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Schellong J, Schellong A, Gast U, Frommberger U, Jatzko A, Schäfer I. [Trauma and memory-A contribution to the current debate in law and psychotherapy]. DER NERVENARZT 2024; 95:608-615. [PMID: 38709253 PMCID: PMC11222194 DOI: 10.1007/s00115-024-01665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/07/2024]
Abstract
The recall of memories of past events, experiences and emotions is a complex process. When experiencing traumatic events, as is the case with sexual violence, a host of additional complexities and difficulties arise. This becomes especially important in court cases which rely mostly or exclusively on the testimony of the victim, where the problem of the fallibility of memory takes center stage. Some research studies emphasize the possibility of inducing, altering or suppressing memories, especially in the context of psychotherapy. This has led to the unfortunate reality that the testimony of victims who have undergone psychotherapy is often considered to be unreliable. This in turn can lead to the impression that a decision has to be made between treatment of the adverse effects of traumatic events and maximizing the chances for a conviction of the perpetrator in court. This article introduces some central concepts of our current understanding of memory and gives an overview of the relevant scientific literature and debate. Following this, it examines the dilemma as it pertains to the different groups of all involved parties (i.e., victims, members of the judiciary and psychotherapists). Lastly, it proposes a framework of how to approach a solution to this problem by focusing on research in critical areas, expansion of therapy guidelines and documentation procedures as well as communication of these efforts to all parties involved.
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Affiliation(s)
- Julia Schellong
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| | | | - Ursula Gast
- Praxis für Psychosomatische Medizin, Mittelangeln, Deutschland
| | - Ulrich Frommberger
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- Privatpraxis, Sölden, Deutschland
| | | | - Ingo Schäfer
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Meister L, Dietrich AC, Stefanovic M, Bavato F, Rosi-Andersen A, Rohde J, Offenhammer B, Seifritz E, Schäfer I, Ehring T, Barth J, Kleim B. Pharmacological memory modulation to augment trauma-focused psychotherapy for PTSD: a systematic review of randomised controlled trials. Transl Psychiatry 2023; 13:207. [PMID: 37321998 DOI: 10.1038/s41398-023-02495-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Trauma-focused psychotherapy (tf-PT) is the first-line treatment for posttraumatic stress disorder (PTSD). Tf-PT focuses on processing and modulating trauma memories. Not all patients benefit, however, and there is room for improvement of efficacy. Pharmacologically augmenting trauma memory modulation in the context of tf-PT may help optimise treatment outcome. To systematically review effects of pharmacologically augmented memory modulation in the context of tf-PT for PTSD (PROSPERO preregistration ID: CRD42021230623). We conducted a systematic review of randomised controlled trials of psychotherapy treatment for PTSD. We included placebo-controlled studies that augmented at least one treatment session pharmacologically targeting memory extinction or reconsolidation. We calculated post-treatment between group (pharmacological augmentation vs placebo control) effect sizes of PTSD symptom severity. We included 13 RCTs. There was large heterogeneity in augmentation procedure and methodological quality. Four studies showed significantly greater PTSD symptom reduction in the pharmacological augmentation group (propranolol, hydrocortisone, dexamethasone, D-cycloserine) compared to placebo. Seven studies showed no significant effect of pharmacological augmentation compared to placebo (D-cycloserine, rapamycin, mifepristone, propranolol, mifepristone combined with D-cycloserine, methylene blue). Two studies showed significantly smaller PTSD symptom reduction in the pharmacological augmentation group (D-cycloserine, dexamethasone) compared to placebo. Results of pharmacological augmentation were mixed overall and heterogenous for the pharmacological agents tested in more than one study. Additional studies and replications are needed to identify which pharmacological agents work, in which combination and to identify patient groups that benefit most to tailor PTSD treatment.
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Affiliation(s)
- Laura Meister
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | | | | | - Francesco Bavato
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Alex Rosi-Andersen
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
- Chronobiology and Sleep Research Group, Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Judith Rohde
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Offenhammer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland.
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
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Kuhlmann E, Scharli P, Schick M, Ditzen B, Langer L, Strowitzki T, Wischmann T, Kuon RJ. The Posttraumatic Impact of Recurrent Pregnancy Loss in Both Women and Men. Geburtshilfe Frauenheilkd 2023; 83:88-96. [PMID: 36643876 PMCID: PMC9835763 DOI: 10.1055/a-1916-9180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/02/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Recurrent pregnancy loss is usually associated with significant psychological distress for both partners of the couple. It may act as a traumatic experience resulting in a posttraumatic stress disorder. The object of this study is to examine the posttraumatic impact of recurrent pregnancy loss on men and women and their interdependencies. Methods Cross-sectional study. All couples referred to the special unit for recurrent pregnancy loss between March 2019 and October 2020 were asked to participate with a sample size of 105 couples and 17 women. They were invited to complete a questionnaire package estimating the prevalence of posttraumatic stress, with anxiety, depression, lack of social support and dysfunctional coping strategies as contributing risk factors. Couple data were analysed with the Actor Partner Interdependence Model, taking the couple as a dyad. Results The response rate was 82.3 percent, with posttraumatic stress being measured in 13.7% of the women versus 3.9% of the men (p = 0.017). For women, number of curettages, controlled for the number of losses, correlated with the severity of posttraumatic stress (p < 0.05). Higher levels of anxiety, depression and lack of social support in women correlated positively with posttraumatic stress in their partners. The men's coping strategy "trivialization and wishful thinking" as well as "avoidance" correlated with more severe posttraumatic stress in the female partners (both p < 0.05). Conclusion The posttraumatic risks within a couple with recurrent pregnancy loss are interdependent. Recurrent pregnancy loss clinics should assess posttraumatic risks of both partners in their routine diagnostic process.
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Affiliation(s)
- Emily Kuhlmann
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Pauline Scharli
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Maren Schick
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany,Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Laila Langer
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Thomas Strowitzki
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany
| | - Tewes Wischmann
- Institute of Medical Psychology, Center for Psychosocial Medicine, University
Hospital Heidelberg, Heidelberg, Germany
| | - Ruben-J. Kuon
- Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s Hospital, Heidelberg, Germany,Korrespondenzadresse Prof. Dr. Ruben-J. Kuon Department of Gynecological Endocrinology and Fertility Disorders, Heidelberg
University Women’s HospitalIm Neuenheimer Feld 44069120 HeidelbergGermany
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