Review of neoteric trauma treatments and suggested practice guidelines

Eye Movement Desensitization and Reprocessing (EMDR), Thought Field Therapy (TFT), Time-Limited Trauma Therapy (TLTT), Traumatic Incident Reduction (TIR), and Visual/Kinesthetic Dissociation (V/KD) are relatively new approaches in the treatment of trauma-related disorders. These approaches have come under intense scientific and professional scrutiny and criticism, with proponents and critics offering diverse and intriguing arguments in support of their respective points of view. This discussion will focus on the current empirical and anecdotal evidence on the efficacy of these five approaches, as well as various criticisms that have been proferred in response to the empirical and clinical literature on treatment efficacy and theory. EMDR will be highlighted, given the growing empirical database on EMDR outcome studies and the contention surrounding the treatment and its’ theory. The evidence for and/or against the other four approaches will also be presented, upon which we will raise for discussion issues relating to methodological rigour, scientific reporting of clinical data, and the interpretation of efficacy studies in general. The discussion will occur within the context of philosophical discourse on the ideal of integration of science and practice, and the feasibility of attaining this ideal within the current scientific Zeitgeist. INTERVENTION RESEARCH, CLINICAL CASE STUDY Sandringham Skills-Based Treatment of Dissociation: A Case Study 238 Chair: ELHAI, Jon D., Nova Southeastern University Discussant: GOLD, Stephen A clinical case study of skills-based treatment of a 48-year-old, female survivor of child sexual abuse (CSA) reporting severe dissociative symptomatology is presented. Chief complaints were daily amnestic episodes, depersonalization, panic attacks, agoraphobia, and consequent long-term unemployment. In contrast to most approaches to therapy for dissociative syndromes, it is argued that treatment does not need to be primarily trauma-focused. Instead treatment focused on targeting dissociation and anxiety by teaching skills to be implemented by the client outside of session. Functional behavioral analysis of particular recent incidents of dissociation were conducted over several sessions. Imagery-based relaxation and progressive muscle relaxation were used and monitored to help the client learn additional methods of reducing distress. Grounding techniques were implemented to counter the dissociative tendency to lose experiential awareness of the here and now. Cognitive interventions were utilized to challenge the erroneous notions reported about dissociative experiences, such as the panic she experienced when her dissociation had been revealed to others. Last, in vivo systematic desensitization was used with a fear hierarchy, ranging from the least to most fearful stimuli that precipitate dissociation, where graduated exposure was followed by relaxation. At termination the client reported elimination of panic attacks, resumption of driving, and marked reduction in frequency and duration of amnestic periods, with substantial additional gains and progress in finding full-time employment reported at 8 month follow-up. Treatment outcome is assessed based on psychological test data obtained at intake, discharge, and 8 month follow-up, as well as client anecdotal report.

Conference

English

Figley, C., Dietrich, A., Maxfield, L., & Gentry, J. E. (1999, November). Review of neoteric trauma treatments and suggested practice guidelines. In Discussion, clinical theory (C. Figley, Chair). Presentation at the International Society for Traumatic Stress Studies 15th Annual Meeting, Miami, FL