Abreaction for conversion disorder: systematic review with meta-analysis.

BACKGROUND: The value of drug interviews in the treatment of conversion disorder is at present unknown. AIMS: To review all the available papers published in English that report on the use of drug interviews for treating conversion/dissociative disorder. METHOD: Databases (including EMBASE, MEDLINE and PsycINFO) were searched from 1920 to 2009. Selected publications had to report on the use of drug interviews in people diagnosed with a conversion/dissociative disorder. Qualitative and quantitative data were extracted. Predictors of a positive response were ascertained using meta-analytic techniques. RESULTS: Fifty-five papers meeting inclusion criteria were identified. No studies compared the intervention with a suitable control group. However, two studies reported high response rates when drug interview was used in individuals with treatment-resistant conversion disorder. In the meta-analysis, the use of suggestion and occurrence of emotional catharsis during the interview were positively associated with recovery. Combining two medications and comorbid psychiatric disorder were negatively associated with recovery. CONCLUSIONS: The evidence for effectiveness of drug interviews is of poor quality but it may be of benefit in the treatment of acute and treatment-resistant conversion disorder. A proactive approach during the interview, making suggestions the individual will respond, could influence outcome. Comorbid psychiatric disorder should be treated conventionally. Experimental studies to determine efficacy are required.

Memory focused interventions (MFI) as a therapeutic strategy in hypnotic psychotherapy.

The prospect of utilizing memory plasticity (the constructive and transitory nature of memory) for therapeutic purposes has not been widely recognized. However, a number of theoretical and clinical venues throughout the last century have shown its potential application. Intensive research conducted during these last decades, pointed out the possibility of influencing human memory in relation to new memories and their specific components. Moreover, the research showed the feasibility of planting alternative early childhood memories and thus altering memories of personal history. Additionally, researchers found that memory is naturally very fallible due to everyday phenomena of forgetfulness, distortion and intrusion of past and present information. Throughout the course of this paper, the integrative overview of these empirical findings with the aforementioned clinical and theoretical foundations serves as a substratum in an attempt to present an integrative therapeutic approach, named Memory Focused Interventions (MFI).

The therapeutic release of anger: Helen Watkins's silent abreaction and subsequent elaborations of the anger rock.

This paper summarizes Helen Watkins's (1980) silent abreaction technique for releasing anger and the subsequent elaborations it has inspired. Discussion of Watkins's seminal article incorporates her verbatim account of the technique, 2 clinical applications, and her encouragement of further adaptations. Other scholars' subsequent contributions include an adaptation for dissociative identity disorder, brief treatment of constant pain syndrome, and inpatient treatment of a suicidally depressed, dissociative survivor of sexual abuse. Commonalities and distinctions among Watkins's work and these modifications are discussed. New case material from the author's practice illustrate further elaborations, with emphasis on the role of releasing anger in the resolution of dissociative defenses and internal fragmentation in dissociative clients. To enhance the clinical utility of this paper, verbatim passages are included for all case illustrations in H. H. Watkins (1980), the 3 published elaborations, and the new case material.

La concepción de la curación Chamánica entre los indígenas Embera de Colombia: un proceso de comunicación socio-cultural y fisiológico / The cure among the Embera indigenous population: a social, cultural and physiological communication process

Este trabajo etnográfico centra su atención en un ritual terapéutico. El artículo describe en detalle un acto de curación realizado por un chamán Embera, de Colombia, a una mujer indígena que se encontraba hospitalizada en estado grave y no estaba respondiendo al tratamiento médico occidental. Se analizan los pasos del ritual en relación con la cultura Embera y se inicia el abordaje de la comprensión de la terapéutica utilizada por el chamánen la cual se observan claramente los momentos de Abreacción. El texto muestra que en la terapéutica indígena la dicotomía cuerpo-alma, individuo-sociedad-cosmos, no se presenta. El proceso curativo indígena, a diferencia del occidental, es de comunicación socio-cultural y fisiológico; es un acto que trasciende fronteras, en la medida que admite tanto la medicina tradicional como la occidental.A lo largo del artículo queda implícito que la medicina tradicional, a pesar del desprestigio y persecución de la cual fue objeto desde hace medio milenio, aún esta activa en el grupo Embera.

Eye movement desensitization and reprocessing. A brief and effective treatment for stress.

1. Eye movement desensitization and reprocessing (EMDR) is an integrative therapy that "unlocks" disturbing memories or beliefs and reprocessess them, in some way, so they are no longer as disabling. 2. EMDR can be used for any experientially based psychological problems and has proven especially effective for traumatic imagery associated with posttraumatic stress disorder. 3. A primary benefit of EMDR is its time efficiency, requiring as few as 3 to 5 hours of treatment. 4. Many potential mechanisms (i.e., cognitive, hypnotic, self-disclosure, biological) may account for the effectiveness of EMDR.

Cleaning up the river: a metaphor for functional digestive disorders.

The irritable bowel syndrome is characterized by abdominal pain, altered bowel habits and various other digestive symptoms. Emotional factors are important in some patients. I describe here a metaphor which links the altered motility of the digestive system to the emotional contents it may embody. A metaphor of a river is used to evoke both a smooth, coordinated flow through the normal digestive tract and a normal flow in the management of the patient's emotions. The possibility that some blockage has occurred in the river, resulting in perturbation of the normal flow is then suggested to the patient. This is followed by a suggestion for the patient to clear the blockage. This approach may lead patients to work on the emotional components of their symptoms, resulting in their subsequent resolution. I have used this approach with several patients and it proved very effective. This paper demonstrates the use of this metaphor in one of the patients.

Trauma-induced dissociative amnesia in World War I combat soldiers. II. Treatment dimensions.

OBJECTIVE: This is the second part of a study of posttraumatic amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse). METHOD: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted. RESULTS: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model. CONCLUSION: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary.

The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder.

The growing body of research into treatment efficacy with Posttraumatic Stress Disorder (PTSD) has, by-and-large, been limited to evaluating treatment components or comparing a specific treatment against wait-list controls. This has led to two forms of treatment, Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavior Therapy (CBT), vying for supremacy without a controlled study actually comparing them. The present research compared EMDR and a CBT variant (Trauma Treatment Protocol; TTP) in the treatment of PTSD, via a controlled clinical study using therapists trained in both procedures. It was found that TTP was both statistically and clinically more effective in reducing pathology related to PTSD and that this superiority was maintained and, in fact, became more evident by 3-month follow-up. These results are discussed in terms of past research. Directions for future research are suggested.

EMDR minus eye movements equals good psychotherapy.

Eye Movement Desensitization and Reprocessing (EMDR) is a therapy roughly equal in efficacy to others currently available. It is argued that this treatment method is efficacious independent of the value of its component parts (e.g., eye movements) and is successful because it applies common and generally accepted principles of psychotherapy. Ten curative principles of this procedure are discussed as reflective of sound psychotherapy practice. It is hoped that an understanding of this therapy from the perspective of the practice and theory of psychotherapy will assist in its study.

Goldfinger: a framework for resolving affect using ideomotor questioning.

The author presents a structured protocol for resolving repressed, suppressed or otherwise dated affect using ideomotor questioning. Essential to this model is a progressive ratification series which addresses affect, cognition and behavior. A questioning tree illustrates the method of affect inquiry and case examples demonstrate its application. This non-invasive, brief procedure is a useful adjunct to other treatment modalities and instrumental in clarifying the focus of treatment.

Advantages and safeguards in using the ideomotor signaling technique: a commentary of Walsh and clinical practice.

Research and some of the valuable applications of ideomotor signaling are discussed. Then in a commentary on the uses and misuses of ideomotor signaling, and on Walsh's (1997) variant of this technique, safeguards are discussed, particularly concerning asking questions regarding the exploring of events from the past.

Magical realism: a cultural intervention for traumatized Hispanic children.

A case study is presented of two Spanish-speaking immigrant children who were run over in an automobile accident and hospitalized, to describe a culturally congruent play-therapy technique. Drawing on the work of Pynoos and Nader, the author argues for an anthropological approach in play therapy to create hyperaroused states for the traumatized child and to use cultural super heroes-what is termed "magical realism." Such an approach can be used with Latin American traumatized children as well as with children from other Third World countries to provide a culturally appropriate intervention to treat the psychological sequelae of trauma.

Incest memories recalled in hypnosis--a case study: a brief communication.

Accuracy of repressed memories recovered in hypnosis cannot be reliably determined with any greater certainty than non-hypnotically recalled events. Therefore, the practice of therapists' accepting hypnotically enhanced memories as veridical, absent corroborating evidence, is not advocated. A 52-year-old woman with a 27-year history of panic attacks and sleep disorder inadvertently recovered incest memories in hypnosis. Photographs and remembered events by other family members were thought by the patient to provide general support although they did not constitute actual proof of abuse. Implications are discussed.

Catharsis and abreaction in the history of psychological healing.

With roots in ancient religious practices of purification and cleansing and in ancient medicine's purgings, Plato evolved a verbal catharsis for diseases of the soul, and Aristotle developed a catharsis of the passions through tragic drama. Through the centuries, most cultures have had recognized contexts in which emotions were evoked, heightened in intensity, and ultimately released or discharged; and cathartic procedures can be detected in many cultures' healing practices. The late decades of the nineteenth century saw the emergence of numerous psychological healings with a cathartic basis. Catharsis came to mean the lively remembering of a traumatic experience in addition to the emotional release; and the term abreaction frequently was used to refer to the emotional release. Subsequently, the notion that the recovered traumatic memories needed to be integrated with the rest of the patient's mental life became a third significant element. The significance of these three factors has been debated vigorously; but, whether it has been some combination of them or merely the emotional discharge, there has been a cathartic element in many twentieth-century approaches to psychological healing.

[Reduction of pain perception of chronically ill children by intermittent infusion therapy]. / Minderung von Schmerzerlebnissen chronisch kranker Kinder bei intermittierender Infusionstherapie.

Chronically ill children who require life-long i.v. infusions in regular intervals (i.e. Agammaglobulinemia, HIV-infection) can be traumatized by such painful procedures. Some children gradually accept such infusions, whereas other children become sensitized and react with increasing fear and resistance. We report on our experience with a combined method of local anaesthesia and active role-plays enacting the i.v. infusion on a puppet. In more than 230 applications (approximately 11 per child) in our outpatient clinic, 19/20 children reported significantly less pain sensations after the 2nd or 3rd application. The children learned to handle actively the threatening situation. The method of local anaesthesia with Lidocaine/Prilocaine and role playing is suitable to relieve pain and reduces distress of such invasive events as regular i.v. infusions are.

The use of hypnotic age progressions as prognostic, ego-strengthening, and integrating techniques.

Age progression as a hypnotherapeutic technique is mentioned infrequently in the literature when compared with its counterpart, age regression. In this paper we explore the use of progressions, or "views of the future," as prognostic indicators of therapeutic progress and as valuable tools for ego strengthening and for the integration of clinical material. Age progressions vary in the types of suggestions given and can be used to promote growth on multiple levels, facilitating treatment goals and deepening the working-through process. We present six cases in which we used different types of age progressions, and we discuss the significance of the progressions used in each case, within the context of relevant clinical material. We conclude from our observations that the use of hypnotic progressions can be a sustaining, valuable aspect of hypnotherapy, particularly in providing an index of the current direction and progression of the therapy process itself.

Untoward effects associated with hypnosis.

There are numerous reports of untoward effects associated with hypnosis but no reports of hypnosis per se causing a serious untoward effect. The context and manipulations performed are markedly different in the various settings where hypnosis is used. The various settings such as stage hypnosis, amateur hypnosis, clinical hypnosis, and research hypnosis must be considered separately when discussing untoward effects. Although the incidence of untoward effects has been studied in the research setting, the incidence of untoward effects is difficult to assess in some settings (such as stage and amateur hypnosis) and has not been adequately assessed in the clinical setting. After reviewing the literature on untoward effects in these various settings, I conclude that amateur and stage hypnosis should not be done because the risk is not balanced by possible benefits. Research hypnosis and clinical hypnosis by well-trained practitioners are safe procedures if certain guidelines are followed.

Using hypnosis for therapeutic abreactions.

Abreaction, the dramatic reliving of traumatic events under hypnosis, is a powerful therapeutic intervention useful in the treatment of victims of trauma. First systematically applied in World War I, abreaction coupled with psychotherapeutic processing of the recovered material is increasingly being used with victims of child abuse and chronic PTSD. Abreactions are helpful in recovering dissociated or repressed traumatic material, reconnecting missing affect with recalled material and for transforming traumatic memories. Although abreactions can be induced with medications, hypnosis is the method of choice except in acute situations where it is not possible to establish rapport. A variety of hypnotic techniques for the induction and management of abreaction are discussed, together with the indications and contraindications for their use.

Patients reporting ritual abuse in childhood: a clinical syndrome. Report of 37 cases.

Thirty-seven adult dissociative disorder patients who reported ritual abuse in childhood by satanic cults are described. Patients came from a variety of separate clinical settings and geographical locations and reported a number of similar abuses. The most frequently reported types of ritual abuse are outlined, and a clinical syndrome is presented which includes dissociative states with satanic overtones, severe post-traumatic stress disorder, survivor guilt, bizarre self abuse, unusual fears, sexualization of sadistic impulses, indoctrinated beliefs, and substance abuse. Questions relating to issues of reliability, credibility and verifiability are addressed in depth, and the findings and implications are discussed.