231 The Efficacy of Time Empowerment Techniques in the Treatment of Depressive Disorders (more recently known as Mental Emotional Release Therapy MER ) A Hypnotherapeutic Activity That Blends Visualization, Neuro-Linguistic Programming, and Light Trance is Evaluated in the Treatment of Major Depressive Disorders and Adjustment Disorders that Contain a Depressive Feature. Patrick Ross Scott, PhD, DCSW HeadsUp Guidance & Wellness Centers of Nevada Abstract To investigate the relative effectiveness of Time Empowerment Techniques, more recently known and henceforth referred to as Mental Emotional Release Therapy (MER ) as an adjunct treatment to Cognitive Behavioral Therapy (CBT) in the treatment of depressive disorders and adjustment disorders with a depressive component, retrospective chart review of 922 electronic health records (EHR) were examined. Ninety-seven participants received MER as compared to a control group of 766 participants who received CBT alone as measured over a two-year period from October 1, 2008 to September 30, 2010. Measures of length of stay inclusive of number of weeks of treatment, as well as number of cumulative sessions were used to evaluate whether those participants receiving MER had shorter lengths of stay. Initial findings of these data revealed that contrary to our hypothesis, pure statistical measures showed just the opposite. Although depressive symptoms were reduced in significantly fewer sessions, this sample of those receiving MER actually had longer lengths of stay than their CBT counterparts. It is anticipated that a future study may reveal the longer length of stay had more to do with rapport and the client s enjoyment of the process. This led to further investigation of the charts themselves and demonstrated that although participant s length of stay in the experimental group was longer, their remission of depressive symptomatology occurred, on average in five sessions. Although a multivariate process, it was discovered that participants receiving MER had a 37% shorter period to remission of depressive symptoms than those who did not. This study represents the first retrospective chart review of MER in relation to the depressive disorders. Recommendations for further controlled study are made. What is Mental Emotional Release Therapy? Originally called Timeline Therapy by Dr. Tad James in the 1980 s and Time Empowerment Techniques by his son Dr. Matthew James early in this century, Mental Emotional Response Therapy (MER ) is a fast and effective process for letting go of the negative emotions of fear, anger, hurt, sadness and guilt. Although classified under the broad umbrella of clinical hypnotherapy, this treatment blends elements of light trance, with the more cognitive aspects of Neuro-Linguistic Programming (NLP). The patient is asked to visualize, imagine or feel their life as occurring on a timeline without beginning or end. They are then invited to float above this timeline to identify root causes of negative emotions, limiting decisions and internal conflicts. Easily taught and replicated, this technique requires no content disclosure to the therapist, unless desired by the patient. Contrary to older forms of regression hypnotherapy, this process, when used for trauma recovery, does not require the patient to re-live past events. This study demonstrated the use of this technique toward the remission of depressive symptomatology. Mental Emotional Release Therapy (MER) B A Past C Event Now Future Page 1 (Contiuned on following page 2)
Research & Data Notes Demographics are interesting to note first for the entire sample taken together that 37.66% (n=325) were male and 62.22% (n=537) were female, 36.48% (n=316) were 18 or under, 42.60% (n=369) were young adults to age 40, 25.63% (n=222) were adults age 41 and over. 62.24% (n=539) came from lower socio-economic areas, while the rest came from the more affluent areas of Las Vegas. The ethnic breakdown fell out along stereotypical lines with the majority of minorities being represented at the downtown clinic and the majority of non-minorities at the suburban clinic. In the control group 83.29% (n=638) were unemployed at the time of treatment, and their insurance was primarily Medicaid. The experimental group showed much less unemployment at 37.11% (n=36), and had higher percentages of private insurance. A 35% unemployment rate, even among more affluent participants is still over double the rate of Las Vegas unemployment of 15%. When controlled for those participants under 18, the percentage drops to 7% of the experimental group, which is more in line with the nation as a whole. This is half the average unemployment rate for adults in Las Vegas. This leads us to believe that at least in this cohort at this time, those participants who underwent a MER process, were largely non-minority, employed and relatively affluent than their inner city counterparts. Ironically, these demographics seem to share little homogeneity and are quite different from urban to suburban in nearly all arenas. Among experimental group participants, 33% suffered from chronic pain, while 43% likely had co-occurring substance use disorders, which may have complicated treatment. 53% were taking psychotropic medications at the time of treatment, which may also have complicated treatment. Methodology Participants From October 1, 2008 to September 30, 2010 this study evaluated 922 participants by chart review that were diagnosed with major depressive disorder or an adjustment disorder with a depressive component. After excluding those patients receiving medication only: 766 participants were assigned to the control group who received Cognitive Behavioral Therapy (CBT) only 97 participants were assigned to the experiment group and received Mental Emotional Release Therapy (MER) in addition to CBT The control group Female (63%), Caucasian (36%), and unemployed (83%) The experimental group Female (60%), Caucasian (80%), and unemployed (37%) The majority of participants were adults between the ages of 26 to 40 Participants were patients seen at 5 Las Vegas area clinics; 3 of which associated with HeadsUp Guidance & Wellness Centers of Nevada (The Archie Grant Housing Development, The Marble Manor Housing Development and the flagship location at the Housing Authority Complex) and 2 affiliated with Summerlin Health & Wellness located in Summerlin, a western suburb of Las Vegas. Apparatus and Materials Prior to treatment, all participants were asked to complete an informed consent form, a treatment and outpatient services contract, a consent form indicating agreement to treatment administered by an intern therapist or practicum student, and provided materials informing HIPAA policy, office procedure and the no-show protocol. Following completion of written agreements, participants were administered two basic screening interviews prior to treatment. The first screening interview (i.e. Behavioral Health Screening) was administered for 30 minutes by any of 4 practicum students from the University of Nevada, Las Vegas School of Social Work. The Behavioral Health Screening (BHS) was used to collect demographic criteria, insurance information and financial status, and administer the PHQ-9 scale to evaluate depression. Following the BHS, a 60-minute intake assessment was conducted by a licensed intern to further understand the client s presenting problems, psychiatric, medical, family, social and substance abuse history and DSM IV diagnoses. Following these procedures participants were assigned to the CBT group or the MER group and data was collected during a twelve-week period in the Fall of 2010 by research assistants from area universities and analyzed for inclusion in the study. Page 2 (Contiuned on following page 3)
Following these procedures participants were assigned to the CBT group or the MER group and data was collected during a twelve-week period in the Fall of 2010 by research assistants from area universities and analyzed for inclusion in the study. Procedure Four graduate students screened the files of all patients from each of the 5 clinics using the Valant Med EMR database; this amounted to more than three thousand records. Data was evaluated according to ICD-9 specific numerical assignments and those diagnosed with major depressive disorder or adjustment disorder with depressed mood were marked for inclusion. In addition, patients identified with the previously mentioned diagnoses were divided into 2 groups: those who received only CBT and those who received MER. Following this data collection, categories were established to evaluate the following: duration of treatment, number of sessions, progression of diagnosis, discharge diagnosis and treatment recommendations, among other variables. 537) and ethmajor- Disorders (more recently known as Mental Emotio 35% n conn as this inner n in luated in the Treatment of Major Depressive Disorders and Adjustment Disord s Scott, PhD, DCSW Wellness Centers of Nevada rs, e com- major nly: Maintai Emotion be simp Tempor g Our me gestalt o As a fun ract, ls ere s When it ster urther. week Page 3 The unc (Contiuned on following page 4) Fewe to an ex
Prime Directives of the Unconscious Mind Runs the body & preserves the body Maintains the integrity of the body and may produce complex behaviors to achieve this The domain of the emotions Emotions reside in the unconscious mind. Individuals out of touch with their unconscious mind may appear to communicate poorly or be simply reactive. Stores memories Temporal (in relationship to time) & atemporal (not in relationship to time) memories are stored for retrieval and reference Organizes memories Our memories are organized generally according to time, but also organized according to subject and feelings. The mechanics of this is a gestalt of emotion from an unconscious memory chain (see figure 2) Page 4 (Contiuned on following page 5)
Represses memories with unresolved negative emotions As a function of self-preservation, memories can be repressed until the unconscious mind feels safe enough to reveal them Presents repressed memories for resolution When it is safe, it can bring those memories to consciousness for integration Is symbolic The unconscious mind uses and responds to symbols, metaphors, stories, fantasies and imagery Key Findings Fewer sessions to recovery: A control group of 766 patients who received Cognitive Behavioral Therapy (CBT) only was compared to an experimental group of 97 patients who also received Mental Emotional Release Therapy (MER ). Participant length of stay in the experimental group was surprisingly longer (13 sessions versus 9 sessions), but the remission of depressive symptoms occurred, on average, in five sessions, significantly shorter than in the control group. In none of the experimental group did the MER process take longer than eight sessions to reach remission of depressive symptoms using DSM-IVTR criteria. Participants receiving MER had a 37% shorter period to remission of depressive symptoms that those who did not. More engaged in treatment: The largest frequency of sessions seemed to coalesce around the 4-7-session range in the control group (73%), whereas in the experimental group a significantly larger percentage of patients continued their treatment into the 8-12 session range (49 %) as compared to 27% for the control group. Among the experimental group, those patients were returned to a higher level of functioning sooner, than their control group counterparts. No documented recidivism: While we cannot be sure of their condition post treatment, there were no documented cases of relapse, recidivism or re-hospitalization after their MER experience. Conversely, the CBT counterparts experienced a 29% recurrence of depressive symptoms motivating them back to treatment and an 11% occurrence of re-hospitalization for psychiatric reasons during the twenty-four month examination period. Limitations The subjective nature of behavioral health research is well documented, this study has many biases and limitations and although raises curiosity about this technique as an adjunct treatment to CBT, controlled research is essential. This study examined existing medical records, and the variety and style of charting certainly varied from patient to patient and chart to chart. Given the number of researchers and the hours spent, we suspect there were variations of inclusion criteria that could account for error in reporting. While clearly the results show promise, a more systematic and clinically scientific approach is necessary. Conclusions We are learning that a multi-disciplinary and collaborative approach to mental health is the most effective. This study represents a small step in adding to the repertoire of holistic approaches and tools utilizing a conscious mind/unconscious mind partnership. Page 5 End of Document