The challenges of treatment evolution and integration.
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The paper addresses distinctions between hypnotic interventions and Eye Movement Desensitizing and Reprocessing (EMDR) and discusses their effect on persons who have symptoms of Posttraumatic Stress Disorder (PTSD). Eye movements in hypnosis and EMDR are considered in terms of the different ways they may affect responses in treatment. A treatment intervention within hypnosis called ECEM (Eye Closure, Eye Movements) is described. ECEM can be used for patients with histories of trauma who did not benefit adequately from either interventions in hypnosis or the EMDR treatment protocol used separately. In ECEM the eye movement variable of EMDR is integrated within a hypnosis protocol to enhance benefits of hypnosis and reduce certain risks of EMDR.
Both Ernest Rossi's ideodynamic accessing model of hypnosis and EMDR are intended to access information stored in the mind-body system. In this paper the author is suggesting that treatment effectiveness can be enhanced by combining these particular models. The similarities and the uniqueness of each method, both theoretically and in terms of the different protocols, are compared to provide a rationale for combining them. Verbatim examples from clinical cases are presented to demonstrate exactly how these models can be usefully combined in clinical practice.
The principles of this conceptual framework are: (1) personality organization is dissociative as well as associative, consisting of ego states, and progresses through stages of psychosocial development; (2) inappropriately activated ego states cause dysfunction, which is habitual or due to the intense affect of disrupted development or unresolved grief or trauma; (3) completely overcoming dysfunction requires therapy with both individual ego states and the personality system; (4) clinical hypnosis provides techniques to enhance accessing ego states; and (5) EMDR combines ego-state therapy with eye movements (EMs) to produce a powerful psychotherapy method. During assessment, ego states responsible for dysfunctional emotional reactions and behavior are identified together with those that could be appropriate instead. Included in the treatment protocol, EMs and clinical hypnosis promote: (1) corrective developmental experiences; (2) resolution of grief and trauma; (3) acquisition of skills and abilities; (4) co-consciousness; and (5) negotiation among ego states. The outcome is an integrated "family of self" that has effectively overcome developmental crises, grief, and trauma, is aware of essential inner resources, and can consciously activate appropriate ego states.
This paper explores how hypnotic principles can be systematically incorporated into the standard EMDR protocol to enhance various ego strength capacities during EMDR treatment. Expanding these skill areas can widen the therapeutic window of possibility for clients with a variety of complex clinical issues, including posttraumatic, dissociative or personality disorders, anxiety symptoms, and depressive difficulties. Clinical case examples are used to illustrate ways of integrating hypnotic principles within a proposed EMDR protocol to promote ego strengthening and facilitate therapeutic change.
Clinical hypnosis and EMDR have both been employed in the treatment of phobias. EMDR has been a controversial treatment method with the research showing mixed results concerning its efficacy. Many studies have shown the effectiveness of hypnosis in the treatment of phobias, but no studies have directly compared hypnosis to EMDR. This paper discusses each approach to treatment, with special emphasis on EMDR. Relevant research and current theories are reviewed along with questions raised and recommendations for future research.
Dissociative Identity Disorder (DID), a chronic childhood onset posttraumatic stress disorder, is currently recognized as a treatable condition. It is considered the paradigmatic dissociative condition and carries with it extreme posttraumatic symptomatology. Therapists skilled in the treatment of DID are typically fluent in the uses of hypnosis for stabilization, affect management, building a safe place and grounding to name of few. EMDR, which has come to the forefront of clinical awareness in the last ten years, seems aptly suited for the treatment of trauma, but can be destabilizing. This paper proposes a protocol, called Wreathing Protocol, for the imbricated use of EMDR and hypnosis in the treatment of not only DID (though this will be the primary focus of the paper), but also Dissociative Disorder Not Otherwise Specified (DDNOS) and chronic Posttraumatic Stress Disorder (PTSD). This protocol is useful to advanced clinicians skilled in both modalities independently. The sequential steps of the Wreathing Protocol will be described and illustrated by a clinical vignette on DID. The clinical implications of the use of the Wreathing Protocol will be discussed in DID as well as the chronic post traumatic spectrum.
Case reports are given of three patients, two suffering from compulsive shop-lifting and one from binge-eating, who responded to a week's treatment with imaginal desensitization after having failed to respond to prolonged interpretative psychotherapy. Expectancy of improvement did not appear to play a major role in their response, but it appears impossible to disprove that expectancy determines the response to this or any form of psychotherapy. Whether or not imaginal desensitization acted specifically in the present study, in view of its cost-efficacy it is suggested it is worthy of trial in impulse disorders which have persisted despite treatment.
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During the last two decades, effective psychotherapeutic interventions have been developed and proven successful in treating patients with Obsessive-Compulsive Disorder (OCD). Behavior therapy, using exposure to anxiety-evoking stimuli and response prevention directed toward rituals, provides lasting benefit for most patients who engage in and comply with treatment. A recent study indicated that, for certain OCD patients, these interventions could be applied successfully in a group therapy context. This article describes the general procedures used in this study to treat obsessive-compulsives with exposure and response prevention in a group context.
Agoraphobia is a complex disorder characterized by substantial personal, social, and occupational disability. This paper presents a cognitive-behavioral model of group psychotherapy for agoraphobia treatment wherein group members are taught active coping skills to reduce anxiety and behavioral avoidance. Therapy occurs in the context of a supportive group, which aids in reducing the social isolation and alienation attendant on this severe anxiety disorder. The model of treatment is amenable to both time-limited and open-ended group therapy formats.
Effectiveness of systematic desensitization for fear reduction, using humorous hierarchy scenes without relaxation, was tested. Participants were 40 students highly fearful of spiders. Using a 24-item behavioral approach test with an American tarantula, participants were matched on fear level and randomly assigned to 1 of 3 treatment groups: (a) systematic desensitization, (b) humor desensitization, and (c) untreated controls. Each participant was seen for 6 sessions, including pretest and posttest. Analyses of covariance of posttest scores revealed that the 2 treatment groups showed greater reduction in fear than the controls on 3 measures but did not differ from each other. Therefore, humor in systematic desensitization reduced fear as effectively as more traditional desensitization. This finding may have therapeutic applications; however, it may also be applicable in advertising to desensitize fear of a dangerous product, such as cigarettes.
Systematic desensitization is re-examined as a treatment for flight fear from the perspective of family-systems theory. The problem of the person who avoids flight is considered first from the viewpoint of behavior therapy, and behavioral treatment is briefly described. This problem is next described in terms of the patients's to society, family, and the therapist. From this perspective, the flight-avoidant person is seen to be an "identified patient"-someone defined as ill by the system in which he or she is enmeshed. The problem is then redefined, not as flight fear, but as the pressure to fly, and implications for treatment are discussed.
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The new sexual therapy, a brief outpatient treatment of sexual dysfunction consisting of structured sexual exercises and conjoint therapeutic sessions, is a systematic intergration of behavioral and psychodynamic elements. Formally consisting of many defining characteristics of a behavior therapy including the direct treatment of a specified problem and the application of behavioral principles, the new sex therapy also relies on psychodynamic understanding. The result is synergistic. Psychodynamic understanding underlies appropriate behavioral intervention, and psychodynamic exploration of resistance enhances the effectiveness of behavioral methods. Behavioral techniques facilitate the most rapid implementation of therapeutic insight. The integration of approaches in the new sex therapy has general significance for psychotherapeutic theory and practice.
In this paper 14 anxiety-reduction techniques are discussed: use of bibliotherapy, use of audiovisual materials, in vivo desensitization via written, programmed exercises; self-exploration/masturbation training; orgasmic reconditioning; simulated orgasm experiences; implosion techniques; sex word desensitization; sexual assertion training; therapist modeling/self-disclosure; systematic desensitization; and cue-controlled relaxation. The sex therapist can integrate these techniques into the sex therapy contract with individuals or couples and use them either singly or in a sequential multiple technique format to reduce sexual anxiety.