اسکریپت نویسی تصویرسازی دوباره به عنوان درمان برای PTSD پیچیده در پناهندگان: مطالعه موردی سری خط پایه چندگانه
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|29650||2013||10 صفحه PDF||سفارش دهید||6668 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 51, Issue 6, June 2013, Pages 274–283
This study tested the effectiveness of Imagery Rescripting (ImRs) for complicated war-related PTSD in refugees. Ten adult patients in long-term supportive care with a primary diagnosis of war-related PTSD and Posttraumatic Symptom Scale (PSS) score > 20 participated. A concurrent multiple baseline design was used with baseline varying from 6 to 10 weeks, with weekly supportive sessions. After baseline, a 5-week exploration phase followed with weekly sessions during which traumas were explored, without trauma-focused treatment. Then 10 weekly ImRs sessions were given followed by 5-week follow-up without treatment. Participants were randomly assigned to baseline length, and filled out the PSS and the BDI on a weekly basis. Data were analyzed with mixed regression. Results revealed significant linear trends during ImRs (reductions of PSS and BDI scores), but not during the other conditions. The scores during follow-up were stable and significantly lower compared to baseline, with very high effect sizes (Cohen's d = 2.87 (PSS) and 1.29 (BDI)). One patient did clearly not respond positively, and revealed that his actual problem was his sexual identity that he couldn't accept. There were no dropouts. In conclusion, results indicate that ImRs is a highly acceptable and effective treatment for this difficult group of patients.
During the last decade there has been an increasing interest in Imagery Rescripting (ImRs) as a treatment or treatment ingredient for a variety of disorders, including PTSD and other anxiety disorders, depression, eating disorders, sleep problems and personality disorders. In ImRs, the patient imagines the (start of a) traumatic (or otherwise negative) experience, and then imagines an intervention that changes the course of events so that a more satisfying outcome is achieved. In original applications often the full trauma was imagined, before rescripting started. For instance, Arntz, Tiesema, and Kindt (2007; also Kindt, Buck, Arntz, & Soeter, 2007) added ImRs to Imaginal Exposure (IE), assuming that it would be ineffective to avoid exposure to the complete trauma memory. Although this study found the combination of IE and ImRs to be better tolerable (significantly less dropout) and more effective in non-fear emotions like shame, guilt, anger, and anger control than IE alone, attempts to apply the technique to highly complex cases necessitated changes in the application of ImRs. Often, these patients refused to relive the full trauma, or dissociated, or ran away. We therefore tried out to start rescripting already during events preceding the actual trauma, so that the patient imagined to be rescued from the trauma and did not have to imagine all the horrible details and feelings of helplessness, shame and guilt associated with the trauma proper. As a side effect, one ImRs often takes no more than 10–15 min; in contrast to the minimal 60 min that was used in the early Arntz et al. (2007) study, and 2–4 ImRs exercises can be done during one session. Clinical observations indicated good effects and high acceptability of the new procedure. Interestingly, this new procedure matches well with new insights from fundamental research, that stress the importance that the event triggering retrieval of the memory should contain new (hence, unexpected) information to bring about a reconsolidation of the memory in a different form (Finnie & Nader, 2012). The new procedure is now described in protocols (Arntz, 2011; 2012; Arntz & van Genderen, 2009), but has not been tested as treatment for complex PTSD.