This study compared the effect of eye movement desensitization and reprocessing (EMDR) therapy versus guided imagery on insomnia severity in patients with rheumatoid arthritis (RA). In this randomized controlled trial, 75 patients with RA were selected via convenience sampling before using block randomization to assign patients into three groups comprised of (a) six sessions of EMDR, (b) six sessions of guided imagery, and (c) a control group. The Persian version of the Insomnia Severity Index was implemented at preintervention and 2 weeks' postintervention as the outcome measure. The EMDR group obtained respective pre-and postintervention mean scores of 23.5 ± 5.2 and 11±2.1, whereas the guided imagery group obtained scores of 24 ± 3 and 15.3 ± 2.3, and the control group obtained scores of 24.2 ± 3.3 and 23.6 ± 3. Pairwise comparisons showed statistically significant differences in insomnia severity between patients from each group, with the EMDR group experiencing a greater reduction in insomnia severity than guided imagery. EMDR and guided imagery were both effective in reducing insomnia severity in RA patients, although the degree of insomnia reduction for patients from the EMDR group was greater than that of the guided imagery group.
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- Go to article: The Effect of EMDR Versus Guided Imagery on Insomnia Severity in Patients With Rheumatoid Arthritis
Eye movement desensitization and reprocessing (EMDR) therapy is a form of psychotherapy used for individuals who have experienced stress-related injuries. Having an unpleasant experience of previous childbirth can cause anxiety and fear of labor in women during the next childbirth. The aim of this study was investigating the effect of the EMDR therapy on childbirth anxiety among multiparous women in the next normal pregnancy, following a prior stillbirth. A randomized controlled clinical trial was conducted with 30 pregnant women after they were admitted for delivery in an urban hospital in Qazvin, Iran, in 2016. The participants were selected using a convenient sampling method and then were randomly assigned into two groups, EMDR intervention (n = 15) and usual treatment control (n = 15). The Van den Bergh Pregnancy-Related Anxiety questionnaire was used to collect data before treatment (on admission when recruited for study) and after treatment (within 24 hours after childbirth). The EMDR therapy for the intervention group was performed with a 90-minute session when participants were admitted in hospital for delivery. The control group received only routine care. Data were collected using descriptive and inferential statistics and p < .05 was considered statistically significant. A statistically significant reduction in the mean anxiety in the EMDR intervention group compared to the control group was reported. Also, a reduction in the scores of posttest compared with pretest was observed in the EMDR intervention group (p < .01). The EMDR therapy reduced childbirth anxiety in pregnant women during normal pregnancy, following previous stillbirth.
Although treatment fidelity measures for eye movement desensitization and reprocessing (EMDR) have been cited in past research, none have been subject to any empirical investigation of reliability. This three-phase study aimed to quantify the interrater reliability of a measure of EMDR treatment fidelity. First, two raters refined the reprocessing section of the EMDR Fidelity Checklist (Leeds, 2016) by developing a descriptive item-by-item scoring system to improve interpretation and reliability. The resultant checklist was piloted on recordings of five EMDR session recordings from the Laugharne et al. (2016) study. The checklist was then revised. Next, the raters used the checklist to assess 15 other recorded EMDR sessions from the same study. The intraclass correlations (ICCs) were in the excellent range for all subscales and total session scores (i.e., >0.75), with an exception of the Desensitization subscale, ICC = 0.69 (0.08, 0.90). Finally, individual items in that subscale were evaluated, finding that five items did not contribute to the ICC. When these were removed/revised, the ICC for this subscale moved into the excellent range, ICC = 0.81(0.43, 0.94). The findings of this study indicate that this checklist may be a reliable measure of treatment fidelity for single reprocessing EMDR sessions with the possible exception of the Body Scan phase. Future research using the checklist with raters who were not involved in checklist development is needed to confirm the generalizability of these findings.
This article discusses strategies for working with patients who present with the specific psychological deficits associated with complex trauma. In order to maintain the patient's stability, safety, and capacity for adaptive information processing (AIP) during sessions, these treatments require an extremely active therapist who is able to help regulate the pace of therapy and the patient's participation in it. Attunement to both patient's and therapist's experience is a core therapeutic process that enables the treatment. Eye movement desensitization and reprocessing (EMDR) therapists must set the frame of the therapy, help to build and then utilize the capacity for AIP, and establish a relationship capable of coregulating the patient's state during both resource development and trauma processing. All of these functions can be enhanced using bilateral stimulation (BLS). They are accomplished via specific therapist actions during sessions: assessing and supporting the capacity for AIP, looking for opportunities to strengthen resources and competencies, and staying attuned to empathic resonances and countertransference. Decisions that shape the treatment process and affect its pacing evolve from an integration of multiple factors: the therapist's attunement to self, patient, and the therapy relationship; and an understanding of complex trauma, dissociation, therapeutic process, and EMDR. Examples of patient–therapist interaction during two EMDR sessions are provided to illustrate therapy process and the use of the treatment relationship in clinical decision-making and coregulation.
- Go to article: Flash Technique Group Protocol for Highly Dissociative Clients in a Homeless Shelter: A Clinical Report
Flash Technique Group Protocol for Highly Dissociative Clients in a Homeless Shelter: A Clinical Report
The Flash Technique is a new protocol for use in the preparation phase of eye movement desensitization and reprocessing (EMDR) to quickly reduce the emotional intensity of traumatic memories, prior to full processing with EMDR. This report presents results from a Flash Technique group for five highly dissociative, currently sober addicts in a men's shelter. This group was an attempt to provide an affordable, trauma-focused intervention for the homeless. As part of the intake, each client met individually with the therapist for 30 minutes, to learn to use the flash technique to process a traumatic memory. Three inventories were used to measure treatment outcome: the Short PTSD Rating Interview (SPRINT), the Dissociative Experience Survey (DES-II), and the Beck Depression Inventory-II (BDI-II). Clients filled out the surveys 3 weeks before the start of the group and had their individual sessions 2 weeks before the start of the group. The DES and BDI-II were repeated at the beginning of the eighth session of the group. Clients' surveys showed a decline in scores after seven sessions of therapy: the DES scores dropped from 39.07 (standard deviation [SD] = 23.01) to 20.48 (SD = 10.02) with d = 0.81 and the BDI-II scores dropped from 32.4 (SD = 11.01) to 13.2 (SD = 8.4) with d = 1.74. Pre- and 2-week posttreatment SPRINT surveys showed scores dropping from 28 [SD = 2.05] pretreatment to 15.75 [SD = 5.19] 2 weeks posttreatment, with d = 6.07.
- Go to article: Brave New Psychiatry and the Idealization of Nonplaces: A Critical Discourse Analysis
In this article, a document presenting a planned psychiatric building in Sweden was analyzed using critical discourse analysis. Focus was on how biomedical perspectives, administration, logistics, and efficiency is materialized in the building. The building is planned without personal consulting rooms or office places. Text and images were understood with reference to Augé's concept of nonplaces; places that are void of meaning. Outpatient practice is portrayed as equal, neglecting power imbalances, diversity, and context. Clinicians and clients are expected to be in transit in an environment centered on transparency and technology, enabling surveillance and control. Encounters and dialogues are never mentioned, while electroconvulsive therapy has its own place both in the document and in the building. Technology is central and presented as necessary for future needs. The idea that current psychiatry represents a story of constant progress, providing precise diagnosis and effective treatment is materialized in the building.
- Go to article: How the Incorrect Belief That Eating Disorders Are Predominantly Genetic Is Maintained
The incorrect belief that anorexia nervosa is predominantly genetic is maintained in the psychiatric literature by a series of misquotations and misrepresentations of research data. An example of this type of scholarship is as an editorial in The American Journal of Psychiatry. Data from family and twin studies referenced in the editorial provide compelling evidence that the genetic contribution to the etiology of anorexia nervosa is small. The incorrect belief that anorexia nervosa is predominantly genetic is maintained, in addition, by statistical procedures such as heritability estimates. The incorrect belief that anorexia nervosa is predominantly genetic should not be endorsed by the American Psychiatric Association, in either its journals, in its published books, or in DSM–V.
Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased selection and interpretation of available evidence. Second, the authors have failed to take into consideration the widespread corruption in the research on antidepressants. Third, the many and serious side effects of antidepressants are not considered. Thus, the recommendation may have deleterious consequences for countless numbers of people, and, in fact, contribute to an increase in the suicide rate rather than a decrease.