[Stabilisation in trauma treatment: necessity or myth?]. / Stabilisatie in traumabehandeling bij complexe ptss: noodzaak of mythe?

BACKGROUND: With regard to the treatment of patients who have been traumatised in childhood by interpersonal trauma and have been diagnosed as having symptoms of complex ptsd, it is advisable that exposure of such patients to traumatic memories should be preceded by a stabilisation phase: during this phase patients can be taught various techniques including particularly those that enable them to regulate their emotions. AIM: To find out whether there is strong empirical evidence for the introduction of a phase-based treatment approach for this patient group. METHOD: We performed a critical evaluation of the available scientific literature and guidelines. We took as our starting point the studies that formed the basis of the Expert Consensus Guidelines for Complex ptsd. RESULTS: Our research shows that trauma-focused treatment, be it with or without a preparatory stabilisation phase, is also effective for patients with complex ptsd symptoms. However, there is certainly no compelling evidence to support the assumption that well-organised and carefully administered evidence-based treatment has to be preceded by a stabilisation phase. CONCLUSION: Among the experts there is uncertainty about the best form of treatment for patients with complex ptsd that has resulted from interpersonal trauma in childhood. For the time being, the severity and complexity of trauma-related problems are not valid reasons for denying patients a period of stabilisation as recommended in national treatment guidelines, nor are they valid reasons for preferring a phase-based treatment over a trauma-focused type of treatment.

Efficacy of eye movement desensitization and reprocessing in the treatment of specific phobias: Four single-case studies on dental phobia.

A series of single-case experiments was used to evaluate the application of Eye Movement Desensitization and Reprocessing (EMDR) to traumatically induced dental phobia. Following two to three sessions of EMDR treatment, three of the four patients demonstrated substantially reduced self-reported and observer-rated anxiety, reduced credibility of dysfunctional beliefs concerning dental treatment, and significant behavior changes. These gains were maintained at six weeks follow-up. In all four cases, the clinical diagnosis present at pretreatment was not present at posttreatment at a clinical level. All patients actually underwent the dental treatment they feared most within three weeks following EMDR treatment. The findings support the notion that EMDR can be an effective treatment alternative for phobic conditions with a trauma-related etiology.

Arterial balloon occlusion of the hypogastric arteries: a life-saving procedure for severe obstetric hemorrhage.

In this case report we describe two patients with life-threatening postpartum hemorrhage who were treated successfully with arterial balloon occlusion of the hypogastric arteries. Arterial balloon occlusion is easy to perform and is applicable under difficult circumstances. The technique should be available in all hospitals that provide obstetric services. Obstetricians should know about it so they can ask their radiologic colleagues to perform the procedure.

Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues.

This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention.

[A new development in the treatment of anxiety and trauma: "eye movement desensitization and reprocessing (EMDR)"]. / Eine neue Entwicklung in der Behandlung von Angst und Traumata: "Eye Movement Desensitization and Reprocessing (EMDR)".

This article presents a new development on the field of psychotherapy: Eye-Movement Desensitization and Reprocessing (EMDR). This recently developed procedure promises rapid and effective treatment of anxiety related complaints, including post-traumatic stress disorders (DSM-III-R). In essence the therapist induces a series of rapid and rhythmic eye-movements. EMDR facilitates cognitive changes and lasting decrease of anxiety. As indicated by research and illustrated by case histories, EMDR can be effective in one session. Until now there is no definitive explanation for the effectiveness of this method.

Prenatal ultrasound diagnosis of an intracranial teratoma influencing management: case report and review of the literature.

Of seventeen cases of prenatally diagnosed intracranial teratomas, fourteen babies were delivered through a cesarean section. All children died before or shortly after delivery. In this report another case is presented of ultrasound diagnosis of an intracranial teratoma. The teratoma filled the whole fetal cranium, and eroded through the skull base into the left maxillary region. In full agreement with the wishes of the parents, conservative management resulted in the spontaneous vaginal delivery of a fetus that died during labor as a result of brain compression and acidosis during the second stage. In contrast with other cases in the literature, no encephalocentesis was performed. In order to minimize maternal morbidity, it is advised to induce or accept labor as soon as the diagnosis is clear and to pursue a vaginal delivery.