An exploration of the processing of suppressed memories during Rebirthing-Breathwork / Uma exploração do processamento de memorias suprimidas durante Rebirthing-Breathwork / Una exploración del procesamiento de memorias suprimidas durante Rebirthing-Breathwork

Rebirthing-Breathwork is a technique that uses the breathing rhythm to activate a somatic-cognitive cycle. When allowed to unfold, this cycle activates suppressed and traumatic memories, brings them to consciousness and leads to their resolution. In this analytic and interpretative study we draw on first-person experiences and clinical observations to describe the phases of a typical Rebirthing Breathwork session. Changes in consciousness and in particular the phases related to the processing of suppressed or traumatic memories during Rebirthing Breathwork are described in detail, with the objective of developing a processing model. The findings are compared with the Adaptive Information Processing model developed by Shapiro to explain the processing of dysfunctional memories during Eye movement Desensitization and Reprocessing (EMDR). Shapiro's model is based on neurobiological theories and on the hypothesis that during EMDR traumatic memories form new connections and are assimilated in larger neural networks. Our findings suggest a different model, which involves the distillation and re-evaluation of subjective conceptual content. We sketch an alternative processing model ­ not based on information processing, but on consciousness and cognition ­ in which the subjective content of the memory is compared to an intuitively perceived higher self-image.(AU)

Rebirthing-Breathwork é uma técnica que utiliza o ritmo respiratório para ativar um ciclo cognitivo-somático. Quando permitido que se desenvolva, esse ciclo ativa memórias traumáticas reprimidas, trazendo-as à consciência e conduzindo-as à sua resolução. Neste estudo analítico e interpretativo utilizamos experiências pessoais e observações clínicas para descrever as fases de uma sessão típica de Rebirthing-Breathwork. Descrevemos em detalhes as mudanças de consciência e, particularmente, as fases relacionadas ao processamento de memórias reprimidas ou traumáticas durante a sessão. As evidências são comparadas ao Adaptive Information Processing model (AIP ­ modelo de processamento de informações adaptativas) desenvolvido por Shapiro para explicar a elaboração de memórias disfuncionais durante a terapia EMDR (Eye Movement Desensitization and Reprocessing, ou Dessensibilização e Reprocessamento por Movimentos Oculares). O modelo de Shapiro é baseado em teorias neurobiológicas e na hipótese de que, durante o EMDR,as memórias traumáticas formamnovas conexõese são assimiladas em redes neurais maiores. As nossas observações sugerem um modelo diferente, que envolve a destilação e reavaliação do conteúdo conceitual subjetivo. Esboçamos um modelo alternativo de processamento ­ não baseado no processamento de informação, mas emconsciência e cognição ­ no qual o conteúdo subjetivo da memória é comparado a uma autoimagem superior que é percebida intuitivamente.(AU)

Rebirthing-Breathwork es una técnica que utiliza el ritmo respiratorio para activar un ciclo cognitivosomático. Cuando permitido que se desarrolle, este ciclo activa memorias suprimidas y traumáticas, lleva las mismas a la conciencia y conduce hacia su resolución. En este estudio analítico e interpretativo aportamos experiencias personales y observaciones clínicas para describir las fases de una sesión típica de Rebirthing-Breathwork. Cambios en conciencia y en especial las fases relativas al procesamiento de memorias suprimidas y traumáticas durante el Rebirthing-Breathwork son descritos en detalles. Las evidencias son comparadas al Adaptive Information Processing model (AIP ­ modelo de procesamiento de informaciones adaptativas) desarrollado por Shapiro para explanación de la elaboración de memorias non-funcionales durante la terapia EMDR (Eye Movement Desensitization and Reprocessing, o Desensibilización y Reprocesamiento por Movimientos Oculares). El modelo de Shapiro es basado en teorías neurobiológicas y en la hipótesis de que, durante el EMDR, las memorias traumáticas forman nuevas conexiones y son asimiladas en redes neurales más grandes. Nuestras observaciones sugieren un modelo distinto, que abarca la destilación y revaluación del contenido conceptual subjetivo. Esbozamos un modelo alternativo de procesamiento ­ non basado en el procesamiento de información, pero en conciencia y cognición ­ en el cual el contenido subjetivo de la memoria es comparado a una autoimagen superior que es percibida intuitivamente.(AU)

Treatment of Dissociative Symptoms and Depression as a Consequence of Mother's Neglect during Childhood, using EMDR: Two Case Studies

The present study reports two cases where clients (age 19 -23 yrs) suffer from major depressive disorderalong with dissociative symptoms. History revealed emotional unavailability, neglect, and physical andverbal abuse by mother. Clients were assessed on Dissociative experience scale (DES) and BeckDepression inventory (BDI). Psychotherapeutic intervention was provided. Clients responded well withEye Movement Desensitization and Reprocessing (EMDR) and after almost one year of treatment, showimprovement in their DES and BDI scores. They become assertive to cope with the situation at home andstable enough to carry out their day to day life. In both the above mentioned cases, mother’s emotionalabuse and emotional neglect during childhood produced the long term impact, thus generating a negativeself schema and flawed perception of outer world which resulted in PTSD as well as dissociativesymptoms and depression. Their shattered ego required a long preparation phase. EMDR helped them inhealing and in enhancing their coping pattern

Add-on Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Adults with Post-traumatic Stress Disorder Who Failed to Respond to Initial Antidepressant Pharmacotherapy

This study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with post-traumatic stress disorder (PTSD) who continued to be symptomatic after more than 12 weeks of initial antidepressant treatment. Scores for the Clinician Administered PTSD Scale (CAPS) were rated pre- and post-EMDR and at a 6-month follow-up. After an average of six sessions of EMDR treatment, seven of 14 patients (50%) showed more than a 30% decrease in CAPS score and eight (57%) no longer met the criteria for PTSD. Our results indicate that EMDR could be successfully added after failure of initial pharmacotherapy for PTSD.

Combined psychopharmacological and psychosocial approaches and the relevance of therapeutic jurisprudence and religion in the successful management of battered woman's syndrome: A case report

INTRODUCTION: Although Battered Woman Syndrome is not listed in the DSM 5 and the ICD 10 as an official diagnosis, it is undeniable that women suffering Intimate Partner Violence (IPV) experience the same cycle of violence, suffer from a common range of symptoms, and have a predictable prognosis. While psychosocial guidelines and support are available, like in our Women and Child Protection Units (WCPU), there is also a gap in the clinical guidelines in treating and managing these cases, which might present with a combination of posttraumatic and depressive symptomatology. In this report, we discuss the case of a 32 year old woman who was subjected to severe physical and emotional abuse by her longtime romantic partner. She consulted at our center seeking help for a psychiatric evaluation for the case she was going to pursue in court but it was apparent she was suffering from posttraumatic, somatic, and depressive symptoms. Supportive therapy was initially done and she was started on Escitalopram and low dose Quetiapine for sleep problems. As her case started gathering steam, issues about the court process, possible setback with her church and possible retaliation from her partner weighed heavily on her. Possible issues were discussed beforehand and successfully faced up to her partner in a church related tribunal and in the fiscal's office. Using an Eye Movement Desensitization and Reprocessing(EMDR) variant, Unfinished Trauma Episode Protocol (U-TEP), her posttraumatic symptoms were eventually addressed. As she started having faith in the legal system and her church, she had restored self-esteem, was active in her social circle and become an advocate in helping other women get proper treatment and to fight for their rights. Besides the clinician advocated treatment along with the services delivered via the WCPU network, the perception of getting justice from social institutions like the judiciary and the church helped in the recovery of this patient. Clinicians dealing with Battered Woman Syndrome should be aware of issues the patient might go through the stages of her fight and that the process of seeking for justice is also a process of mental healing.

Diseño a doble ciego y el uso de placebos psicológicos en investigación de resultados en psicoterapia: Es posible? Un estudio piloto de viabilidad / Double blind design and the use of psychological placebos in outcomes research in psychotherapy: Is it possible? A pilot feasibility study

El uso de placebos y diseños a doble ciego ha cumplido un papel crucial en la investigación clínica en Medicina. Su aplicación a la investigación de resultados en psicoterapia ha sido controversial. Muchos autores niegan la posibilidad de su aplicación debido a que el terapeuta debería conocer la condición del procedimiento aplicado. Se presenta detalladamente un estudio en el que se utilizó un procedimiento placebo correspondiente a EMDR (Eye Movement Desensitization and Reprocessing- Desensibilización y Reprocesamiento por Movimientos Oculares) con un Diseño Experimental de Caso Único. Los objetivos fueron los siguientes: poner a prueba la viabilidad de la implementación de un placebo de tipo psicológico en EMDR y la aplicación de un diseño a doble ciego en el estudio de resultados en EMDR. Se seleccionaron tres pacientes que sufrían de Trastorno por Estrés Postraumático. Se estableció una línea de base de la sintomatología presentada. Luego, los sujetos fueron asignados aleatoriamente a tres condiciones experimentales durante tres sesiones: (a) aplicación del protocolo EMDR sin ningún tipo de estimulación con auriculares en silencio (placebo 1), (b) aplicación del protocolo EMDR con estimulación bilateral auditiva simultánea (no alternada) (placebo 2) y (c) aplicación del protocolo estándar de EMDR con estimulación auditiva bilateral alternada (tratamiento activo). Tales procedimientos resultaron igualmente creíbles para el paciente y para el terapeuta. Esto permitió el desarrollo de un diseño de investigación a doble ciego para la investigación de resultados en EMDR. Finalmente, se discuten algunas posibles aplicaciones e implicancias de la introducción del uso de placebos psicológicos y diseño a doble ciego en la investigación en psicoterapia.

Double blind design and placebos have been of crucial importance in medical clinical research. Their use in outcomes research in the field of psychotherapy has been controversial, though. Their feasibility in such case has been denied by many authors based on the assumption that the psychotherapist would need to know the nature of the applied procedure. In view of this, the author has conducted a pilot feasibility study on three subjects within the context of his doctoral dissertation. Said dissertation aims at establishing the role of alternating bilateral auditory stimulation in the processing of traumatic memories as used in the EMDR (Eye Movement Desensitization and Reprocessing) technique. To such end, the EMDR basic principles and procedures are introduced -with particular attention to alternating bilateral auditory stimulation- and a pilot study using placebos during EMDR administration is presented in detail. The goals of this study are testing the feasibility of: (a) using a psychological placebo in EMDR therapy, and (b) applying a double blind design study in EMDR outcomes research. A single case experimental design was performed on three different patients suffering from PTSD (Posttraumatic Stress Disorder). A symptomatology baseline was established through out three weekly sessions using the DTS (Davidson Trauma Scale) and the OQ-45.2 (Outcomes Questionnaire 45.2). First, three CDs were recorded -one with no sound at all (CD-1, silence condition); another one with auditory stimulation consisting of a tic-tac sound recorded in monaural condition, and reproduced simultaneously over both earphones at a rate of one beat per second (CD-2, monaural condition) and a third one with alternating bilateral auditory stimulation consisting of the exact same sound recorded in stereophonic condition, and reproduced alternatively over the left and right earphones (CD-3, stereo condition)-. At a second stage, these three experimental conditions were assigned randomly to the three subjects, who were administered: (a) EMDR protocol without any type of stimulation, with no sound coming out of the earphones using CD-1 (placebo 1), (b) EMDR protocol with simultaneous bilateral auditory stimulation using CD-2 (placebo 2), and (c) EMDR protocol with alternating bilateral auditory stimulation using CD-3 (active treatment). In all cases, the experimental conditions were implemented during three full sessions in which the CDs were reproduced for the subjects through earphones, instead of speakers, to ensure that the psychotherapist was unaware of the actual conditions. Subsequently, the standard EMDR protocol (i.e., with alternating bilateral auditory stimulation) was administered to each subject until the end of the treatment, determined either by the symptoms being resolved or the maximum of ten sessions being completed. As a result of this pilot study, the author concludes that the feasibility of using double blind studies and placebos in EMDR psychotherapy has indeed been established. Since no apparent difficulties in the administration of the placebos were detected during the study, the use of psychological placebos seems viable. Such procedure is equally credible for the patient as well as for the psychotherapist, which renders possible the development of a double blind design in EMDR outcomes research. It should be noted, though, that the credibility of the placebo was not formally assessed, but rather was perceived through the author’s informal observation. Developing assessment criteria and formal tools to evaluate the credibility of placebo procedures is advisable if future investigations on the subject are to be carried. Even though this study was conducted under a Single Case Experimental Design, the placebo procedure employed could be easily adapted for its use in between group’s designs. Finally, some of the possible applications and consequences regarding the introduction of placebos and double blind design in psychotherapy research are discussed.

Treatment Response of Affect Regulation Group Therapy for Recently Traumatized School Children / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the treatment effect and predictors of response of affect regulation group therapy (ARGT) delivered to a group of recently traumatized children. METHODS: A total of 464 school children, who had witnessed or confronted a tragic accident at school, were given a single-session of affect regulation group therapy, that which included psychoeducation and affect regulation elements from eye movement desensitization and reprocessing. Of 213 children whose with initial score of Subject Unit of Disturbance Scale (SUDS) score over 4, we compared pre- and post-treatment scores and performed conducted the responder vs. non-responder comparison. The pPost-traumatic disorder (PTSD) symptom scores measured by using Child Reaction to Traumatic Events Scale-Revised (CRTES-R), demographic variables, and clinical variables were considered. RESULTS: Affect regulation group therapy was effective for children who had experienced an acute traumatic event (t=16.3, p<0.001). Baseline SUDS score of for non-responder were was significantly higher (t=-2.89, p<0.001) and CRTES-R score approached a level of significance level (t=-1.72, p=0.09). However, results of logistic regression analysis identified showed that the pretreatment SUDS score was the only significant predictor of non-response. CONCLUSION: Affect regulation group therapy appeared to be effective for children who had undergone experienced an acute traumatic event. And in addition, the survivors' subjective distress was more important to treatment response than severity of PTSD symptoms severity.

Efectividad de tratamiento EMDR en personas guatemaltecas con síntomas de trauma psicológico / The Effectiveness of EMDR Treatment for Guatemalans with Symptoms of Trauma

Guatemala tiene una baja proporción de psicólogos para la población general (6.89 por cada 100,000 personas), lo que hace imperativo que los tratamientos terapéuticos sean exitosos, eficaces y eficientes. El presente estudio exploró la eficacia de Eye Movement Desensitization and Reprocessing (EMDR) en la reducción de los niveles de síntomas de trauma psicológico. Siete participantes con síntomas moderados a graves fueron sometidos a tres sesiones de terapia EMDR. La frecuencia y la intensidad de los síntomas que manifestaron los participantes redujeron significativamente después de la terapia. Los síntomas no disminuyen (o aumentaron) en un grupo control que no recibió terapia EMDR. Estos resultados sugieren que el método EMDR puede servir a corto plazo como un tipo de tratamiento exitoso que los terapeutas pueden utilizar con pacientes que manifiestan síntomas de trauma psicológico.

Guatemala has a relatively low ratio of psychologists to the general population (6.89 psychologists per 100,000 people), which makes it imperative that the therapeutic treatments utilized by psychologists are successful, effective and efficient. The current study explored the effectiveness and efficiency of Eye Movement Desensitization and Reprocessing (EMDR) therapy on lowering the levels of symptoms of psychological trauma among Guatemalan participants. Seven participants with moderate to grave symptoms underwent three sessions of EMDR therapy with a therapist trained and certified in EMDR techniques. The frequency and intensity of symptoms experienced by the participants decreased significantly after the therapy. Over the same time period, symptoms of trauma did not decrease (or increase) in a control group who did not receive EMDR therapy. These results suggest that EMDR could serve as a short-term, successful type of treatment for therapists to employ with clients who manifest symptoms of psychological trauma.

A Pilot Study of Brief Eye Movement Desensitization and Reprocessing(EMDR) for Treatment of Acute Phase Schizophrenia

OBJECTIVES: Eye movement desensitization and reprocessing(EMDR) is a novel, time-limited psychotherapy originally developed for treatment of psychological trauma. The effectiveness of this therapy has been validated only for posttraumatic stress disorder; however, EMDR is often applied to other psychiatric illnesses, including other anxiety disorders and depression. This pilot study tested the efficacy of EMDR added to the routine treatment for individuals with acute stage schizophrenia. METHODS: This study was conducted in the acute psychiatric care unit of a university-affiliated training hospital. Inpatients diagnosed with schizophrenia were randomly assigned to either three sessions of EMDR, three sessions of progressive muscle relaxation(PMR) therapy, or only treatment as usual(TAU). All the participants received concurrent typical treatments(TAU), including psychotropic medication, individual supportive psychotherapy and group activities in the psychiatric ward. The Positive and Negative Syndrome Scale(PANSS), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were administered by a clinical psychologist who was blinded to the patients' group assignment. RESULTS: Forty-five patients enrolled and forty patients(89%) completed the post-treatment evaluation. There were no between-group differences in the withdrawal rates of patients during the treatment or at the three-month follow-up session. All three groups improved significantly across each of the symptomatic domains including schizophrenia, anxiety, and depressive symptoms. However, a repeated measures ANOVA revealed no significant differences among the groups over time. Effect size for change in total PANSS scores was also similar across treatment conditions, but effect size for negative symptoms was large for EMDR(0.60 for EMDR, 0.39 for PMR and 0.21 for TAU only). CONCLUSION: These findings supported the use of EMDR in treating the acute stage of schizophrenia but the results failed to confirm the effectiveness of the treatment over the two control conditions in three sessions. Further studies with longer courses of treatment, more focused target dimensions of treatment, and a sample of outpatients are necessary.

Military Psychiatry and Deployments:Post-traumatic Stress Disorders in Bundeswehr Soldiers / 解放军医学杂志

In the 15 years since the end of the Cold War, the extended task spectrum of the Bundeswehr has included missions abroad. These entail special psychological stress for soldiers. Some develop unspecific stress symptoms, while others develop post-traumatic stress disorders as a result of their exposure to stress. The Bundeswehr has created a medical and psychological stress concept to organize the prevention of stress and trauma. In its military hospitals (particularly in Hamburg), the Bundeswehr has established special facilities for trauma therapy, which will be presented and described in the following article.

Treatment of Posttraumatic Stress Disorder / 신경정신의학

Posttraumatic stress disorder (PTSD) is a psychiatric disorder which cause is certain, and mechanism of PTSD has been studied actively for decades. The various kinds of therapy, based on the pathophysiology of PTSD, were applied and among them eye movement desensitization and reprocessing (EMDR), therapy for sleep, transcranial magnetic stimulation (TMS) and psychopharmacotherapy that showed considerable effect for patients with PTSD would be introduced.

Eye Movement Desensitization and Reprocessing(EMDR) for Post-traumatic Stress Disorder / 신경정신의학

This article reviews existing Eye Movement Desensitization and Reprocessing (EMDR) literature concerning its effectiveness, theory, mechanism, and procedural aspects in the treatment of post-traumatic stress disorder (PTSD). Evidence from randomized clinical trials and meta-analyses indicates that EMDR is as effective as well established treatments such as exposure and cognitive behavior therapy. And moreover, EMDR may be more efficient in terms of unnecessary homework assignment and fewer treatment sessions. The current status of EMDR occupies one of legitimate and standard psychotherapeutic approaches in adult PTSD treatment. Mechanism for treatment efficacy is poorly understood at present and putative at most, however, there is a growing body of literature on neurobiological change after successful EMDR treatment.

Changes in the Regional Cerebral Perfusion after Eye Movement Desensitization and Reprocessing: A SPECT Study of Two Cases

Over the last decade, EMDR(Eye Movement Desensitization and Reprocessing) has emerged as a promising new treatment for trauma and other anxiety-based disorders. However, neurobiological mechanism of EMDR has not been well understood. Authors report SPECT findings of two patients of PTSD before and after EMDR. Brain 99mTc-ECD-SPECT was performed before and after EMDR treatment. To evaluate the significance of changes in the regional cerebral perfusion, t-test was conducted on the resulting images using SPM99. In addition, clinical scales(CAPS, CGI, STAI) were employed to asses the changes in the clinical symptoms of the patients. After EMDR treatment, each showed significant improvement in clinical symptoms. The cerebral perfusion increased in bilateral dorsolateral prefrontal cortex, and decreased in the temporal association cortex. The differences in the cerebral perfusion between patients after treatment and normal controls decreased. These changes appeared mainly in the limbic area the and the prefrontal cortex. These results suggest that EMDR may show the therapeutic effect through 1) improvement in the emotional control by increased activity in the prefrontal cortex, 2) inhibited hyperstimuli on amygdala by deactivation of the association cortex, 3) inhibition on past trauma related memory, and 4) keeping the functional balance between the limbic area and the prefrontal cortex. This case report needs further replication from studies with larger sample.

Family Violence: Psychiatric Aspects / 신경정신의학

OBJECTIVE: Psychiatrists have recently paid attention to family violence victims, possibly due to the increase of the case, difficulty in case finding and management, and unfavorable treatment outcome. In this review article, the author introduced knowledge and clinical guideline for desirable approach. METHODS: This article was from review of articles and the author's 20 years clinical experience at the victim clinic. RESULTS: Incidence of family violence in Korea is three fold higher than that of the United States and China. Batterers' personality and behavior pattern, their characteristic action of violence, victims' victimization process, victims' emotional and cognitive response, characteristics of victims' clinical behavior, desirable attitude of psychiatrists, and the 7 stage approach by the author were introduced.