This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.
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This chapter focuses on identifying and working with dissociative symptoms and dissociative disorders in a therapeutic context, providing a road map to assist with the pacing and planning of clinical interventions. Rapid eye movement (REM) sleep can be conceptualized as a household strength processor that can accommodate the usual processing requirements of daily life. Posttraumatic stress disorder (PTSD) has been historically defined as requiring a trauma that is outside the range of normal human experience. Hypoarousal and parasympathetic activation that are an intrinsic part of dissociative symptoms are much more difficult to assess. The original painful memories live on in flashbacks and nightmares as well as in reenactments of the unconscious dynamics captured from the family of origin’s enactments of perpetration, victimization, rescuing, and neglect. Excessive sympathetic nervous system activation is easily construed to be an indicator of psychopathology.
This chapter reviews the disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. It talks about the neural underpinnings of self-referential processing and examines how they may relate the integrity of the default mode network (DMN). The chapter describes the deficits in social cognition, with a particular focus on theory of mind in PTSD and the neural circuitry underlying direct versus avert eye contact. It then addresses the implications for assessment and treatment. Johnson demonstrated that self-referential processing is associated with the activation of cortical midline structures and therefore overlaps with key areas of the DMN in healthy individuals. Healthy individuals exhibited faster responses to the self-relevance of personal characteristics than to the accuracy of general facts. Less activation of the medial prefrontal cortex (PFC) was observed for the contrast of self-relevance of personal characteristics relative to general facts as compared to controls.
This book was conceived out of the authors' shared vision to synthesize key neurobiological developments with effective developments in clinical practice to offer both understanding and practical guidance for the many practitioners working to heal people burdened with traumatic sequelae. It is unique in bringing in all levels of the brain from the brainstem, through the thalamus and basal ganglia, to the limbic structures, including the older forms of cortex, to the neocortex. The book looks at the neurochemistry of peritraumatic dissociation (PD) and explores the effects on neuroplasticity and the eventual structural dissociation. Individual chapters focus on the definition of PD and tonic immobility (TI) and their associations with posttraumatic psychopathology, and review disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. Separate chapters focus on the modulatory role of the neuropetides in attachment as well as autonomic regulation, and highlight mesolimbic dopamine (ML-DA) system as central to the experiences of affiliation, attachment urge when under threat, attachment urge during experience of safety, and to the distress of isolation and/or submission. The book while increasing awareness of different parts of the self and ultimately creating a more stable sense of self, also incorporates psychoanalytic, cognitive behavioral, and hypnotic methods, as well as specific ego state, somatic/sensorimotor therapies, eye movement desensitization and reprocessing (EMDR), and variations of EMDR suitable for working with trauma in the attachment period. The latter methods are explicitly information-processing methods that address affective and somatic modes of processing.
This chapter presents a combined creative-corrective approach to working with the bereaved by emphasizing on cognitive assessment as a tool for social workers. It determines how best to facilitate an adaptive grief process with individuals who experience traumatic loss or complicated grief. Cognitive therapies (CT) and cognitive behavior therapies (CBTs) were found suitable with individuals suffering from posttraumatic stress disorder (PTSD), anxiety, and chronic or traumatic grief. Grief as a process of reorganizing one’s life and searching for a meaning following a loss through death is a painful experience. The Adversity Beliefs Consequences (ABC) model is based on a cognitive theoretical model to be applied in treatment of bereaved individuals. Like other cognitive models, rational emotive behavior therapy (REBT) emphasizes the centrality of cognitive processes in understanding emotional disturbance, distinguishing between two sets of cognitions that people construct, rational and irrational ones and their related emotional and behavioral consequences that differ qualitatively.
This chapter focuses on self-care for Eye Movement Desensitization and Reprocessing (EMDR) practitioners. The protocol was derived from the notes of Neal Daniels, a clinical psychologist who was the director of the posttraumatic stress disorder (PTSD) Clinical Team at the Veterans Affairs Medical Center. In Dr. Daniels’s words, the procedure is short, simple, effective. Right after the session or later on in the day when it is possible, bring up the image of the patient, do 10–15 eye movements (EMs); generate a positive cognition (PC) and install it with the patient’s image, and do 10–15 EMs. Once the negative affects have been reduced, realistic formulations about the patient’s future therapy are much easier to develop. Residual feelings of anger, frustration, regret, or hopelessness have been replaced by clearer thoughts about what can or cannot be done. Positive, creative mulling can proceed without the background feelings of unease, weariness, and ineffectiveness.
Sexual trauma includes any type of physical touching or other activity of a sexual nature that is against our will or done without our consent. This chapter defines sexual trauma as anything that occurred or was threatened to occur that was experienced as a violation of a sexual nature. Sexual trauma occurs in many different forms and any sexual trauma can be deeply wounding, requiring new skills for healing. Military sexual trauma (MST) refers to experiences of sexual trauma that occur while a person is serving on active duty military service. The link between MST and homelessness is a perfect example of accumulated symptoms. MST was related to symptoms of posttraumatic stress disorder (PTSD). Forced sex may be viewed as an act of domination to inflate one’s sense of self-importance or power. Psychological symptoms include negative thought patterns such as negative thinking, negative thoughts around trust, safety, and self-blame.
Eye movement desensitization and reprocessing (EMDR) Standard protocol connects a trauma model of relationships to Bowen’s concept of differentiation. In addition to those couples where a traumatic episode, prior to or during the relationship, has had a clear impact on the relationship, highly reactive couples are those who profit most from integrating EMDR into their couples work. EMDR can play an important role when reactivity in sessions blocks therapist interventions or resists routine interventions; when one or both partners are so reactive as to be abusive. When EMDR is used to treat trauma, therapists generally look for treatment change specific to the trauma and its posttraumatic stress disorder (PTSD)-like symptoms. In couples therapy, the desired outcomes are more the generalized effects of EMDR and those we might expect from EMDR performance enhancement.
This chapter looks at dissociation, psychosis, and schizophrenia from a phenomenological standpoint. Phenomenology is the lens through which psychiatrists look at mental illness, and psychiatry as a specialty has looked at people in this way from its earliest days. In taking a phenomenological view of dissociation and psychosis, the chapter reiterates some of the dissonance brought by Laing when he invited people to understand schizophrenia as a theoretical model and not a biological entity. Extreme dissociation is the most primitive form of survival, where a human being is confronted with events that are impossible to process. Treating schizophrenia by formulating it within a trauma and dissociation paradigm allows for the application of eye movement desensitization and reprocessing (EMDR) therapy, which is one of the current international gold-standard psychotherapies for posttraumatic stress disorder (PTSD).
This chapter covers psychiatric diagnoses that might be applied to children seen in primary care: pediatric bipolar disorder, major depression, attention deficit hyperactivity disorder (ADHD), and posttraumatic stress disorder (PTSD). It discusses the diagnoses of the context in the neuroscience explaining the disorder. The chapter reviews the efficacy of current pharmacological treatments along with explanations regarding how they impact physiology, and considers side effects. It also provides alternatives to drugs administered for distress in the children themselves. The profile of adults with bipolar I differs dramatically from the behavioral pattern of children being diagnosed as having pediatric bipolar disorder. The Food and Drug Administration (FDA) has approved fluoxetine/Prozac for the treatment of depression in children. Antidepressants carry an FDA black-box warning for suicidal ideation in children and adolescents. Stimulant drugs are the mainstay of treatment for ADHD. The number of children in foster care receiving antipsychotic drugs is particularly notable.