Analyse et comparaison de discours de patients douloureux chroniques durant une thérapie de soutien par opposition à l’utilisation de la thérapie Eye Movement Desensitization and Reprocessing (EMDR)

IntroductionThe use of EMDR – Eye Movement Desensitization and Reprocessing – being innovative in the area of chronic pain. If his efficiency as show in the specific litterature, the way its work it is really different than usual therapy.ObjectiveThe main objective of this work is to compare the speech of patients during the use of EMDR vs. supportive therapy in a supported unit of chronic pain to the hospital.MethodsForty-five patients divided into three groups received EMDR therapy (standard protocol), EMDR therapy (pain protocol) as well as supportive therapy. All interviews were transcribed and analyzed using the software Alceste.ResultsThe results show that the semantic classes differ between the three forms of therapy, as well as passive or active posture of the patient during the therapy.ConclusionThese results give us an additional insights into what happens in fine in different types of therapy.     

Inhibitory Learning for Anxiety-Related Disorders

This article reviews the articles in this issue that describe the strategies derived from the inhibitory learning model as applied to exposure therapy for anxiety disorders. The major principles of inhibitory learning are to create and strengthen nonthreat associations in memory (largely by engaging prefrontal cortical regions), and to effectively retrieve those nonthreat associations in the long term. Several case vignettes are provided that demonstrate how the principles of inhibitory learning (which include maximizing expectancy violations, limiting distraction, fear antagonistic actions, deepened extinction, elimination of safety behaviors, occasional reinforced extinction, increasing variability of exposures and offsetting reinstatement and context renewal effects) can be applied in clinical practice.     

How do I cope with pain? Let me count the ways: awareness of pain coping behaviors and relationships with depression and anxiety

Patients with chronic pain are often undertreated with medications alone and need alternative ways of coping. Identifying pain coping skills patients use may be beneficial; however, no research has investigated whether patients are aware of their coping skills. The purpose of this study was to determine whether patients are aware of their pain coping skills, whether certain patient characteristics were related to using coping strategies, and whether coping strategies were related to psychiatric symptoms. Chart reviews were conducted on seventy-eight chronic pain patients who completed a semi-structured psychological interview. Patients endorsed using more coping strategies on the measure compared to the verbal self-report. Identifying with certain patient demographics was related to higher use of some coping strategies. Symptoms of anxiety and depression were also related to the use of some coping strategies. Anxiety was negatively related to ignoring the pain and using self-talk coping statements and positively related to catastrophizing. Depression was negatively related to the use of distraction, ignoring the pain, and using self-talk coping statements. Depression and pain severity were both positively related to catastrophizing and prayer. Results suggest that clinicians may need to help patients become aware of adaptive coping strategies they already use and that the use of certain coping strategies is related to lower levels of depression and anxiety.     

From Traumatic Language to Posttraumatic Language: The Development of Language in Therapy According to the “Phenomenon of Hope” Model

Hope and language are part of the human development process starting from birth and continuing through all the stages of development. They are tools that help us to cope in complex situations. Environmental failure produces trauma, which damages the “self” and impairs the development of hope and language. The individual experiences “pessimistic hope” and “drained hope” and begins using “concrete language” and “pseudo-language.” Such profiles and languages indicate functional difficulties, including the inability to establish mature intimate personal relationships. When traumatic events such as those experienced in military combat compound childhood trauma (environmental failure), mental and functional difficulties buried by our defense systems may rise to the surface and worsen and chronic complex trauma may ensue. Psychotherapy for chronic complex trauma is complex. The therapeutic approach that is used in the “hope phenomenon” model includes five therapy stages that allow us to examine the effect of a trauma on personality and function. Here we examine the link between the five stages of therapy and the use of language. According to my experience, patients use concrete language and pseudo-language in the beginning of the therapeutic connection. As this connection and therapist-patient alliance evolves and deepens and the client and therapist move through the various stages, the patient then starts to use “plural language.” Concrete language and pseudo-language are used in the pessimistic hope and drawn hope stages, respectively, until a profile characterized by a realistic and mature hope emerges. This profile goes hand in hand with an ability to use plural language. This article examines the development of hope and language in a complex posttraumatic stress disorder (PTSD) patient who was treated using the hope phenomenon model. Consent for the therapy details to be used in this article was given by the patient.     

Working Through Countertransference: Navigating Between Safety and Paranoia for a Client With Complex Trauma History and Borderline Personality Organization

The aftermath of complex trauma deeply impacts one's self-organization and interpersonal relationships, often resulting in clients who present to therapy with borderline characteristics and are typically labeled as difficult to treat. Further clinical complications with paranoid features may quickly place the therapist at a loss with respect to managing perceived and/or actual threats to client safety. Using psychodynamic theories, especially Kleinian understandings of psychosis and Winnicottian approaches to early disturbance and its impact on the emergence of self, this article provides a detailed case illustration that explores how a critical reflection of countertransference as “enactment,” “communication,” and “imagination” can help the therapist to understand the client's unconscious symbolic psychic struggles and to guide treatment selections in the therapy process.     

Long-Term Guilt and Hostility Underlying Posttraumatic Stress Symptoms in War Combatants and Ex-Prisoners of War

The link between posttraumatic guilt and posttraumatic stress disorder has gained recognition over the past decades and was recently expressed in the modifications made to the diagnostic criteria for the disorder under the DSM-V. Yet, the psychological dynamics underlying this relation are still not fully understood. The present study introduces a model whereby different dynamics between guilt and hostility are related to posttraumatic stress disorder symptoms (PTSS), following different traumatic war experiences. One hundred and forty-four former prisoners of war (ex-POWs) and 143 comparable combatants participated in the study, 30 years after the war, reporting on their PTSS, guilt, and hostility. Moderation analyses revealed a three-way interaction, where high hostility buffered the effect of guilt on PTSS only among ex-POWs. This finding suggests a distinctive dynamic among guilt, hostility, and PTSS following diverse traumatic events. Specifically, it appears that hostility can have a mitigating effect on the negative outcomes of guilt for ex-POWs following trauma, but not for non-POW veterans. The theoretical reasoning and the clinical implications of these findings are discussed.     

Secondary traumatic stress in emergency medicine clinicians

Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending ≥10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.     

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome

Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross‐sectional study compared self‐reported alexithymia and observer‐rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self‐reported alexithymia was measured with the Toronto Alexithymia Scale‐20 (TAS‐20) and emotional awareness with an observer‐rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self‐reported alexithymia in the TAS‐20 compared to HC, but had similar emotional awareness capacity in the observer‐rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS‐total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self‐reported alexithymia and observer‐rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.     

Using Therapeutic Riding as an Intervention for Combat Veterans: An International Classification of Functioning,Disability, and Health (ICF) Approach

The aim of the study was to examine the effects of therapeutic horseback riding on posttraumatic stress symptoms, quality of life, and functioning of combat veterans using the International Classification of Functioning, Disability, and Health (ICF) as a framework. Fifty-one veterans and active duty service members participated in an 8-week therapeutic riding program. The study findings revealed clinically significant decrease in PTSD symptoms, improved social functioning, vitality, less interference of emotions on daily activities, and increased participation. Qualitative themes discovered included improved confidence, trust, acceptance of self and others, and gratitude. Qualitative and quantitative data linked to the ICF components.