درمان هراسهای خاص با حساسیت زدایی حرکات چشم و پردازش مجدد (EMDR): پروتکل، وضعیت تجربی و مسائل مفهومی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|30578||1999||17 صفحه PDF||سفارش دهید||7759 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Anxiety Disorders, Volume 13, Issues 1–2, January–April 1999, Pages 69–85
This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention. Behavioral therapy has proven to be of great practical value in the treatment of fears and phobias. This approach involves systematic desensitization, imaginal exposure, and real-life exposure. Research on specific phobias has shown equivalent effectiveness for systematic desensitization and flooding in imagery (e.g., Marks, Boulougouris, & Marset, 1971), while imaginary procedures were generally found to be less effective than exposure in vivo (e.g., Barlow, Leitenberg, Agras, & Wincze, 1969). It is a widely accepted notion that exposure in vivo (i.e., graded and prolonged exposure to the phobic stimuli) is the treatment of choice for specific phobias (e.g., Emmelkamp, Bouman, & Scholing, 1989). A typical example of the exposure in vivo procedure is the treatment of spider phobia, which can be roughly described as follows. First, the client is introduced to a spider in a sealed container at what the client considers to be a safe distance. After much of the client’s anxiety has subsided, the client is asked to either approach the container or pull it closer. After the client looks at the container closely, it is opened. Next, the client touches the spider with a pencil, later with a finger, and finally allows the spider to creep on the client’s bare fingers and hands. Further, the client is encouraged to practice approaching the phobic objects between sessions while refraining from avoidance and escape behaviors as much as possible. Exposure in vivo is often combined with other techniques, including modelling by the therapist, cognitive interventions to correct catastrophic misinterpretations (e.g., De Jongh et al., 1995a), and applied tension to prevent fainting in the case of blood–injury–injection phobias (Öst & Sterner, 1987). It appears that certain types of circumscribed phobias can be effectively treated in one session, often lasting no more than 3 hours Öst 1989 and Öst 1997. These rapid treatment results may leave the impression that specific phobias in general can be successfully treated within a few sessions. However, single-session treatments of 3 hours or less have been found effective only in relation to a limited range of monosymptomatic phobias, particularly snake, spider, and injection phobias (see Öst, 1997 for an overview). This raises the question as to whether the available outcomes can be generalized toward more complex phobias. As a matter of fact, there are a variety of phobias for which controlled outcome studies are totally lacking, such as phobias of choking, vomiting, and driving. Clinical observations suggest that other specific phobias, such as thunderstorm phobia and extensive claustrophobia, generally require more elaborate treatment (see e.g., Emmelkamp et al., 1989 for a case report on behavioral treatment of a fear of swallowing that lasted 33 sessions). 1 With respect to this issue, Öst (1997) concluded: “Thus, there is a great need for further research on most types of specific phobias, both in order to evaluate current treatments for those phobias for which outcome studies are lacking and to develop new treatment methods” (p. 245). A new treatment procedure that has recently been proposed for individuals suffering from specific phobias is Eye Movement Desensitization and Reprocessing (EMDR; Shapiro, 1995). EMDR is recommended as a structured, noninvasive, and time-limited method, that can be applied either as a specific intervention or in the broader context of other treatment approaches. A number of controlled studies show that EMDR accelerates recovery from pathologies that have arisen from disturbing life events, in particular Posttraumatic Stress Disorder (PTSD; Shapiro, 1999 [this issue]). The primary goal in this treatment paradigm is to process the memories of the initial events that set the pathology in motion, rather than extinction of the conditioned responses through a strategy of gradual or prolonged exposures to the feared stimuli. If an adequate literature would indicate that EMDR treatment for specific phobias is in some way equally effective as exposure in vivo, there may be a number of advantages in applying EMDR. For example, it is possible to use EMDR in circumstances under which real-life exposure is difficult to pursue or the phobic stimuli are hard to obtain. Certainly not all therapists will have small and large dogs, rats, wasps, or snakes readily available in their offices. Related to this point are the costs of treatment. For instance, it may be more useful to apply EMDR than exposure in vivo in a case of flight phobia for which, as part of their treatment, clients have to take costly flights (Öst, 1997). This paper is devoted to the treatment of specific phobias with EMDR, and is structured as follows. First, the use of the EMDR protocol with specific phobias will be described. Next, the current empirical evidence on the application of EMDR with specific phobias is addressed. Finally, some conceptual issues in relation to EMDR treatment are addressed, including the most central question as to what EMDR could contribute to the treatment of specific phobias.