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PTSD - Etiology and Two Types of Treatments

Ramsis Hanna
rambahan_1953@yahoo.com
2012 / 5 / 14

There are various approaches of treating Posttraumatic Stress Disorder (PTSD). These methods include medications and Cognitive Behavioral Therapy (CBT). This study will concentrate on the definition and etiology of PTSD as well as two types of Cognitive Behavioral Therapies, which are Eye Movement Desensitization Reprocessing (EMDR) with its eight phases and Eye Movements (EMs) inclusion, and Evidence-Based Treatment (EBT) with specific concentration on challenges to its guidelines disseminations. A comparison dealing with aspects of similarities and differences between the two methods, concerning persons addressed by the methods, challenges that face each approach and points of strength in each treatment will be made. Finally, some findings of how EMs work out in the EMDR method, and how training and supervision can impact the performance of EBT practitioners will be discussed with some prospects of each treatment.

(PTSD) is defined as a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma. There are different causes of PTSD: an actual terrifying event, un-integrated memories, an associated meaning, or personal vulnerability. Researchers and neurologists still differ in the cause of PTSD (Couineau & Australian, 2011). Some scientists believed that the traumatic event such as combat or military experience, sexual or physical abuse or assault, a serious accident, or a natural disaster such as a fire, tornado, flood, or earthquake was the main cause of PTSD (Couineau & Australian, 2011).

On the other hand, other scientists believed that the personís response or reaction to the event is the main cause and the event was not of that importance. Neurologist Jean Martin Charcot (1825Ė1893) attributed the etiology of trauma symptoms to the response of predisposed individuals to a terrifying event (Couineau & Australian, 2011).

Pierre Janet (1859Ė1947) saw that the early-established cognitive schemas or subconscious fixed ideas in life were the causes of neurotic trauma symptoms (Couineau & Australian, 2011). Joseph Breuer and Sigmund Freud (1893) proposed that susceptibility of the person, not the event, was the cause of PTSD (Couineau & Australian, 2011). This debate led to differing core assumptions of theories, diagnostic criteria, and the focus of therapies used to treat PTSD (Couineau & Australian, 2011).

Eye Movement Desensitization and Reprocessing (EMDR) is a form of psychotherapy that was developed by Francine Shapiro (1989) (Schubert & Lee, 2009). It aims at resolving trauma symptoms by desensitizing traumatic memories (Schubert & Lee, 2009). EMDR is an integrative, comprehensive treatment approach that contains many elements of effective psychodynamic, cognitive-behavioral, experiential, interpersonal, and physiological therapies (Schubert & Lee, 2009).

EMDR consists of eight phases. In the first phase, the patientís history is exposed and overall treatment plan is made. The second phase aims at making the member choose a place, an image or a memory where he/she feels safe, secure and comfortable. In the third phase, a target for MEDR is developed by a snapshot image. In the fourth phase the member is asked to focus on the image, the negative cognition and the disturbing emotion. Then he/she follows a moving object. After a set of movement, the member tells what has come up. The process is repeated till the member can concentrate on the original target or whatever thought or memory. He/she can tell about his current level of stress. The fifth phase is called the installation phase where the positive cognition is activated. The sixth phase is called the body scan to identify any pain, stress or discomfort. The seventh phase is called debriefing where appropriate information and support are given. The eighth phase is for the re-evaluating the memberís progress (Schubert & Lee, 2009).

Evidence-based Treatment (EBT) is a strategy by which professionals try to identify the way in which decisions should be made by specifying evidence for a practice, and by rating it according to its scientific soundness, thus excluding other unsound practices (Couineau & Australian, 2009).

Even though Both EMDR and evidence-based treatment are similar in some aspect as they both come under the category of cognitive behavioral therapy, they are different in other aspects. While EMDR is addressed to clients or patients with PSTD, Based-evidence treatment is addressed to practitioners, clinicians or therapists (Couineau & Australian, 2009).
The EMDR is concentrating on the client led by his/her therapist to be aware of his/her condition. It reveals, accesses, and processes past, present, and future pathological stored memories (Schubert & Lee, 2009). However, the evidence based treatment (EBT) requires the practitioners to catch up with the latest knowledge, and apply it on the case they are treating (Couineau & Australian, 2009). Through evidence-based treatment (EBT) professionals and decision-makers try to specify the way in which decisions are made by identifying such evidence for a practice, and by rating it according to its scientific soundness, hence eliminating unsound or excessively risky practices in favor of those that have better outcomes (Couineau & Australian, 2009).

The challenges that face EMDR may be different from those that confront EBT. EMDR remains controversial because its method and theoretical foundation are still questionable. In fact, since its initiation, there have been a lot of divergent reactions from scientists and professionals towards EMDR (Schubert & Lee, 2009). It was not first accepted, and it was criticized because of the impression of being proposed as a one-session cure for PTSD(Schubert & Lee, 2009). However, EMFR, as previously mentioned, is a structured eight-phase treatment approach that aims to access and process past, present, and future aspects of dysfunctional memories that form the basis of current pathology.

Evidence-based Practices (EBP) are not used by most practitioners (Couineau & Australian, 2009). There was also a lack of accuracy in the processes of assessment; and it has also been observed that there are some defects in the use of validated scales to ascertain diagnosis (Couineau & Australian, 2009).

EMDR and EBT, each has its own advantages that distinguish it from other approaches of treatments for PTSD. Two of the most distinguishing aspects of EMDR are these. First, it integrates elements of effective psychodynamic, imaginable, cognitive therapy, interpersonal,experiential, physiological and somatic therapies. Second, it uses a unique element of bilateral stimulation (e.g. eye movements, tones, or tapping) during each session of its structured eight-phase approach (Schubert & Lee, 2009).

On the other hand, EBT uses various methods (e.g. carefully summarizing research and putting out accessible research summaries) to encourage, professionals and other decision-makers to pay more attention to evidence that can inform their decision-making (Schubert & Lee, 2009).

There are certain aspects or factors that specifically concern each treatment method. The first one is the eye movement concerning EMDR. The second one is the dissemination and training strategies concerning evidence-based intervention treatment(Schubert & Lee, 2009).

The role of eye movements EMs in EMDR is still controversial as some critics believe that EMs are unnecessary for the method. (Schubert & Lee, 2009). Yet, it is still too early to exclude the need for EMís (Schubert & Lee, 2009). Research suggests that EMs may contribute to the effectiveness of EMDR through a number of different processes. They decrease the vividness and/or emotionality of autobiographical memories (Schubert & Lee, 2009). They enhance the retrieval of episodic memories (Schubert & Lee, 2009). They increase cognitive flexibility and may change inter hemispheric coherence in frontal areas of the brain (Schubert & Lee, 2009). Research has also demonstrated that EMs produces psycho physiological dearousal when accessing distressing memories (Schubert & Lee, 2009). Other treatment studies measured physiological changes during EMDR and indicate that the EMs are associated with physiological responses that are characteristic of an orienting response, but may also resemble physiological characteristics of REM sleep (Schubert & Lee, 2009).

As reported by patients, EDMR was appreciated as an effective method as it did remarkably better than other therapies. However, some scientists believe it does not significantly differ from trauma-focused Cognitive Behavioral Therapy (CBT) or Stress Management (SM) treatments. Yet, It was classified as an evidence-based level A treatment for PTSD by The International Society of Stress Studies practice guidelines (Schubert & Lee, 2009). Thus, more research is now required to examine the precise causal role of the EMs in EMDR (Schubert & Lee, 2009).

Dissemination and training strategies of evidence-based interventions have achieved little levels of improvement and care as practice guidelines and new evidence-based interventions are rarely used (Couineau & Australian, 2009). Cochrane Reviews of control group application trials concluded that a brief educational intervention in the workplace resulted in a 5.6% increase in the use of recommended practices, audit and feedback produced a 5% increase, and educational meetings and workshops achieved a 6% increase for simple target behaviors (Couineau & Australian, 2009). . There was a decline in the use of recommended practices for complex behaviors such as the provision of Cognitive Behavior Therapy (Couineau & Australian, 2009). Many attempts to encourage evidence-based mental health interventions have depended on passive knowledge dissemination techniques resulting in small improvements in practice and no change in cases of complex clinical behaviors (Couineau & Australian, 2009).

On the other hand, large implementation programs that use active approach to promote evidence-based practice are now made available and produce encouraging results (Couineau & Australian, 2009). For example, the Improving Access to Psychological Therapies (IAPT) project in the U.K. engaged stake holders and delivered extensive training and supervision. Pilot studies from this project reported that 55-56% of clients had recovered and had, to great extent, maintained their health status at 10 months (Couineau & Australian, 2009).

It was found that training with regular supervision was effective in samples of community clinicians who had been trained in the use of manualized treatments (Couineau & Australian, 2009). There still calls for more research in effective strategies of disseminations and implementations of evidence-based treatment for PTSD (Couineau & Australian, 2009). It has been reported that the use of multiple strategies is more effective in changing cliniciansí behavior than single strategies because of taking into account the different levels of the health care system(Couineau & Australian, 2009). Thus, it addresses specific barriers associated with targeted clinical improvement (Couineau & Australian, 2009). Yet, more recent reviews have found that multiple strategies have been no more effective than single strategies (Couineau & Australian, 2009). Some experts argue that it is difficult to interpret results of systematic reviews because the implementation strategies effectiveness varies depending on the clinical behavior or system, the setting of implementation, its timing, and target group (Couineau & Australian, 2009). Moreover, dissemination and training strategies are seldom based on proven theoretical models to identify factors that influence professional behavior or effect organizational change. (Couineau & Australian, 2009). Generally, the study indicates the need to investigate the context of evidence-based care, as well as the barriers. (Couineau & Australian, 2009). Thus, treatments, EMDR and Evidence-based practices have been proven to be effective over time.




References:

Schubert, S., & Lee, C. W. (2009). Adult PTSD and its treatment with EMDR: A review of controversies, evidence, and theoretical knowledge. Journal of EMDR Practice and Research, 3(3), 117-132. http://search.proquest.com/docview/222693677?accountid=11809

Couineau, A.,Forbes, D.(2011). Using predictive models of behavior change to promote evedince-based treatment for PTSD. Psychological Trauma Theory, Research, Practice, and policy,3(2), 266-275. http://library.kean.edu:2055/ehost/detail?sid=52443fbf-e784-4836-aef4-9065bf9052c6%40sessionmgr104&vid=1&hid=123&bdata=JkF1dGhUeXBlPWNvb2tpZSxpcCx1cmwsY3BpZCZjdXN0aWQ9a2VhbmluZiZzaXRlPWVob3N0LWxpdmU%3d#db=psyh&AN=2011-19187-001




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