Ideal Parent Figure method in the treatment of complex posttraumatic stress disorder related to childhood trauma: a pilot study.

Background: There is a consensus within the trauma field for the necessity of a three-phase treatment programme for complex posttraumatic stress disorder (CPTSD). This pilot study focuses on the stabilisation phase, the goal of which is the development of psychological resources and the reduction of disabling symptoms. Objective: To test the efficacy of the Ideal Parent Figure (IPF) method as a stabilization treatment for CPTSD patients with a history of childhood trauma. Method: The sample was comprised of 17 adults with a history of childhood trauma concomitant with CPTSD symptoms consulting at a clinic in France. Participants enrolled in a 5-week psychotherapy programme based on the IPF method, a semi-structured visualization programme designed to treat attachment disturbances. Measures of DESNOS symptoms, psychological symptoms, quality of life, and adult attachment were administered pre- and posttreatment as well as at 8-month follow-up. Results: A significant decrease in symptom severity and attachment traumatization and a significant increase in quality of life were found, both with medium-to-large effect sizes. The 8-month follow-up assessment showed outcome stability. Conclusions: These results suggest that treating attachment disturbances directly with an approach akin to the Ideal Parent Figure method may lead to fast and stable improvement for individuals with CPTSD.

Planteamiento: Existe consenso dentro del campo del trauma sobre la necesidad de un programa de tratamiento de tres fases para el trastorno por estrés postraumático complejo (TEPTC). Este estudio piloto se centra en la fase de estabilización, cuyo objetivo es el desarrollo de recursos psicológicos y la reducción de síntomas incapacitantes. Objetivo: evaluar la eficacia del método de la figura parental ideal (IPF, siglas en inglés de Ideal Parent Figure) como tratamiento de estabilización para pacientes con TEPTC con antecedentes de trauma infantil. Método: La muestra estaba compuesta por 17 adultos con antecedentes de trauma infantil concomitante con síntomas de TEPTC que fueron a consulta en una clínica en Francia. Los participantes se inscribieron en un programa de psicoterapia de 5 semanas basado en el método IPF, un programa de visualización semiestructurado diseñado para tratar las alteraciones del apego. Se administraron mediciones de síntomas de DESNOS, síntomas psicológicos, calidad de vida y apego adulto antes y después del tratamiento, así como en un seguimiento a los 8 meses. Resultados: Se encontró una disminución significativa en la gravedad de los síntomas y la traumatización por apego, y un aumento significativo en la calidad de vida, ambos con tamaños de efecto de mediano a grande. La evaluación de seguimiento a los 8 meses mostró estabilidad en los resultados. Conclusiones: Estos resultados sugieren que el tratamiento de los trastornos de apego directamente con un enfoque similar al método de la figura parental ideal puede conducir a una mejoría rápida y estable para las personas con TEPTC.

A double-blind sham controlled study of right prefrontal repetitive transcranial magnetic stimulation (rTMS): therapeutic and cognitive effect in medication free unipolar depression during 4 weeks.

BACKGROUND: Transcranial magnetic stimulation (TMS) has become a therapeutic tool in psychiatric diseases. METHODOLOGY: The objective was to evaluate the efficacy of TMS in unipolar depression: the percentage of responders (>50% HDRS reduction) and remission (HDRS score < or =8, after four weeks of active TMS treatment in depressed patients free of any antidepressive agent versus placebo-TMS. RESULTS: 27 patients were randomized in two groups: rTMS (N=11) versus sham TMS (N=16). Statistical differences were detected between sham and TMS treated groups on remission (0/16 versus 4/11 p=0.032, 1/16 versus 6/11 0.028 and 1/16 versus 7/11 p=0.011 at day 14, day 21 and day 28, respectively) and on response (2/16 versus 5/11 at day 14 (NS), 2/16 versus 7/11 p=0.0115 at day 21 and 1/16 versus 7/11 (p=0.025) day 28, respectively, using the exact Fisher test). Significant differences were observed between day 1 versus day 8 (p<0.01), day 15, day 21 and day 28 (p<0.001) in TMS group and only versus day 21 (p<0.01) and day 28 (p<0.05) for the sham group. ANOVA comparison between TMS and sham groups was significant at day 14 and day 28 (p<0.05). LIMITATIONS: The few number of patients. CONCLUSION: Our study has shown an efficacy of right rTMS in free medication unipolar depression over a month. Nevertheless, number of patients included is limited and multicentric studies will be necessary to specify the antidepressive action of TMS.

Repetitive transcranial magnetic stimulation as an add-on therapy in the treatment of mania: a case series of eight patients.

The aim of this study is to assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) as an add-on therapy in the treatment of manic bipolar patients. Eight patients were enrolled in an open trial. They received fast rTMS (five trains of 15 s, 80% of the motor threshold, 10 Hz) over the right dorsolateral prefrontal cortex (DLPFC). They were evaluated using the Mania Assessment Scale (MAS) and the Clinical Global Impression (CGI) at baseline and at day 14. All patients were taking medication during the treatment trial. There was a significant improvement of manic symptoms at the end of the trial. No side effects were reported. The results show a significant improvement of mania when patients are treated with fast rTMS over the right DLPFC. However, these results have to be interpreted with caution since they derive from an open case series and all the subjects were taking psychotropic medication during rTMS treatment. Double-blind controlled studies with a sham comparison condition should be conducted to investigate the efficiency of this treatment in manic bipolar disorders.