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Results for “Desensitization, Psychologic”

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PubMed2002

Salivary cortisol levels and the cortisol response to dexamethasone before and after EMDR: a case report.

Trauma survivors with posttraumatic stress disorder (PTSD) have been shown to have lower basal cortisol levels in the urine, plasma, and saliva than in trauma survivors without PTSD, nontraumatized mentally ill, or healthy subjects. We report on a case study in which we measured pre- and post-Eye Movement Desensitization and Reprocessing (EMDR) treatment salivary cortisol levels and salivary cortisol response to 0.50 mg of dexamethasone in a 41-year-old female with chronic PTSD symptoms. Our goal was to determine whether symptom improvement following trauma-focused treatment (EMDR) is associated with changes in basal salivary cortisol or in the cortisol response to dexamethasone administration. Our findings show moderate symptom improvement, an increase in basal cortisol levels, and a more attenuated cortisol hypersuppression in response to the dexamethasone suppression test following EMDR treatment. These results suggest the potential utility of including neuroendocrine measures in the assessment of treatment outcome in PTSD.

Adult↗

PubMed2002

Exploring change mechanisms in EMDR applied to "small-t trauma" in short-term dynamic psychotherapy: research questions and speculations.

This article represents a process of preliminary search and discovery regarding the active mechanisms in Eye Movement Desensitization and Reprocessing (EMDR) when used in Short-Term Dynamic Psychotherapy (STDP). Patients' (N = 7) responses to EMDR interventions were categorized as either "trauma" or "resolution" responses and examined in relationship to (a) the number of EMDR sets, (b) patient Global Assessment of Functioning Rating (GAF) scores, and (c) raw change in Subjective Units of Distress (SUD) ratings of severity of traumatic memory and Validity of Cognition (VoC) ratings of positive cognitions before and after EMDR sessions. Further subcategorization and development of the broad categories of trauma and resolution were recommended and may be useful in shedding light on how change happens in EMDR. This study was exploratory and attempted only to identify possible variables for further study. However, the results show potential relationships among variables that merit further refinement and study. Research questions generated from this study are discussed.

Adult↗

PubMed2003

Evaluation of a meridian-based intervention, Emotional Freedom Techniques (EFT), for reducing specific phobias of small animals.

This study explored whether a meridian-based procedure, Emotional Freedom Techniques (EFT), can reduce specific phobias of small animals under laboratory-controlled conditions. Randomly assigned participants were treated individually for 30 min with EFT (n = 18) or a comparison condition, diaphragmatic breathing (DB) (n = 17). ANOVAS revealed that EFT produced significantly greater improvement than did DB behaviorally and on three self-report measures, but not on pulse rate. The greater improvement for EFT was maintained, and possibly enhanced, at six- to nine-months follow-up on the behavioral measure. These findings suggest that a single treatment session using EFT to reduce specific phobias can produce valid behavioral and subjective effects. Some limitations of the study also are noted and clarifying research suggested.

Adult↗

PubMed2002

EMDR 12 years after its introduction: past and future research.

Eye Movement Desensitization and Reprocessing (EMDR) was one of the first treatments of posttraumatic stress disorder (PTSD) to be evaluated in controlled research and has to date been empirically supported by 13 such studies. This article reviews the historical context and empirical research of EMDR over the past dozen years. Historically, EMDR's name has caused confusion in that "desensitization" is considered to be only a by-product of reprocessing and because the eye movement component of EMDR is only one form of dual stimulation to be successfully used in this integrative approach. Research is needed to determine the comparative efficacy of EMDR relative to cognitive-behavioral treatments of PTSD. However, this has been hampered by the lack of independent replication studies of the latter treatments. Current component analyses of EMDR have failed to effectively evaluate the relative weighting of its procedures. Parameters for future research and the testing of protocols for diverse disorders are suggested.

Cognitive Behavioral Therapy↗

PubMed2002

The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD.

The controlled treatment outcome studies that examined the efficacy of EMDR in the treatment of posttraumatic stress disorder have yielded a range of results, with the efficacy of EMDR varying across studies. The current study sought to determine if differences in outcome were related to methodological differences. The research was reviewed to identify methodological strengths, weaknesses, and empirical findings. The relationships between effect size and methodology ratings were examined, using the Gold Standard (GS) Scale (adapted from Foa & Meadows, 1997). Results indicated a significant relationship between scores on the GS Scale and effect size, with more rigorous studies according to the GS Scale reporting larger effect sizes. There was also a significant correlation between effect size and treatment fidelity. Additional methodological components not detected by the GS Scale were identified, and suggestions were made for a Revised GS Scale. We conclude by noting that methodological rigor removes noise and thereby decreases error measurement, allowing for the more accurate detection of true treatment effects in EMDR studies.

Cognitive Behavioral Therapy↗

PubMed2002

Is EMDR an exposure therapy? A review of trauma protocols.

This article presents the well established theoretical base and clinical practice of exposure therapy for trauma. Necessary requirements for positive treatment results and contraindicated procedures are reviewed. EMDR is contrasted with these requirements and procedures. By the definitions and clinical practice of exposure therapy, the classification of EMDR poses some problems. As seen from the exposure therapy paradigm, its lack of physiological habituation and use of spontaneous association should result in negligible or negative effects rather than the well researched positive outcomes. Possible reasons for the effectiveness of EMDR are discussed, ranging from the fundamental nature of trauma reactions to the nonexposure mechanisms utilized in information processing models.

Affect↗

PubMed2002

EMDR: a putative neurobiological mechanism of action.

Numerous studies have provided evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR) in the treatment of posttraumatic stress disorder (PTSD), including recent studies showing it to be more efficient than therapist-directed flooding. But few theoretical explanations of how EMDR might work have been offered. Shapiro, in her original description of EMDR, proposed that its directed eye movements mimic the saccades of rapid eye movement sleep (REM), but provided no clear explanation of how such mimicry might lead to clinical improvement. We now revisit her original proposal and present a complete model for how EMDR could lead to specific improvement in PTSD and related conditions. We propose that the repetitive redirecting of attention in EMDR induces a neurobiological state, similar to that of REM sleep, which is optimally configured to support the cortical integration of traumatic memories into general semantic networks. We suggest that this integration can then lead to a reduction in the strength of hippocampally mediated episodic memories of the traumatic event as well as the memories' associated, amygdala-dependent, negative affect. Experimental data in support of this model are reviewed and possible tests of the model are suggested.

Affect↗

PubMed2002

Comparison of two treatments for traumatic stress: a community-based study of EMDR and prolonged exposure.

This pilot study compared the efficacy of two treatments for postraumatic stress disorder (PTSD): Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE). Data were analyzed for 22 patients from a university-based clinic serving the outside community (predominantly rape and crime victims) who completed at least one active session of treatment after three preparatory sessions. Results showed both approaches produced a significant reduction in PTSD and depression symptoms, which were maintained at three-month follow-up. Successful treatment was faster with EMDR as a larger number of people (7 of 10) had a 70% reduction in PTSD symptoms after three active sessions compared to 2 of 12 with PE. EMDR appeared to be better tolerated as the dropout rate was significantly lower in those randomized to EMDR versus PE (0 of 10 vs. 3 of 10). However all patients who remained in treatment with PE had a reduction in PTSD scores. Finally, Subjective Units of Distress (SUDS) ratings decreased significantly during the initial session of EMDR, but changed little during PE. Postsession SUDS were significantly lower for EMDR than for PE. Suggestions for future research are discussed.

Cognitive Behavioral Therapy↗

PubMed2004

Behavioral treatment of debilitating test anxiety among medical students.

This article presents and illustrates the behavioral treatment of medical students and physicians whose debilitating test anxiety was associated with their failure to pass the United States Medical Licensing Examination (USMLE) or a specialty board test. Seventy-two medical trainees were treated consecutively because of at least one failure to pass these professional examinations. Behavioral treatment focused on their anxiety, which resulted in the "dual deficits" of poor test preparation, poor test performance, or both. Treatment featured progressive muscle relaxation, systematic desensitization, the self-control triad, behavioral rehearsal, and a psychoeducational component. Ninety-three percent of the clients eventually passed the examination while in treatment. Pass rates for this group were substantially higher than the national average for repeat USMLE test takers. Limitations of this treatment method are that it seemed too elaborate for some medical trainees and was less effective with those who had difficulty evoking anxiety.

Adult↗

PubMed2004

Etiology and treatment of social anxiety: a commentary.

Substantial advances in our understanding of the etiology and treatment of performance anxiety have occurred during the past decade. It has become clear that the development of efficient and effective treatments cannot be divorced from knowledge of the specific form of psychopathology being treated and that treatments must be tailored to this psychopathology. After describing a current model of the etiology of performance anxiety and social phobia, this commentary notes the common factors present across the rich and diverse set of articles in this issue describing treatments from different approaches and different theoretical orientations. To the extent that these common factors are important mechanisms of action, it is possible that the future will introduce more unified and more effective, efficient, and theoretically informed treatment for performance anxiety as well as the potential for preventive techniques.

Adult↗

PubMed2004

Challenges in treating obsessive-compulsive disorder: introduction.

This issue of In Session is devoted to challenges in the treatment of obsessive-compulsive disorder (OCD). The remarkable diversity of symptoms and the comorbidity in OCD pose substantial challenges to practitioners seeking to treat this disorder. After briefly reviewing the clinical features of OCD and its typical treatment, we provide brief descriptions of the six articles this issue comprises. Articles focus on the treatment of OCD with comorbid depression, compulsive hoarding, incompleteness, and repugnant obsessions, and on treatment of children who have OCD. The final article describes pharmacotherapy for OCD. All articles feature case vignettes and provide practitioners with clinical recommendations.

Adult↗

PubMed2004

Treatment of compulsive hoarding.

Compulsive hoarding and saving symptoms, found in many patients who have obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to antiobsessional medications and cognitive-behavioral therapy (CBT). Specific CBT strategies targeting the characteristic features of the compulsive hoarding syndrome have had better results. This article provides an overview of the compulsive hoarding syndrome, a review of treatment approaches and their efficacy, a case presentation, and a detailed discussion of intensive, multimodal CBT for compulsive hoarding. New insights into the neurobiological characteristics of compulsive hoarding that might direct future treatment development are also presented.

Antipsychotic Agents↗

PubMed2004

Understanding and treating incompleteness in obsessive-compulsive disorder.

Incompleteness-the troubling and irremediable sense that one's actions or experiences are not "just right"--appears to underlie many of the symptoms of obsessive-compulsive disorder (OCD). Because incompleteness may reflect basic sensory-affective dysfunction, it presents a challenge to clinicians wishing to apply cognitive-behavioral treatments. In this article, I review ways of adapting well-demonstrated treatment principles to this condition. A case is presented and then used to discuss challenges in conducting cognitive-behavioral therapy with this population. Behavioral methods aimed at habituation (e.g., exposure and ritual prevention [ERP]) are probably more applicable than conventional cognitive techniques. However, even these may result in modest long-term gains; relapse is a probability if they are not actively practiced after treatment cessation.

Adult↗

PubMed2004

Cognitive-behavioral treatment of repugnant obsessions.

Obsessions often occur in the form of repugnant sexual, aggressive, or blasphemous thoughts, images, impulses, or doubts. This article describes the phenomenon of repugnant obsessions and reviews the cognitive-behavioral model of obsessive-compulsive disorder (OCD). Caveats and recommendations are provided and a case illustration is presented. Repugnant obsessions are highly amenable to treatment; but developing an idiographic conceptualization of the client's obsessive-compulsive cycle is important. Treatment resources are presented throughout.

Aggression↗

PubMed2004

Cognitive-behavioral therapy for children who have obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a relatively chronic and impairing disorder in children and adolescents. Whereas childhood OCD was largely ignored in the past, major advances in the identification and treatment over the past 20 years have led to a significant upsurge in the prevalence of youngsters seeking treatment for this problem. The present article describes the use of exposure-based cognitive-behavioral therapy (CBT) for the treatment of childhood OCD. Although the phenomenology of OCD is largely consistent across the age span, traditional adult CBT approaches have been modified for use with children and adolescents in order to address those developmental differences that do exist. The case example describes the use of CBT for a child who has OCD and highlights these developmental considerations, including age-appropriate techniques to address family involvement in the disorder and the impact of symptoms on the psychosocial functioning of the patient.

Adolescent↗

PubMed2004

Pharmacotherapy for obsessive-compulsive disorder.

Pharmacotherapeutic options for obsessive-compulsive disorder (OCD) have expanded over the past half-century since medications were first found to be effective for the treatment of OCD. Currently, the serotonin reuptake inhibitors (SRIs) represent the first-line pharmacotherapy for OCD. High dosages and long trials of the SRIs are needed for adequate treatment of OCD. The use of SRIs for the treatment of OCD is reviewed, then other pharmacotherapeutic treatment options, including SRI augmentation and alternative monotherapies, are discussed. The preponderance of data demonstrates that SRI augmentation with neuroleptics is efficacious for treatment-refractory OCD. There is substantially less evidence supporting other alternative strategies. Finally, neurosurgical and device-based approaches for treatment-refractory OCD are reviewed.

Antipsychotic Agents↗

PubMed2005

Prolonged Exposure versus Eye Movement Desensitization and Reprocessing (EMDR) for PTSD rape victims.

This controlled study evaluated the relative efficacy of Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) compared to a no-treatment wait-list control (WAIT) in the treatment of PTSD in adult female rape victims (n = 74). Improvement in PTSD as assessed by blind independent assessors, depression, dissociation, and state anxiety was significantly greater in both the PE and EMDR group than the WAIT group (n = 20 completers per group). PE and EMDR did not differ significantly for change from baseline to either posttreatment or 6-month follow-up measurement for any quantitative scale.

Adult↗

PubMed2005

Exposure utilization and completion of cognitive behavioral therapy for PTSD in a "real world" clinical practice.

This study assessed rates of imaginal exposure therapy (ET) utilization and completion of cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD) in a clinical setting and examined variables associated with CBT completion. Using a clinical definition, the completion rate of CBT was markedly lower than rates reported in randomized trials. CBT completion was inversely related to severity of overall pretreatment measures of PTSD, avoidance, hyperarousal, depression, impaired social functioning, and borderline personality disorder. Regression yielded avoidance and depression as unique predictors of completion. Most dropouts occurred before starting imaginal ET, although initiating ET was associated with greater likelihood of completion. Results highlight methodological differences between research and practice notions of treatment completion and the need for further study of variables influencing CBT completion in practice settings.

Adult↗