Agenda: Recovery/Healing/Therapy

Transcription

1 Agenda: Recovery/Healing/Therapy Announcements I. Exposure therapy II. EMDR III. Specialized/experimental approaches IV. Herman Closing 16POT9a - 1

2 Announcements Final exam Th 6/9 9-11am bring green scantron Format and content all multiple choice 2/3 new material (post-midterm), 1/3 old material (roughly) half lecture, half readings (roughly) Study guide posted 16POT9a - 2

3 Announcements No sections or office hours next Mon Alternate review section times for Priscilla s sections Wed 6/1 5:00pm Stevenson 152 Fri 6/3 4:00pm Phys Sciences 136 Can also attend Sona or Sarah section on 6/1 or 6/3 My alternate office hour: 6/ am 16POT9a - 3

4 Extra credit Announcements see concerning Gitta s guest lecture and alternative option (1 point) online evaluation (1 point) Upcoming guest lecture Th 5/26: Christine King (this Thurs) restorative justice and non-violent communication 16POT9a - 4

5 I. Exposure Therapy Used within CBT framework Helpful in dealing w/anxiety originally developed for people w/phobias May be less helpful for PTSD Gentle exposure to traumatic memories or stimuli Goal is to break link with anxiety and distress Several sub-types 16POT9a - 5

6 Systematic Desensitization Pair relaxation with either images of traumatic event ( imaginal desensitization ) or stimuli related to traumatic event ( in vivo desensitization ) Graduated approach Therapist monitors anxiety level or monitor through biofeedback Client provides input and feedback throughout gives sense of control 16POT9a - 6

7 Flooding Goal: Produce feelings of anxiety by exposure to traumatic cues similar to feelings during flashbacks BUT, experienced within safety of therapeutic environment safety allows processing of experience and emotions 16POT9a - 7

8 II. EMDR Eye Movement Desensitization and Reprocessing (EMDR) Was "discovered" by Francine Shapiro in 1987 Widely used to treat trauma symptoms Initially controversial less so, now 16POT9a - 8

9 EMDR Goal is to process memories so that they lose their traumatic "charge Many studies testing treatment efficacy show EMDR and CBT about equally effective in relieving symptoms EMDR might work more quickly (fewer sessions needed) EMDR might last longer 16POT9a - 9

10 Eye Movements You'll see a simulated treatment that requires patient to move eyes rapidly from left to right Most researchers and therapists now believe that eye movement is not necessary Bilateral sound (headphones that "beep") Bilateral tactile (hand-held devices that buzz) 16POT9a - 10

11 Film EMDR: A Closer Look Warning: Simulated session with client who briefly mentions an experience of childhood abuse While watching, think -- does EMDR share elements with BT/CBT Exposure (systematic desensitization, flooding?) 16POT9a - 11

12 EMDR on youtube EMDR: A closer look not available at McHenry Here are two introductions to EMDR on youtube v=gtllfdcje0q v=bqbfij5vwma 16POT9a - 12

13 Efficacy Am Psychological Association EMDR "probably efficacious" for civilian PTSD Am Psychiatric Association EMDR given "highest level of recommendation" for trauma treatment World Health Organization Trauma-focused CBT and EMDR only techniques recommended for trauma 16POT9a - 13

14 Meta-analyses Bisson et al. (2013) CBT and EMDR superior to other treatments Watts et al. (2013) CBT and EMDR are most studied therapies; both are effective Rodenburg et al (2009) (children) EMDR better than control EMDR better than CBT 16POT9a - 14

15 Example study van der Kolk et al. (2007) EMDR vs. Prozac vs. placebo All groups improved Prozac > placebo EMDR >> Prozac, EMDR >> placebo 8 months later 60% of EMDR group completely cured Prozac group relapsed 16POT9a - 15

16 How is EMDR different? EMDR gives rapid access to loosely associated memories helps put them in larger context Verbalization not necessary Can work even if no trusting relationship with therapist although better if that exists 16POT9a - 16

17 How is EMDR different from CBT? Detailed description of trauma not needed No direct challenge to beliefs No homework 16POT9a - 17

18 Critiques EMDR works because it s an exposure therapy 2001 meta-analysis EMDR no better than CBT what is effective in EMDR is not new and what is effective is not new 2013 meta-analysis treatment w/eye movements better than wo/eye movements 16POT9a - 18

19 How does EMDR work? Mechanisms are still under investigation Simultaneously orienting attention outward and inward might be imp orienting outward may invoke a relaxation response or it may disrupt the traumatic memory network Bilateral stimulation may be imp may produce REM-like state that helps with memory consolidation/processing 16POT9a - 19

20 III. Specialized Approaches Body work/somatic Experiencing Peter Levine, David Berceli Nervous system needs to complete the trauma cycle "Trauma releasing" exercises involve shaking v=nmjdkzdmllc 16POT9a - 20

21 Internal family systems therapy We all have different parts to the self Trauma can change these parts e.g. childlike/playful part becomes frozen and numb parts can become more rigid parts can become dissociated extreme version: DID 16POT9a - 21

22 IFS Typical parts managers help navigate the world fire-fighters emergency responders, act impulsively when triggered exiles frozen parts that carry the pain Parts are organized to protect the internal family, the self The Self exists under these protective parts confident, calm, curious 16POT9a - 22

23 How it works talk therapy IFS each part talks sometimes, stands aside sometimes goal is to rest in the Self mindful self-leadership Role play: v=mozj47xosp0 16POT9a - 23

24 Yoga Other techniques reconnection with body self-regulation Neurofeedback see brain waves on monitor feedback helps in learning to be in calm state 16POT9a - 24

25 Specialized Approaches Experimental pharmacological treatments propanolol MDMA- assisted psychotherapy increases feelings of trust and empathy, which may facilitate therapy CNN video (Ecstasy being used as PTSD treatment): v=qvzfiepe690 16POT9a - 25

26 IV. Last Words from Herman Two things are key Trust between client and therapist Empowerment client must have control do not allow abuse experience and sense of powerlessness and helplessness to be reenacted in the therapeutic context 16POT9a - 26

27 Wisdom from Winnie the Pooh 16POT9a - 27

28 Wisdom from Pooh The things that make me different are the things that make me. 16POT9a - 28

29 Wisdom from Pooh You are braver than you believe. Stronger than you seem. And smarter than you think. 16POT9a - 29

30 Wisdom from Pooh If the person you are talking to does not appear to be listening, be patient. It may simply be that he has a small piece of fluff in this ear. 16POT9a - 30

31 Wisdom from Piglet More Tao of Pooh at: 16POT9a - 31