wide range of treatment options in an analog sample. 160 individuals, with varying degrees of trauma history, were asked to imagine themselves undergoing a trauma, developing PTSD, and seeking treatment. Participants evaluated 7 different treatment descriptions, which depicted treatment options that they might encounter in a clinical setting. Participants rated their most and least preferred treatments along with their personal reactions to and the perceived credibility of each treatment. Participants also completed a critical thinking skills questionnaire. Participants predominantly chose exposure or another variant of cognitive-behavioral therapy as their most preferred therapy, and those who chose exclusively empirically supported treatments evidenced higher critical thinking skills. The present study contributes to a growing literature indicating that patients may be more interested in these therapies than indicated by utilization rates. The problem of underutilization of empirically supported treatments for PTSD in clinical practice may be due to therapist factors. [Author Abstract]
Keywords: Adults Americans Cognitive Processes Cognitive Therapy College Students Evidence Based Treatment Exposure Empirically Supported Treatment Patient Preference Posttraumatic Stress Disorder Posttraumatic Stress Disorder Psychoanalytic Psychotherapy Psychotherapeutic Processes PTSD Selective Serotonin Reuptake Inhibitors Stressors Survivors TFT Thought Field Therapy
Accuracy Verified: Yes
2. van Etten, M. L., & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5(3), 126-144. doi:10.1002/(SICI)1099-0879(199809).
Language: English
Format: Journal
Abstract:
A meta-analysis was conducted on 61 treatment outcome trials for PTSD. Conditions included drug therapies (TCAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies (behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR), relaxation training, hypnotherapy, and dynamic therapy), and control conditions (pill placebo, wait-list controls, supportive psychotherapies, and non-saccade EMDR control). Psychological therapies had significantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies. In terms of symptom reduction, psychological therapies were more effective than drug therapies, and both were more effective than controls. Among the drug therapies, the SSRIs and carbamazepine had the greatest effect sizes, although the latter was based upon a single trial. Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differences across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. However, SSRIs had some advantage over psychological therapies in treating depression. Follow-up results were not available for most treatments, but available data indicates that treatment effects for behaviour therapy and EMDR are maintained at 15-week follow-up. [Author Abstract]
Keywords: Antimanic Drugs Benzodiazepine Derivatives Hypnotherapy Meta Analysis Monoamine Oxidase Inhibitors Posttraumatic Stress Disorder Psychoanalytic Psychotherapy PTSD Relaxation Therapy Selective Serotonin Reuptake Inhibitors Treatment Effectiveness Tricyclic Derivatives
Accuracy Verified: Yes
3. Cerquetani, S. (2011). Conheça o EMDR: Uma nova terapia para traumas [Learn about EMDR: A new therapy for trauma]. Viva Saúde. Retrieved from http://revistavivasaude.uol.com.br/saude-nutricao/103/conheca-o-emdr-uma-nova-terapia-para-traumas-a-240723-1.asp on 12/15/2011..
Language: Portuguese
Format: Magazine
Abstract:
Em 1984, Rosana Leite sofreu um acidente de carro e rompeu os tendões da mão direita, e não dirigiu à noite por mais de 15 anos. Já Silvia Guz lesionou o tendão do cotovelo na mesma circunstância, quase perdeu os movimentos do braço e sentia dores constantes. Apesar dos tratamentos convencionais, as lembranças e as dores de ambas não desapareciam. Mas, com a técnica terapêutica Eye Movement Desensitization and Reprocessing (Dessensibilização e Reprocessamento por meio dos Movimentos Oculares - EMDR), elas conseguiram superar seus traumas num tempo mínimo.
In 1984, Rosana Milk suffered a car accident and broke the tendons of his right hand, and did not drive at night for more than 15 years. Silvia Guz already injured the tendon of the elbow in the same condition, almost lost his arm movements and was in constant pain. Despite conventional treatment, the memories and the pain did not disappear either. But with the therapeutic technique Eye Movement Desensitization and Reprocessing (via Desensitization and Reprocessing Eye Movement - EMDR), they managed to overcome their trauma in minimum time.
Keywords: Automobile Accident General Overview
Accuracy Verified: Yes
4. van Rood,Y., & de Roos, C. (2010, June). EMDR in the treatment of body dysmorphic disorder. Presentation at the annual meeting of the EMDR Europe Association, Hamburg, Germany.
Language: English
Format: Conference
Abstract:
Body dysmorphic disorder (BDD) is defined in the Diagnostic
and Statistical Manual IV-TR (DSM-IV-TR) as a disorder characterised by a preoccupation with an imagined defect
in one's appearance (American Psychiatric Association (APA),
1994). BDD can be treated effectively with selective serotonin reuptake inhibitors (SSRls) or cognitive behaviour therapy (CBT)
(Williams et al.. 2006). CBT interventions which are most often
described in the literature are exposure and response prevention
(ERP) and cognitive techniques. These interventions successfully
weaken the catastrophic expectations of the patients.
However, they do not affect the negative valence of patients'
appearance. This negative meaning is not inborn but acquired
during life through association with distressful or even traumatic
events. Patients with BDD often report stressful events as the
starting point of their complaints (Buhlmann et al., 2007) as
well as PTSS like symptoms. i.e. intrusions (Osman et al.. 2004).
Processing of these unprocessed memories might free the way
to the development of a more positive meaning of their appearance.
Indeed, case series have been described in which EMDR
has been successfully applied in the treatment of BDD (Brown
et al , 1997). In the first part of this workshop background information
will be presented which might help identifying BDD
patients who might profit from EMDR and planning subsequent
EMDR treatment. In the second part of the workshop we share
our experiences treating BDD patients with EMDR. Clinical issues
will be analysed using videotaped cases of patients for illustration.
The goal of this workshop is to increase knowledge and
understanding of the use of EMDR in the treatment for BDD.
American Psychiatric Association (APA) (1994). Diagnostic and
statistical manual of mental disorders. (4th ed.) Washington
DC. American Psychiatric Association.
Brown, K. W., McGoldrick, T., & Buchanan, R. (1997). Body
dysmorphic disorder: Seven cases treated with eye movement
desensitization and reprocessing. Behavioural and Cognitive
Psychotherapy. 25(2), 203-207
Buhlmann, U., Cook, L. M., Fama, 1. M., & Wilhelm, 5. (2007).
Perceived teasing experiences in body dysmorphic disorder.
Body Image. 4, 381-385.
Osman. S., Cooper, M., Hackmann, A,, & Veale, D. (2004).
Spontaneously occurring images and early memories in people
with body dysmorphic disorder Memory, 12, 428-436.
Williams, J., Hadjistavropoulos, T., & Sharpe, D. (2006). A meta-
analysis of psychological and pharmacological treatments for
Body Dysmorphic Disorder. Behaviour Research and Therapy.
44, 99-111.
Keywords: Body Dysmorphic Disorder
Accuracy Verified: Yes
5. Moura, J. G. D. (2012, Novembro). EMDR – Construção de diagnóstico comum ou acertando o alvo [EMDR - Construction of common diagnosis or hitting the target]. In temas diversos. Apresentação no II Congresso Brasileiro de EMDR, Brasília, Brasil.
Language: Portuguese
Format: Conference
Abstract:
A estabilização é o momento do processo onde recebemos o paciente construímos rapport, entendimento comum do que esta se passando, damos informações psicopedagógicas sobre o trauma e o que é EMDR e o preparamos para as próximas fases. Esta apresentação pretende focar esta primeira etapa, que seria a construção do que convencionamos chamar de setting terapêutico dentro da perspectiva do EMDR. Este é um momento fundamental para o sucesso do tratamento. Quando nos posicionamos de forma correta frente a ele construindo um entendimento comum, que também podemos chamar de diagnostico comum, emparelhamos, damos sentido e fluidez ao processo. Reproduzimos e ativamos dentro do jogo psicoterapêutico capacidade inata de nós seres humanos de mimetização e sincronização com o outro na intenção de realizar algo, aprender e melhorar nossas chances de sobreviver. Lançamos mão constantemente como terapeutas desta aptidão para resolução das equações trazidas por nossos pacientes e não raramente nos beneficiamos aprendendo mais sobre nós e o mundo. Este processo pressupõe um exercício de entrar na plástica do outro, estranhá-la e refletir
para e com ele sobre o que o aflige e suas potencialidades. Como se dá este processo? Como podemos transformar impressões em narrativa? Como construímos um diagnostico comum?
The stabilization process is the time where we get the patient build rapport, common understanding of what is going on, we psychopedagogical information about trauma and what is EMDR and prepare for the next phases. This presentation aims to address this first phase, the construction of what would conventionally call the therapeutic setting within the perspective of EMDR. This is a critical time for successful treatment. When positioned correctly in front of him building a common understanding, which we can also call common diagnosis, emparelhamos, give direction and fluidity to the process. Reproduced within the game and activate innate ability psychotherapeutic us humans to mimic and synchronize with each other in an attempt to accomplish something, learn and improve our chances of survival. We used this constantly as therapists ability to solve the equations brought by our patients and not infrequently we benefit by learning more about ourselves and the world. This process involves an exercise of plastic entering the other, her strange and reflect
and to him about what ails you and your capabilities. How is this process? How can we turn impressions into narrative? How to build a common diagnosis?
Keywords: Body Language Building Common Diagnosis Phases 1 Phase 2 Stabilization
Accuracy Verified: Yes
6. Corrigan, F. M., & Jennett, J. (2004, August). Ephedra alkaloids and brief relapse in EMDR-treated obsessive compulsive disorder. Acta Psychiatrica Scandinavica, 110(2), 158. doi:10.1111/j.1600-0047.2004.00368.x.
Language: English
Format: Journal
Abstract:
Letter to the editor commenting on an article by E. Ernst (see record 2003-05653-002). We report the case of a patient who was effectively treated for severe obsessive compulsive disorder but relapsed briefly following ingestion of herbal products containing ephedra alkaloids that she bought to facilitate weight loss. The patient was a 29-year-old woman with a 10-year history of obsessive compulsive disorder who was referred for Eye Movement Desensitisation and Reprocessing (EMDR) when her condition had not responded to cognitive behavior therapy nor to various medications including Fluoxetine, Paroxetine, Clomipramine and Amitriptyline. Her score on the Dissociative Experiences Scale was low and there was nothing in the clinical history to suggest major dissociative disorder, so after preparation with mindfulness, relaxation and safe place imagery she proceeded to treatment with EMDR. Nine months later she reported a relapse into increased anxiety with a partial return to compulsive thoughts and behaviours after she had obtained a herbal health product sold to promote weight loss. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
Keywords: Comment Desensitization Ephedra Letter Luvoxamine Obsessive Compulsive Disorder OCD Plant Preparations Relapse Reply Review Serotonin Uptake Inhibitors
Accuracy Verified: Yes
7. Burne, J. (2004). Healing without Freud or prozac. London, England: The Independent.
Language: English
Format: Newspaper
Abstract:
Where do you get the blues? Most people would say in the head. That's
where we look for mental problems. Depression, anxiety, distress are all the
result of brain chemistry going wrong - not enough serotonin, for example.
And that's why we treat them with talking therapies and "serotonin reuptake
inhibitors" such as Prozac.
Keywords: General London Overview
Accuracy Verified: Yes
8. Occhi, S., Albiol, L. M., & Cicognani, E. (2007). Il disturbo post-traumatico da stress: Una rassegna [Post-traumatic stress disorder: A review]. Psicoterapia Cognitiva e Comportamentale, 13(3), 323-344.
Language: Italian
Format: Journal
Abstract:
Questo articolo presenta una rassegna aggiornata teorico del Post-Traumatico da Stress Disorder (PTSD) concetto, un disturbo mentale che può comparire dopo essere stato esposto direttamente o indirettamente, ad un evento traumatico. L'articolo inizia con una descrizione della sintomatologia, suddivisi in: rivivere l'evento traumatico, evitamento, ottundimento reattività generale e ipervigilanza. Questo è seguito da una presentazione dei più recenti studi che indicano la presenza di disordine da stress post-traumatico nella popolazione, sia nella popolazione generale e nei soggetti direttamente coinvolti in un evento traumatico. Post-traumatico da stress sintomi del disturbo sono identificati mediante questionari specifici descritti nella sezione riferimento a strumenti di indagine. Lo studio delle basi biologiche per il PTSD è diventata particolarmente significativo negli ultimi anni, e abbiamo analizzato questo contesto in modo più approfondito per questo motivo, con particolare riferimento al ruolo dell'asse ipotalamo-ipofisi-surrene. Un impulso importante dello studio del PTSD è dovuto alla crescente importanza dato alla prevenzione, intesa come riduzione dell'impatto dei disturbi psichiatrici che concentrandosi su Eye Movement Desensibilizzazione e ritrattamento (EMDR), il trattamento psicologico, con il supporto di tecniche che riguarda la terapia cognitivo comportamentale e il trattamento farmacologico che prevede l'uso di inibitori della ricaptazione della serotonina selettiva, quali siano le forme più studiate. (PsycINFO record del database (c) 2008 APA, tutti i diritti riservati)
This article presents an updated theoretical review of the Post-Traumatic Stress Disorder (PTSD) concept, a mental disorder that can appear after being exposed directly or indirectly to a traumatic event. The article begins with a description of the symptomatology, divided in: re-living the traumatic event, avoidance, dulling general reactivity and hyperarousal. This is followed by a presentation of the most recent studies which indicate the presence of post-traumatic stress disorder in the population, both in the general population and in subjects directly involved in a traumatic event. Post-traumatic stress disorder symptoms are identified by using specific questionnaires described in the section referring to investigation instruments. The study of the biological bases for PTSD has become particularly significant in recent years, and we analysed this context in greater detail for this reason, with particular reference to the role of the hypothalamo-pituitary-adrenocortical axis. An important boost of the study of PTSD is due to the increasing importance placed on prevention, understood as a reduction of the impact of psychiatric disorders which focusing on Eye Movement Desensitisation and Reprocessing (EMDR), on psychological treatment, with the support of techniques that concerns cognitive behavioral therapy and pharmacological treatment that involves the use of serotonin selective reuptake inhibitors, which are the forms studied most. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
Keywords: Posttraumatic Stress Disorder PTSD Review
Accuracy Verified: No
9. Bryant, R. A., & Friedman, M. J. (2001, March). Medication and non-medication treatments of post-traumatic stress disorder. doi:10.1097/00001504-200103000-00004. Current Opinion in Psychiatry, 14(2), 119-123. doi:10.1097%2F00001504-200103000-00004.
Language: English
Format: Journal
Abstract:
Recent developments in the psychological and pharmacological management of post-traumatic stress disorder are reviewed. This review of controlled outcome studies indicates that: (i) cognitive behavior therapy is the psychological treatment of choice; (ii) different components of cognitive behavior therapy can be effective; (iii) eye movement desensitization and reprocessing is not as effective as cognitive behavior therapy; (iv) selective serotonin re-uptake inhibitors are the pharmacological treatment of choice; and (v) there is increasing support for nefazadone but not for cyproheptadine in reducing the symptoms of post-traumatic stress disorder. The need for increased treatment effectiveness and the integration of recent findings into clinical practice is discussed. [Author Abstract]
Keywords: Atypical Antidepressants Cognitive Therapy Drug Therapy Literature Review Posttraumatic Stress Disorder PTSD Selective Serotonin Reuptake Inhibitors Treatment Treatment Effectiveness
Accuracy Verified: Yes
10. Bossini, L., Poliziotto, N., Tavanti, M., Calossi, S., Lombardelli, A., Vatti, G., & Castrogiovanni, P. (2006, Febbraio). Neuroimaging e PTSD: Dati morfovolumetrici e loro variazioni dopo trattamento [Neuroimaging and PTSD: Facts morfovolumetrici and their changes after treatment]. Presentazione al Congresso XI SOPSI (Società Italiana di Psicopatologia), Roma, Italia.
Language: Italian
Format: Conference
Abstract:
Introduzione: molti studi concordano sulla riduzione del volume ippocampale nei pazienti affetti da PTSD 1 e che tale alterazione anatomica è correlata con deficit cognitivi e
con la gravità dei sintomi. Comunque ad oggi non è stato ancora chiarito se l’atrofia ippocampale rappresenta l’esito di un effetto neurotossico del trauma o, piuttosto, una condizione
preesistente che predispone allo sviluppo di alcune patologie psichiatriche. Già da tempo studi su animali dimostrano
come lo stress causi atrofia ippocampale e inibizione della
neurogenesi, con meccanismi verosimilmente legati ai glucocorticoidi, all’increzione del fattore corticotropo, all’aumento degli aminoacidi eccitatori, all’inibizione fattore
neurotrofico cerebrale con perdita della plasticità neuronale. Nell’uomo, tuttavia, i risultati non sono così lineari. Da un
lato alcuni studi hanno individuato come fattore principale l’aumento dei glucocorticoidi 2, dall’altro tale teoria è stata fortemente criticata 3. Secondo Yehuda il meccanismo di
atrofia ippocampale è dovuto ad un’alterazione dell’asse
Ipotalamo-Ipofisi-Surrene (HPA), ma in termini di una bassa
increzione di glucocorticoidi che determina un aumento del
feedback negativo dell’asse stesso ed un’ipersensibilità recettoriale.
Indipendentemente dal meccanismo d’azione, la perdita di neuroni a livello ippocampale nei soggetti che hanno subito eventi traumatici sembra sufficientemente dimostrata e, fino a poco tempo fa, era considerata irreversibile. In realtà l’ippocampo sembra presentare una inusuale e spontanea capacità rigenerativa. Questo dato è stato individuato in molte specie animali e, in un unico studio, anche nell’uomo 4. Inoltre recenti evidenze pre-cliniche e cliniche hanno indicato che gli SSRI (Selective Serotonin Reuptake Inhibitors) promuovono la neurogenesi e riducono l’atrofia ippocampale
indotta dallo stress nell’animale 5 e nell’uomo sono in grado
di ridurre i sintomi del PTSD, incrementare le dimensioni
dell’ippocampo e ridurre i deficit mnesici tipici della patologia
6 7. Un altro fattore che sembra essere in grado di stimolare la neurogenesi negli animali sembra essere “l’ambiente arricchito” verosimilmente tramite i meccanismi molecolari dell’apprendimento che sembrano in grado di attivare la trascrizione dell’mRNA per il Brain Derived Neurotrophic Factor. Questo dato della letteratura supporta il razionale dell’efficacia della psicoterapia anche se l’unico studio
che valuta le modificazioni morfostrutturali dopo psicoterapia non ha riportato risultati positivi 8. Gli scopi di questo studio sono:
– valutare la presenza di atrofia ippocampale nei pazienti affetti da PTSD (T0-drug-free);
– valutare l’effetto della terapia: farmacologica con SSRI e
psicoterapica con EMDR (Eye Movement Desensitization and Reprocessing) sia sul piano clinico e neuropsicologico,
che sul volume ippocampale, sia sulla memoria (T1). Metodologia: abbiamo analizzato un campione di 20 pazienti, di età compresa tra i 15 ed i 65 anni, reclutati nell’ambulatorio psichiatrico del Policlinico universitario di
Siena affetti da PTSD e un gruppo di controllo di soggetti
sani appaiati per sesso, età, peso e altezza. I soggetti di entrambi
i gruppi sono stati sottoposti ad uno studio morfovolumetrico
computerizzato dell’Ippocampo tramite RM (Risonanza Magnetica). Inoltre, i diciassette pazienti con PTSD sono stati valutati tramite la somministrazione di test neuropsicologici
e scale psicometriche per approfondire il quadro
psicopatologico e valutare l’eventuale presenza di deficit cognitivi. Nei soggetti affetti da PTSD dopo un periodo di sei mesi di
terapia psicofarmacologica sono stati ripetuti i test neuropsicologici,
le scale psicometriche e l’analisi morfovolumetrica dell’ippocampo tramite RM.
Tre pazienti, dopo le valutazioni al T0, hanno effettuato un protocollo terapeutico con solo EMDR e sono stati rivalutati
dopo 8 sedute (due mesi).
Risultati: i risultati della prima parte sperimentale (T0-drug-free) evidenziano che le dimensioni dell’ippocampo di
sinistra nei soggetti affetti da PTSD sono significativamente minori rispetto ai controlli sani. Dai risultati osservati al follow-up (T1-post-terapia) è possibile
evincere che la terapia nei soggetti considerati è associata ad un miglioramento della sintomatologia e ad un aumento
dei volumi ippocampali, pari al 9,87% per l’ippocampo di destra e dell’8,37% per l’ippocampo di sinistra. Questi dati
sono concordi con i dati presenti in letteratura, anche se la percentuale di recupero su base neuroplastica nel nostro studio
risulta sensibilmente superiore rispetto ai due studi presenti in letteratura incremento pari al 4,6% 6; pari al 5% 7. I tre pazienti che hanno effettuato terapia con EMDR hanno
anch’essi mostrato al T1 un miglioramento sintomatologico (CAPS non più positiva per i criteri diagnostici) ed un aumento
medio dei volumi ippocampali pari a 338,25 mm3 per
l’ippocampo DX e 357,93 mm3 per l’ippocampo SN.
Conclusioni: la terapia nei soggetti considerati si è associata ad un aumento dei volumi ippocampali (9,87%-8,37%).
L’aumento dei volumi ippocampali appare rilevante, consistente con i dati in letteratura, sebbene quantitativamente superiore, sottolineando l’efficacia degli SSRI verosimilmente tramite il meccanismo di attivazione della neurogenesi;
è ipotizzabile che l’aumento di volume non sia da imputare ad un aumento delle cellule gliali ma ad un aumento di neuroni ippocampali visto il contemporaneo miglioramento clinico. Particolarmente interessante ci sembra il dato relativo all’efficacia clinica e sulla plasticità neurale della EMDR.
Questa osservazione su solo tre casi, necessita chiaramente di essere confermata su un campione più ampio ma rappresenta la prima evidenza in letteratura di un’azione della psicoterapia
diretta alla struttura cerebrale.
Introduction: Many studies agree on the reduction of hippocampal volume in patients with PTSD and that an anatomical alteration is correlated with cognitive deficits and the severity of symptoms. However to date has not yet been clarified whether hippocampal atrophy is the result of a neurotoxic effect of trauma or, rather, an underlying condition that predisposes to the development of some psychiatric disorders. For some time animal studies show that stress causes hippocampal atrophy and inhibition of neurogenesis, by mechanisms probably related to glucocorticoids, all'increzione corticotropo factor, increased excitatory amino acid, inhibition of brain neurotrophic factor with loss of neuronal plasticity. In humans, however, the results are not so linear. On the one hand, some studies have identified as the main factor increasing glucocorticoid two other such theory was strongly criticized 3. According to Yehuda mechanism of hippocampal atrophy is due to an alteration of hypothalamic-pituitary-adrenal (HPA), but in terms of a low secretion of glucocorticoids leading to an increase of negative feedback axis and the same receptor hypersensitivity . Regardless of the mechanism of action, loss of neurons in hippocampus in people who have suffered traumatic events seems sufficiently established and, until recently, was considered irreversible. In fact, the hippocampus appears to be an unusual and spontaneous regenerative capacity. This figure has been identified in many animal species and in one study in humans 4. Moreover, recent evidence pre-clinical and clinical studies have shown that SSRIs (Selective Serotonin Reuptake Inhibitors) promote neurogenesis and reduce stress-induced hippocampal atrophy in animals 5 and humans are able to reduce symptoms of PTSD, increase the size of the hippocampus and reduce the deficit mnesic typical of the disease 6 7. Another factor that seems to be able to stimulate neurogenesis in animals seems to be "enriched environment" probably through molecular mechanisms of learning that seem able to activate the transcription of mRNA for Brain Derived Neurotrophic Factor. This finding supports the rationale of the literature of the effectiveness of psychotherapy, even if the only study that evaluates changes morphostructural after psychotherapy has shown positive results 8. The aims of this study are: - To evaluate the presence of hippocampal atrophy in patients with PTSD (T0-drug-free) - to assess the effect of therapy: pharmacological SSRI and psychotherapy with EMDR (eye movement desensitization and reprocessing) is a clinical and neuropsychological, and on hippocampal volume, and memory (T1). Methods: We analyzed a sample of 20 patients, aged between 15 and 65, recruited nell'ambulatorio Psychiatric University Hospital of Siena with PTSD and a control group of healthy subjects matched by sex, age, weight and height. Subjects in both groups were subjected to a computerized study morfovolumetrico dell'Ippocampo using MRI (Magnetic Resonance). In addition, seventeen patients with PTSD were assessed through administration of psychometric scales and neuropsychological tests to study the psychopathological picture and evaluate the possible presence of cognitive deficits. In subjects with PTSD after a period of six months of pharmacological therapy were repeated neuropsychological tests, scales psychometric analysis morfovolumetrica hippocampus by MRI. Three patients at T0 after assessments, carried out a treatment protocol with only EMDR and were reassessed after eight sessions (two months). Results: The results of the first experiment (T0-drug-free) show that the size of the left hippocampus in patients with PTSD are significantly lower compared to healthy controls. The results observed during the follow-up (T1-post-therapy) can be inferred that therapy in patients considered to be associated with improvement in symptoms and an increase in hippocampal volume, equal to 9.87% for the right hippocampus and 8, 37% for the left hippocampus. These data are consistent with the data in the literature, although the recovery rate based on neuroplastic in our study is significantly higher than in the two studies in the literature increase of 4.6% 6; 5% 7. The three patients who have treatment with EMDR have also shown an improvement in symptoms at T1 (CAPS no longer positive for the diagnostic criteria) and an average increase in hippocampal volume amounted to 338.25 mm3 for the hippocampus and DX 357, 93 mm3 for the hippocampus SN. Conclusions: Therapy in patients considered was associated with an increase in hippocampal volume (9.87% -8.37%). The increase in hippocampal volume appear to be relevant, consistent with the literature data, although quantitatively greater, stressing the effectiveness of SSRIs probably through the mechanism of activation of neurogenesis, it is conceivable that the increase in volume is attributable to an increase glial cells but an increase of hippocampal neurons seen the simultaneous clinical improvement. Seems particularly interesting given the relative clinical effectiveness of EMDR and neural plasticity. This observation on only three cases, clearly needs to be confirmed on a larger sample but represents the first evidence in the literature of action of psychotherapy directed at brain structure.
Keywords: Posttraumatic Stress Disorder PTSD
Accuracy Verified: Yes
11. Creamer, M., & O'Donnell, M. (2002). Post-traumatic stress disorder. Current Opinion in Psychiatry, 15(2), 163-168. doi:10.1097/00001504-200203000-00007.
Language: English
Format: Journal
Abstract:
This paper provides an overview of recent developments in the literature on post-traumatic stress disorder. Epidemiological studies indicate that approximately 15-25% of individuals experiencing a significant trauma will go on to develop post-traumatic stress disorder, although approximately half will recover without formal intervention. Potential vulnerability factors for post-traumatic stress disorder have been identified, but the mechanisms and complexities require further exploration, with recent research suggesting that prevalence rates and risk factors may differ across populations. Studies of psychological treatment have demonstrated prolonged exposure and cognitive therapies to be equally beneficial, whereas eye movement desensitization and reprocessing may be useful but perhaps less effective in the long term. Pharmacological treatment studies indicate that selective serotonin reuptake inhibitors may be the first choice of drug treatments for post-traumatic stress disorder. Non-selective primary prevention strategies remain contentious, although secondary prevention, in the form of cognitive behavioural interventions for acutely symptomatic survivors, appears to reduce the subsequent development of post-traumatic stress disorder.
Keywords: Cognitive Therapies Drug Therapy Exposure Therapies Posttraumatic Stress Disorder Prevention Primary Prevention PTSD Risk Factors Secondary Prevention Susceptibility (Disorders) Treatment Vulnerability Factors
Accuracy Verified: Yes
12. Cahill, P. C., Pontoski, K., & D’Olio, C. M. (2005, September). Posttraumatic stress disorder and acute stress disorder II: Considerations for treatment and prevention. Psychiatry, 2(9), 34-46.
Language: English
Format: Journal
Abstract:
Posttraumatic stress disorder is a common and often chronic and disabling anxiety disorder that can develop after exposure to highly stressful events characterized by actual or threatened harm to the self or others. This is the second of two invited articles summarizing the nature and treatment of PTSD and the associated condition of acute stress disorder (ASD). The present article reviews evidence for the efficacy of psychological and pharmacological treatments for PTSD and ASD. In summary, cognitive behavior therapy (CBT) has been found efficacious in the treatment of chronic PTSD as well as the treatment of ASD/prevention of PTSD. The selective serotonin reuptake inhibitors, sertraline, paroxetine, and fluoxetine, have been found efficacious in the treatment of chronic PTSD, with sertraline and paroxetine receiving the FDA indication for this condition. There is less evidence for efficacious medications in the treatment of ASD/prevention of PTSD. At present, hydrocortisone and propranolol show the greatest promise. Limitations of these treatments, including dropout and a significant number of patients showing no or only partial response, are discussed as well as issues related to selecting among efficacious treatments.
Keywords: ASD Acute Stress Disorder Posttraumatic Stress Disorder PTSD
Accuracy Verified: Yes
13. Davidson, J. R. T., Stein, D. J., Shalev, A.Y., & Yehuda, R. (2004, Spring). Posttraumatic stress disorder: Acquisition, recognition, course, and treatment. Journal of Neuropsychiatry and Clinical Neuroscience, 16(2), 135-147. doi:10.1176/appi.neuropsych.16.2.135.
Language: English
Format: Journal
Abstract:
Following exposure to trauma, a large number of survivors will develop acute symptoms of posttraumatic stress disorder (PTSD), which mostly dissipate within a short time. In a minority, however, these symptoms will evolve into chronic and persistent PTSD. A number of factors increase the likelihood of this occurring, including characteristic autonomic and hypothalamic-pituitary-adrenal axis responses. PTSD often presents with comorbid depression, or in the form of somatization, both of which significantly reduce the possibilities of a correct diagnosis and appropriate treatment. Mainstay treatments include exposure-based psychosocial therapy and selective serotonin reuptake inhibitors, such as paroxetine and sertraline, both of which have been found to be effective in PTSD. This paper looks at the course of PTSD, its disabling effect, its recognition and treatment, and considers possible new research directions.
Keywords: Comorbidity Posttraumatic Stress Disorder PTSD Recognition and Treatment SSRIs
Accuracy Verified: Yes
14. van Loey, N. E. E., & van Son, M. J. M. (2003). Psychopathology and psychological problems in patients with burn scars: Epidemiology and management. American Journal of Clinical Dermatology, 4(4), 245-272. doi:10.2165/00128071-200304040-00004.
Language: English
Format: Journal
Abstract:
Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and PTSD, which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization [EMDR] are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life. In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance. [Author Abstract]
Keywords: Burns Comorbidity Epidemiology Literature Review Posttraumatic Stress Disorder Predisposition PTSD Survivors Treatment
Accuracy Verified: Yes
15. van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007, January). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1), 37-46. doi:10.4088/JCP.v68n0105.
Language: English
Format: Journal
Abstract:
Objective: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for PTSD. This study compared the efficacy of a selective serotonin reuptake inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. Method: 88 PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003. Results: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. Conclusions: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma. [Author Abstract]
Keywords: Adults Depressive Disorders Empirical Study Posttraumatic Stress Disorder PTSD Quantitative Study Random Clinical Trial RCT Selective Serotonin Reuptake Inhibitors Stressors Survivors Treatment Effectiveness
Accuracy Verified: Yes
16. Kapfhammer, H.-P. (2008, December). Therapeutische möglichkeiten nach traumatischen erlebnissen [Therapeutic possibilities after traumatic experiences]. Psychiatria Danubina, 20(4), 532-545.
Language: German
Format: Journal
Abstract:
Acute Belastungsstörung (ASD) und Posttraumatische Belastungsstörung (PTSD) sind häufige, aber nicht zwingend psychologische Folgeerscheinungen nach einem Trauma. Eine wichtige Untergruppe der Patienten vor einer chronischen Verlauf der Erkrankung mit einem erhöhten psychiatrischen Komorbidität und erhebliche Beeinträchtigungen in psychosozialen Anpassung assoziiert. Der typische psychopathologische Symptome von ASD und PTSD werden am besten in einem multifaktoriellen Modell der Integration sowohl neurobiologische und psychosoziale Einflüsse beschrieben. Die komplexen Ätiopathogenese von akuten und posttraumatischen Belastungsstörung begünstigt multimodalen Ansätzen in der Behandlung. Differential psychotherapeutische und pharmakologische Strategien zur Verfügung stehen. In einer kritischen Studie über empirische Studien, können psychologische Debriefing nicht als einen positiven Ansatz betrachtet werden, als allgemeine vorbeugende Maßnahme in der unmittelbaren posttraumatischen Phase empfohlen werden. Positive Auswirkungen der kognitiv-verhaltenstherapeutischen Interventionen kann für ASD eingerichtet werden. Psychodynamische Psychotherapie, kognitive Verhaltenstherapie und EMDR zeigen viel versprechende Ergebnisse bei der Behandlung von PTSD. Wesentliche klinische Einschränkungen der Patienten innerhalb von speziellen Probenahmen Forschungseinrichtungen, jedoch nicht gestatten, eine bedingungslose Verallgemeinerung dieser Daten zu psychiatrischen Routineversorgung. In einer empirischen Analyse der SSRIs sind die meisten und am besten untersuchten Medikamente für ASD und PTSD. Im Vergleich zu trizyklischen Antidepressiva SSRIs zeigen ein breiteres Spektrum an therapeutischen Wirkungen und sind besser verträglich. Die Substanzklassen der SNRI, DAS, SARI und NaSSA sind als Medikamente der zweiten Wahl angesehen werden. Sie versprechen eine therapeutische Wirksamkeit der SSRI gleichwertig, wobei bisher nur in offenen Studien untersucht. MAO-Hemmer können eine positive therapeutische Potenzial verfügen, müssen ihr Profil der Nebenwirkungen geachtet, jedoch werden. Mood-Stabilisatoren und atypische Neuroleptika können in Anspruch genommen werden und vor allem im Add-On-Strategien. Benzodiazepine sollten nur mit Vorsicht erhöht für eine kurze Zeit in den Staaten der akuten Krise eingesetzt werden. In frühen Interventionen, die blockierende Substanzen norepinephric Hyperaktivität scheinen vielversprechende Alternativen. Stress Dosen von Hydrocortison kann als experimentelle pharmakologische Strategie betrachtet so weit sein. [PubMed]
Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following trauma. A major subgroup of patients face a chronic course of illness associated with an increased psychiatric comorbidity and significant impairments in psychosocial adaptation. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. The complex etiopathogenesis of acute and posttraumatic stress disorder favours multimodal approaches in the treatment. Differential psychotherapeutic and pharmacological strategies are available. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. Positive effects of cognitive-behavioral interventions can be established for ASD. Psychodynamic psychotherapy, cognitive-behavioral therapy and EMDR show promising results in the treatment of PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care. In an empirical analysis the SSRIs are the most and best studied medications for ASD and PTSD. In comparison to tricyclic antidepressants SSRIs demonstrate a broader spectrum of therapeutic effects and are better tolerated. The substance classes of SSNRI, DAS, SARI and NaSSA are to be considered as drugs of second choice. They promise a therapeutic efficacy equivalent to the SSRIs, being investigated so far only in open studies. MAO-inhibitors may dispose of a positive therapeutic potential, their profile of side effects must be respected, however. Mood stabilizers and atypical neuroleptics may be used first and foremost in add-on strategies. Benzodiazepines should be used only with increased caution for a short time in states of acute crisis. In early interventions, substances blocking the norepinephric hyperactivity seem to be promising alternatives. Stress doses of hydrocortisone may be considered as an experimental pharmacological strategy so far.[PUBMED]
Keywords: Acute Stress Disorder ASD Posttraumatic Stress Disorder PTSD
Accuracy Verified: Yes
17. Forbes, D., Creamer, M. C., Phelps, A. J., Couineau, A. L., Cooper, J. A., Bryant, R. A., McFarlane, A. C., Devilly, G. J., Matthews, L. R., & Raphael, B. (2007, July). Treating adults with acute stress disorder and post-traumatic stress disorder in general practice: A clinical update. Medical Journal of Australia, 187(2), 120-123.
Language: English
Format: Journal
Abstract:
General practitioners have an important role to play in helping patients after exposure to severe psychological trauma. In the immediate aftermath of trauma, GPs should offer "psychological first aid", which includes monitoring of the patient's mental state, providing general emotional support and information, and encouraging the active use of social support networks, and self-care strategies. Drug treatments should be avoided as a preventive intervention after traumatic exposure; they may be used cautiously in cases of extreme distress that persists. Adults with acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) should be provided with trauma-focused cognitive behaviour therapy (CBT). Eye movement desensitisation and reprocessing (EMDR) in addition to in-vivo exposure (confronting avoided situations, people or places in a graded and systematic manner) may also be provided for PTSD. Drug treatments should not normally replace trauma-focused psychological therapy as a first-line treatment for adults with PTSD. If medication is considered for treating PTSD in adults, selective serotonin reuptake inhibitor antidepressants are the first choice. Other new generation antidepressants and older tricyclic antidepressants should be considered as second-line pharmacological options. Monoamine oxidase inhibitors may be considered by mental health specialists for use in people with treatment-resistant symptoms.
Keywords: Acute Stress Disorder Anti-Depressants ASD MAO Inhibitors Posttraumatic Stress Disorder PSTD SSRIs
Accuracy Verified: Yes
18. Fisher, N. (2010, April). Treatment options for combat veterans with PTSD. Poster presented at the 2nd Bi-Annual International European Society for Trauma and Dissociation Conference, Belfast, Northern Ireland.
Language: English
Format: Conference
Abstract:
In this review I explored the most effective treatment options available for military veterans with Post Traumatic Stress Disorder. Specifically, psychotherapy and pharmacotherapy was examined. Psychotherapy encompassed cognitive behavioral therapy, emotional desensitization and reprocessing and exposure therapy. Pharmacotherapy included selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, novel antidepressants and benzodiazepines. Meta analyses, literature reviews and research experiments formed the basis for the comparisons between treatments. The main findings include that the psychotherapies cognitive behavioral therapy and eye movement desensitization and reprocessing, and the pharmacotherapy selective serotonin reuptake inhibitors are the most superior treatments for veterans with PTSD.
Learning Outcomes
Delegates will learn about the variables which make treating combat veterans with PTSD different than other groups with PTSD. In terms of treatment, psychotherapeutic and psychopharmacologic options will be examined. Delegates will leave the presentation aware of what current research states on treatment efficacy of CBT, EMDR, Exposure Therapy, Antidepressants and Anxiolytics.
Keywords: Poster Posttraumatic Stress Disorder PSTD Veterans
Accuracy Verified: Yes
19. Cohena, J. A., Mannarino, A. P., & Rogal, S. (2001, January). Treatment practices for childhood posttraumatic stress disorder. Child Abuse and Neglect, 25(1), 123-135. doi:10.1016/S0145-2134(00)00226-X.
Language: English
Format: Journal
Abstract:
Objective: This study surveyed practices in treating childhood PTSD among child psychiatrists and non-M.D. therapists with self-identified interest in treating traumatized children. Method: An anonymous survey was mailed to 207 child psychiatrists ("medical") [members of the American Academy of Child and Adolescent Psychiatry] and 460 nonphysician ("non-medical") therapists [members of the International Society for Traumatic Stress Studies] inquiring about current interventions used to treat children with PTSD. Results: 247 responses were received: of 77 medical and 82 nonmedical respondents who currently treat children with PTSD, a wide variety of modalities are used. Most preferred modalities among medical responders were pharmacotherapy, psychodynamic, and cognitive-behavioral therapy. Most preferred modalities among nonmedical respondents were cognitive-behavioral, family, and nondirective play therapy. 95% of medical respondents used pharmacotherapy for this disorder; most preferred medications to treat childhood PTSD were selective serotonin reuptake inhibitors and alpha-adrenergic agonists. Several significant differences between medical and nonmedical practices were identified. Conclusions: There is little clinical consensus regarding the effectiveness of the many modalities used to treat traumatized children who have PTSD symptoms; empirical research is particularly needed to evaluate the efficacy of pharmacotherapy and EMDR. [Author Abstract]
Keywords: Adolescents Arousal Avoidance Children Drug Therapy Mental Health Personnel Reexperiencing Posttraumatic Stress Disorder PTSD Treatment Effectiveness
Accuracy Verified: Yes