ABSTRACT
Treatment Rationale: Exposure to repeated sexual trauma, particularly during childhood, often leads to protracted mental health problems. Childhood adversity is specifically associated with complex posttraumatic stress disorder (PTSD) presentation, which is particularly tenacious and treatment refractory, and features severe emotion dysregulation. Augmentation approaches have been suggested to enhance treatment efficacy in PTSD thus integrating first-line psychotherapy with mechanistically informed self-neuromodulation procedures (i.e. neurofeedback) may pave the way to enhanced clinical outcomes. A central neural mechanism of PTSD and emotion dysregulation involves amygdala hyperactivity that can be volitionally regulated by neurofeedback. We outline a treatment rationale that includes a detailed justification for the potential of combining psychotherapy and NF and delineate mechanisms of change. We illustrate key processes of reciprocal interactions between neurofeedback engagement and therapeutic goals.Case Study: We describe a clinical case of a woman with complex PTSD due to early and repetitive childhood sexual abuse using adjunctive neurofeedback as an augmentation to an ongoing, stable, traditional treatment plan. The woman participated in (a) ten sessions of neurofeedback by the use of an fMRI-inspired EEG model of limbic related activity (Amygdala Electrical-Finger-Print; AmygEFP-NF), (b) traditional weekly individual psychotherapy, (c) skills group. Before and after NF training period patient was blindly assessed for PTSD symptoms, followed by a 1, 3- and 6-months self-report follow-up. We demonstrate mechanisms of change as well as the clinical effectiveness of adjunctive treatment as indicated by reduced PTSD symptoms and improved daily functioning within this single case.Conclusions: We outline an integrative neuropsychological framework for understanding the unique mechanisms of change conferring value to conjoining NF applications with trauma-focused psychotherapy in complex PTSD.
Self-neuromodulation procedures that regulates limbic-related activity in adjunction to therapy show clinical effectivity in complex PTSD.We present an integrative perspective of neurofeedback embedded in psychotherapy, illustrated by a single case report.A single case provides an illustration of the potential utility of multifaced treatment including psychotherapy with adjunctive neurofeedback.
Subject(s)
Neurofeedback , Stress Disorders, Post-Traumatic , Female , Humans , Neurofeedback/methods , Psychotherapy , Self Report , Stress Disorders, Post-Traumatic/psychology , Treatment OutcomeABSTRACT
Este artículo presenta una investigación, realizada en dos etapas, que estudia al Abuso Sexual Infantil (ASI) como fenómeno clínico, enmarcada en sus expresiones representacionales, conceptuales y culturales. Interroga a profesionales de instituciones que trabajan con abuso, trazando un itinerario analítico comprensivo de abordajes tanto clínicos, como de políticas de intervención desarrolladas. Metodológicamente realizamos un estudio observacional, analítico y longitudinal ambispectivo, con diseño cualitativo, aplicado en dos cohortes de tiempo (2005-2006 y 2011-2012), para profundizar el conocimiento de comprensiones y estrategias clínicas que profesional e institucionalmente han abordado al ASI. Sus resultados destacan: sobrejudicialización y sobrepatologización del ASI, necesidad de profundizar el trabajo interdisciplinario, dificultades del abordaje individual de reparación y prevención, desasosiego y malestar subjetivo de los profesionales, presencia social y mantención de situaciones de abuso con patrones de género predominantemente autoritarios, y devastador daño psíquico de víctimas directas e indirectas.
This study investigates Sexual Child Abuse (SCA) in its clinical context, including its representational, conceptual, and cultural expressions. Working with professionals of institutions, following an analytic yet understanding method, this study traces their approaches at the clinical level as well as intervention policies. Methodologically, the investigation is observational, analytic, and longitudinal, and qualitative design study, including two temporal cohorts (2005-2006 and 2011-2012). These methods were chosen to acquire better knowledge regarding the strategies used in clinics. Relevant results include: excessive tendencies to treat the matter as a juridical case and as pathology; the need for interdisciplinary work; the difficulty of repairing and preventing; the presence of discontent and unease in professionals related to their work; social relations in the presence of SCA of an authoritarian type; and the devastating psychic damage, both direct and indirect, in its victims.
Subject(s)
Humans , Male , Female , Child , Child Abuse, Sexual , Child Abuse , Public PolicyABSTRACT
La clínica con los adultos abusados sexualmente en la infancia, pudiera ser una de las líneas de investigación de mayor importancia en los estudios sobre Abuso Sexual Infantil (ASI). Su abordaje es relevante no sólo en el tratamiento del paciente adulto que sufre, sino que hecha luz sobre el conocimiento de las consecuencias a largo plazo del ASI. Estos temas son abordados empírica y teóricamente en este trabajo ilustrado a través de tres casos clínicos.
A clínica com adultos abusados sexualmente na infância poderia ser uma das linhas de pesquisa da maior importância nos estudos sobre Abuso Sexual Infantil (ASI). Sua abordagem é relevante não só no tratamento do paciente adulto que sofre, senão também pelo conhecimento das conseqüências a longo prazo do ASI. Esses temas são abordados empírica e teoricamente no trabalho, ilustrando com três casos clínicos.
La clinique d’adultes abusés sexuellement pendant l’enfance pourrait être l’un des axes d’investigation le plus important dans les études sur l’Abus Sexuel Infantil (ASI). Son abord est pertinent non seulement du point de vue du traitement du patient adulte qui souffre, mais aussi dans la mesure où il éclaircit la connaissance des conséquences du ASI à long terme. Ces thèmes sont abordés empiriquement et théoriquement dans ce travail illustré par trois cas cliniques.
The clinic study of sex-abused adults could be one of the most important keys in SIA investigations. Its confrontation is relevant not only in the treatment of adults that are suffering, but for the knowledge of long term abuse consequences. These themes are dealt by a theoretical and empirical approach and illustrated trough the discussion of clinical cases.