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BACKGROUND: Eye Movement Desensitization and Reprocessing (EMDR) is a well-established psychological therapy for the treatment of post-traumatic stress disorder, based on the recommendations of clinical practice guidelines. However, these guidelines are not as consistent in recommending EMDR interventions for the early treatment of post-traumatic symptoms. The main objective of this review is to evaluate the effectiveness of EMDR therapy for early intervention after a traumatic event. METHODS: A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. We included individuals exposed to a recent traumatic event (within 3 months of a traumatic incident). Outcomes on PTSD, depression and anxiety in post-treatment, and at follow-up at 3, 6 and 12 months, as well as on safety and tolerability were extracted. RESULTS: A total of 11 RCTs were found. Studies showed beneficial effects of early EMDR interventions on post-traumatic symptoms at post-treatment and at 3-month follow-up. No differences were found between EMDR and no intervention or another intervention in the remaining analyses. LIMITATIONS: The main limitations are the low quality of the studies, the small number of studies per outcome assessed, and the small sample sizes. CONCLUSIONS: There is evidence for the short-term beneficial effect of early EMDR interventions on post-traumatic symptoms. Although it appears to be a safe therapeutic choice, more studies are necessary that include safety data.
Subject(s)
Eye Movement Desensitization Reprocessing , Stress Disorders, Post-Traumatic , Humans , Eye Movement Desensitization Reprocessing/methods , Stress Disorders, Post-Traumatic/therapy , Outcome Assessment, Health CareABSTRACT
Background: Anhedonia refers to the diminished capacity to experience pleasure. It has been described both as a symptom of depression and an enduring behavioral trait that contributes its development. Specifically, in stroke patients, anhedonia has been closely linked to depression, resulting in reduced sensitivity to everyday pleasures and intrinsic motivation to engage in rehabilitation programs and maintain a healthy active lifestyle. This condition may hinder patients' recovery, diminishing their autonomy, functioning, and quality of life. Objective: We aimed to explore the prevalence and level of anhedonia and those variables that might be associated in patients with both ischemic and hemorrhagic stroke at subacute and chronic phases of the disease. Methods: We conducted an exploratory cohort study with a sample of 125 patients with subacute and chronic stroke presenting upper-limb motor deficits. We measured participants' level of anhedonia with four items from the Beck Depression Inventory-II that describe the symptoms of this condition: loss of pleasure, loss of interest, loss of energy, and loss of interest in sex. We also collected demographic and clinical information and evaluated motor and cognitive functions as well as levels of depression, apathy, and various mood states. The results were compared to a sample of 71 healthy participants of similar age, sex, and level of education. Results: Stroke patients demonstrated a significantly higher prevalence (18.5-19.7%) and level of anhedonia compared to the healthy controls (4.3%), regardless of stroke phase, level of motor impairment, and other clinical variables. Furthermore, post-stroke anhedonia was associated with lower levels of motivation and higher levels of negative mood states such as fatigue and anger in the long term. Importantly, anhedonia level was superior in stroke patients than in healthy controls while controlling for confounding effects of related emotional conditions. Conclusion: This study provides novel evidence on the prevalence, level and factors related to anhedonia post-stroke. We emphasize the importance of assessing and treating anhedonia in this population, as well as conducting large-scale cohort and longitudinal studies to test its influence on long-term functional and emotional recovery.
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Introducción: Las personas con fibromialgia refieren una notable interferencia de la enfermedad en su calidad de vida. A pesar de que los síntomas de la fibromialgia suelen seguir un curso crónico, la calidad de vida de las pacientes puede mejorar. Por consiguiente, la mejoría de la calidad de vida debería ser un objetivo terapéutico prioritario. El objetivo de este estudio longitudinal fue evaluar los determinantes de la calidad de vida en las pacientes con fibromialgia seis meses después de haber recibido un tratamiento multidisciplinario. Método: En 40 pacientes seleccionadas consecutivamente se analizaron las variables previamente descritas como sólidos determinantes de la calidad de vida antes y seis meses después de realizar un tratamiento multidisciplinario. Se realizó un análisis de componentes principales del cambio observado en cada uno de estos determinantes y se analizó su relación con la mejoría de la calidad de vida mediante análisis de regresión multivariante. Resultados: El análisis de los componentes principales observó 7 factores independientes que explicaron el 76.4% de la varianza entre sujetos del cambio en las variables clínicas evaluadas. Los análisis de regresión multivariantes mostraron que la mejoría en las distintas facetas de la calidad de vida dependió principalmente de las creencias favorables a la posibilidad de disminuir el dolor mediante recursos propios y de un afrontamiento activo que conllevara un incremento de la capacidad funcional subjetiva.Conclusiones: Dada la cronicidad de los síntomas de la fibromialgia, la mejoría de la calidad de vida de las pacientes debería basarse en la promoción de las creencias de control del dolor y el incremento de la autoeficacia teniendo, no obstante, en cuenta el efecto a la vez negativo y positivo de la ayuda externa.(AU)
Introduction: People with fibromyalgia report a significant interference of the disease in their quality of life. Although the symptoms of fibromyalgia usually follow a chronic course, the quality of life of patients can improve. Therefore, improving quality of life should be a priority therapeutic goal. The objective of this longitudinal study was to assess the determinants of quality of life in patients with fibromyalgia six months after receiving multidisciplinary treatment. Method: In 40 consecutively selected patients, the variables previously described as solid determinants of quality of life were analyzed before and six months after receiving a multidisciplinary treatment. A principal component analysis of the change observed in each of these determinants was performed and their relationship with improvement in quality of life was analyzed using multivariate regression analysis. Results: Principal component analysis of change found 7 independent factors that explained 76.4% of the between-subject variance of change in clinical variables assessed. The multivariate regression analysis showed that the improvement in the different facets of quality of life depended mainly on the promotion of perceived ability to control pain through ones own resources and on active coping that would lead to an increase in subjective functional capacity. Conclusions: Given the chronicity of fibromyalgia symptoms, improvement of patients quality of life should be based on the promotion of pain control beliefs and the increase of self-efficacy considering, however, the effect both negative and positive of significant others assistance.(AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Quality of Life , Fibromyalgia , Therapeutics , Self Efficacy , Internal-External Control , Longitudinal Studies , PainABSTRACT
Anhedonia is the diminished motivation and sensitivity to pleasurable stimuli. It has been reported to be more prevalent in patients with chronic pain as compared to healthy controls. Endometriosis is a chronic inflammatory systemic disease with a significant psychosocial impact that compromises wellbeing and the day-to-day life of patients. Women with endometriosis show significant psychological distress, even more pervasive when chronic pelvic pain is present. In the current review we will discuss the role of anhedonia in endometriotic chronic pelvic pain. We will also present new lines of research that could lead to more fully clarifying the psychological impact of endometriosis and its detrimental repercussions to quality of life and mental health.
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The fast-slow paradigm of life history (LH) focuses on how individuals grow, mate, and reproduce at different paces. This paradigm can contribute substantially to the field of personality and individual differences provided that it is more strictly based on evolutionary biology than it has been so far. Our study tested the existence of a fast-slow continuum underlying indicators of reproductive effort-offspring output, age at first reproduction, number and stability of sexual partners-in 1,043 outpatients with healthy to severely disordered personalities. Two axes emerged reflecting a double-track pathway to fast strategy, based on restricted and unrestricted sociosexual strategies. When rotated, the fast-slow and sociosexuality axes turned out to be independent. Contrary to expectations, neither somatic effort-investment in status, material resources, social capital, and maintenance/survival-was aligned with reproductive effort, nor a clear tradeoff between current and future reproduction was evident. Finally, we examined the association of LH axes with seven high-order personality pathology traits: negative emotionality, impulsivity, antagonism, persistence-compulsivity, subordination, and psychoticism. Persistent and disinhibited subjects appeared as fast-restricted and fast-unrestricted strategists, respectively, whereas asocial subjects were slow strategists. Associations of LH traits with each other and with personality are far more complex than usually assumed in evolutionary psychology.
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When interacting in error-prone environments, humans display different tolerances to changing their decisions when faced with erroneous feedback information. Here, we investigated whether these individual differences in error tolerance (ET) were reflected in neurophysiological mechanisms indexing specific motivational states related to feedback monitoring. To explore differences in ET, we examined the performance of 80 participants in a probabilistic reversal-learning task. We then compared event-related brain responses (ERPs) of two extreme groups of participants (High ET and Low ET), which showed radical differences in their propensity to maintain newly learned rules after receiving spurious negative feedback. We observed that High ET participants showed reduced anticipatory activity prior to the presentation of incoming feedback, informing them of the correctness of their performance. This was evidenced by measuring the amplitude of the stimulus-preceding negativity (SPN), an ERP component indexing attention and motivational engagement of incoming informative feedback. Postfeedback processing ERP components (the so-called Feedback-Related Negativity and the P300) also showed reduced amplitude in this group (High ET). The general decreased responsiveness of the High ET group to external feedback suggests a higher proneness to favor internal(rule)-based strategies, reducing attention to external cues and the consequent impact of negative evaluations on decision making. We believe that the present findings support the existence of specific cognitive and motivational processes underlying individual differences on error-tolerance among humans, contributing to the ongoing research focused on understanding the mental processes behind human fallibility in error-prone scenarios.
Subject(s)
Brain/physiology , Decision Making/physiology , Feedback, Psychological/physiology , Individuality , Reversal Learning/physiology , Anticipation, Psychological/physiology , Attention/physiology , Cognition/physiology , Electroencephalography , Evoked Potentials , Humans , Motivation/physiology , Neuropsychological Tests , Probability , PsychometricsABSTRACT
Anhedonia is characterized by a reduced capacity to experience pleasure in response to rewarding stimuli and has been considered a possible candidate endophenotype in depression and schizophrenia. However, it is still not well understood whether these reward deficits are confined to anticipatory and/or to consummatory experiences of pleasure. In the present study, we recorded electrophysiological responses (event-related brain potentials [ERPs] and oscillatory activity) to monetary gains and losses in extreme groups of anhedonic and nonanhedonic participants. The anhedonic participants showed reduced motivation to incur risky decisions, especially after monetary rewards. These sequential behavioral effects were correlated with an increased sensitivity to punishment, which psychometrically characterized the anhedonic group. In contrast, both electrophysiological measures associated with the impacts of monetary losses and gains--the feedback-related negativity (FRN) and the beta-gamma oscillatory component--clearly revealed preserved consummatory responses in anhedonic participants. However, anhedonics showed a drastic increase in frontal medial theta power after receiving the maximum monetary gain. This increase in theta oscillatory activity could be associated with an increase in conflict and cognitive control for unexpected large positive rewards, thus indexing the violation of default negative expectations built up across the task in anhedonic participants. Thus, the present results showed that participants with elevated scores on Chapman's Physical Anhedonia Scale were more sensitive to possible punishments, showed deficits in the correct integration of response outcomes in their actions, and evidenced deficits in sustaining positive expectations of future rewards. This overall pattern suggests an effect of anhedonia in the motivational aspects of approach behavior rather than in consummatory processes.
