Indicatori di cambiamento in pazienti con disturbi da eventi stressanti: Impiego della heart rate variability Indicators of change in patients with disorders of stressful events: Use of heart rate variability
Description
Introduzione: i pazienti traumatizzati presentano alterazioni sintomatiche quali intrusività, evitamento ed aumentato arousal, che ostacolerebbe la possibilità di elaborazione/integrazione delle tracce mnesiche, oltre ad esprimersi a livello periferico. Tecniche specifiche di trattamento sembrano promuovere l’elaborazione/integrazione delle memorie traumatiche, tra cui la Eye Movement Desensitization and Reprocessing (EMDR). Nella ricerca valutativa è quindi necessario affiancare alle scale psicologiche un appropriato indicatore biologico di attivazione neurovegetativa. La variabilità della frequenza cardiaca (Heart Rate Variability – HRV) esprime l’integrità funzionale del sistema neurovegetativo in risposta allo stress e può essere misurata nei domini di tempo o di frequenza. Lo studio della HRV è stato applicato in psichiatria ai disturbi d’ansia (panico, DOC, PTSD) e dell’umore (depressione unipolare) in ricerche trasversali (confronto con controlli sani) e longitudinali di trattamento farmacologico (triciclici, SSRIs) ma in pochi casi a trattamenti psicoterapici. Gli AA. valutano l’impiego della HRV come indicatore biologico nel trattamento psicoterapeutico di pazienti con Disturbo dell’adattamento erdurante da oltre un mese dopo l’esposizione ad eventi vitali stressanti (EVS). Metodi: sono stati reclutati 6 soggetti (M/F = 1/5, età 40,5 ± 11,0) esposti ad EVS ed avviati a ciclo di trattamento psicoterapico breve (4-6 sedute a cadenza settimanale) di tipo specifico (EMDR) o generico (colloqui supportivi). Costituivano criteri di esclusione: età 65 anni; comorbilità psichiatrica, neurologica e cardiologica; uso di farmaci interferenti. Le valutazioni psicopatologiche sono state eseguite al reclutamento (TBASE: colloquio anamnestico, MINI, Brief COPE), a inizio e fine ciclo di trattamento (TINI, TFINE: IES, SCL-90-R), a uno e tre mesi di follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Le registrazioni Holter sono state effettuate ad ogni intervallo valutativo coprendo: 60 min. attività libera, 10 min. tilt-test, 3-5 min. ascolto dell’evento traumatico, 30-45 min. seduta psicoterapica. Sono stati impiegati test statistici non parametrici per l’analisi delle correlazioni (Spearman) e delle differenze (Wilcoxon). Risultati preliminari: vengono valutate le correlazioni a TINI e le variazioni T90 vs. TINI. Sono significative le seguenti correlazioni: ansia fobica SCL e SDNN (dev. standard intervalli R-R) [r = + 0,9; p = ,037]; collera-ostilità SCL e SDNN [r = -0,95; p =.014]; depressione SCL e r-MSSD (radice media somma quadrati diff. R-R) [r = + 0,9; p = ,037]; sint. intrusivi IES e LF (basse frequenze) [r = -0,9; p = ,037]. Sono risultate statisticamente significative le seguenti variazioni: IES totale [Z = -1,99; p = ,046], sintomi intrusivi IES [Z = -2,21; p = ,027], sintomi di evitamento IES [Z = -1,99; p = ,046], ideazione paranoide SCL [Z = -2,21; p = ,027]; R-R, LF e LF/HF (rapporto basse/alte frequenze) durante ascolto evento [Z = -2,02; p = ,043]. Discussione: a livello basale gli indicatori HRV di distress vegetativo correlano positivamente con collera-ostilità e sintomi intrusivi, negativamente con ansia e depressione. Anche dopo tre mesi dalla fine del trattamento gli interventi psicoterapeutici tendono a ridurre i punteggi sintomatici, e migliorano il bilancio simpato-vagale durante il riascolto dell’evento traumatico.
Introduction: trauma patients have symptomatic changes such as intrusiveness, avoidance and increased arousal, which hampers the development / integration of memory traces, as well as speak at the peripheral level. Specific techniques of treatment seem to promote the formulation and integration of traumatic memories, including eye movement desensitization and reprocessing (EMDR). In evaluation research is therefore necessary to combine psychological scales appropriate indicator organic autonomic activation. The heart rate variability (Heart Rate Variability - HRV) expresses functional integrity of the autonomic nervous system in response stress and can be measured in time or frequency domains. The study of HRV has been applied in psychiatric disorders anxiety (panic, DOC, PTSD) and mood (unipolar depression) in cross-disciplinary (compared with healthy controls) and longitudinal drug treatment (tricyclic SSRIs), but in a few cases in psychotherapeutic treatment. The AA. evaluate the use of HRV as a biological indicator in the psychotherapeutic treatment of patients with adjustment disorder erdurante more than a month after exposure to stressful life events (EVS). Methods: 6 subjects were recruited (M / F = 1 / 5, age 40.5 ± 11.0) exposed to EVS and initiated treatment cycle psychotherapeutic short (4-6 sessions weekly) type specific (EMDR) or generic (hearing supported). Exclusion criteria were: age 65 years, psychiatric comorbidity, neurological and cardiological, use of drugs interfering. Psychopathological assessments were performed at recruitment (TBASE: anamnestic interview, MINI, Brief COPE) at the beginning and end of treatment cycle (TINI, TFINE: IES, SCL-90-R) in a three-month follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Holter recordings were made at each interval evaluation covering: 60 min. free activity, 10 min. tilt-test, 3-5 min. listening to the traumatic event, 30-45 minutes. psychotherapy session. Were used nonparametric statistical tests for analysis correlations (Spearman) and differences (Wilcoxon). Preliminary results: the correlations are evaluated and changes TINI vs. T90. TINI. Significant correlations are the following: SCL phobic anxiety and SDNN (standard dev. RR intervals) [r = + 0.9, p =, 037]; anger-hostility SCL SDNN [r = -0.95, p =. 014]; SCL depression r-mssd (root mean square sum diff. RR) [r = + 0.9, p =, 037]; sint. IES intrusive and LF (low frequency) [r = -0.9, P =, 037]. Were statistically significant, the following changes: IES total [Z = -1.99, p =, 046], IES intrusive symptoms [Z = -2.21, p =, 027], symptoms of avoidance IES [Z = -1.99, p =, 046] , SCL paranoid [Z = -2.21, p =, 027], RR, LF and LF / HF ratio (low / high frequencies) while listening event [Z = -2.02, p =, 043]. Discussion: At baseline HRV indicators of distress correlated positively with growing anger-hostility, and intrusive symptoms, negatively with anxiety and depression. Even after three months of the end of psychotherapeutic treatment interventions aimed at reducing symptom scores and enhance sympathetic vagal balance during the playback of the traumatic event.
Introduction: trauma patients have symptomatic changes such as intrusiveness, avoidance and increased arousal, which hampers the development / integration of memory traces, as well as speak at the peripheral level. Specific techniques of treatment seem to promote the formulation and integration of traumatic memories, including eye movement desensitization and reprocessing (EMDR). In evaluation research is therefore necessary to combine psychological scales appropriate indicator organic autonomic activation. The heart rate variability (Heart Rate Variability - HRV) expresses functional integrity of the autonomic nervous system in response stress and can be measured in time or frequency domains. The study of HRV has been applied in psychiatric disorders anxiety (panic, DOC, PTSD) and mood (unipolar depression) in cross-disciplinary (compared with healthy controls) and longitudinal drug treatment (tricyclic SSRIs), but in a few cases in psychotherapeutic treatment. The AA. evaluate the use of HRV as a biological indicator in the psychotherapeutic treatment of patients with adjustment disorder erdurante more than a month after exposure to stressful life events (EVS). Methods: 6 subjects were recruited (M / F = 1 / 5, age 40.5 ± 11.0) exposed to EVS and initiated treatment cycle psychotherapeutic short (4-6 sessions weekly) type specific (EMDR) or generic (hearing supported). Exclusion criteria were: age 65 years, psychiatric comorbidity, neurological and cardiological, use of drugs interfering. Psychopathological assessments were performed at recruitment (TBASE: anamnestic interview, MINI, Brief COPE) at the beginning and end of treatment cycle (TINI, TFINE: IES, SCL-90-R) in a three-month follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Holter recordings were made at each interval evaluation covering: 60 min. free activity, 10 min. tilt-test, 3-5 min. listening to the traumatic event, 30-45 minutes. psychotherapy session. Were used nonparametric statistical tests for analysis correlations (Spearman) and differences (Wilcoxon). Preliminary results: the correlations are evaluated and changes TINI vs. T90. TINI. Significant correlations are the following: SCL phobic anxiety and SDNN (standard dev. RR intervals) [r = + 0.9, p =, 037]; anger-hostility SCL SDNN [r = -0.95, p =. 014]; SCL depression r-mssd (root mean square sum diff. RR) [r = + 0.9, p =, 037]; sint. IES intrusive and LF (low frequency) [r = -0.9, P =, 037]. Were statistically significant, the following changes: IES total [Z = -1.99, p =, 046], IES intrusive symptoms [Z = -2.21, p =, 027], symptoms of avoidance IES [Z = -1.99, p =, 046] , SCL paranoid [Z = -2.21, p =, 027], RR, LF and LF / HF ratio (low / high frequencies) while listening event [Z = -2.02, p =, 043]. Discussion: At baseline HRV indicators of distress correlated positively with growing anger-hostility, and intrusive symptoms, negatively with anxiety and depression. Even after three months of the end of psychotherapeutic treatment interventions aimed at reducing symptom scores and enhance sympathetic vagal balance during the playback of the traumatic event.
Format
Conference
Language
Italian
Original Work Citation
Frustaci, A., Pozzi, G., Aurigemma, C., La Rosa, C., Lanza, G., Fernandez, I., & Ruggeri, G. (2006, Febbraio). [Indicators of change in patients with disorders of stressful events: Use of heart rate variability]. Poster presented at the XI Congress SOPSI (Italian Society of Psychopathology) Conference, Rome, Italy. Italian
Citation
“Indicatori di cambiamento in pazienti con disturbi da eventi stressanti: Impiego della heart rate variability Indicators of change in patients with disorders of stressful events: Use of heart rate variability,” Francine Shapiro Library, accessed May 15, 2024, https://francineshapirolibrary.omeka.net/items/show/20114.