The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder

The growing body of research into treatment efficacy with Posttraumatic Stress Disorder (PTSD) has, by-and-large, been limited to evaluating treatment components or comparing a specific treatment against wait-list controls. This has led to two forms of treatment, Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavior Therapy (CBT), vying for supremacy without a controlled study actually comparing them. The present research compared EMDR and a CBT variant (Trauma Treatment Protocol; TTP) in the treatment of PTSD, via a controlled clinical study using therapists trained in both procedures. It was found that TTP was both statistically and clinically more effective in reducing pathology related to PTSD and that this superiority was maintained and, in fact, became more evident by 3-month follow-up. These results are discussed in terms of past research. Directions for future research are suggested.

Incipient multiple personality in children. Four cases

Despite extensive study of child abuse and increasing interest in multiple personality, there has been no way of identifying abused children who are potential multiples, and only rarely has multiple personality been diagnosed before adulthood. This article describes four cases where dual identity was claimed by the child and/or trance states were evident in response to questions or stimuli related to traumatic events. In addition, the three children who were treated according to a program developed to integrate multiple personalities in adults showed unification of consciousness and immediate disappearance of or reduction in symptoms, together with other positive personality changes. Improvements were maintained on follow-up. From behaviors noted in these children, together with symptoms found in published biographical and autobiographical accounts of the childhood of persons with multiple personality, a list of 20 behavioral signs was derived which should be of assistance in helping teachers and other professionals who have frequent contact with children to identify potential multiples. Six subjective items were also given to be used in interviewing suspected cases. Incidence of incipient multiple personality and approaches to differential diagnosis are discussed. Three levels of family pathology are described and treatment approaches are suggested for each category, together with cautions about the need for careful clinical judgment. Finally, a systematic play therapy approach to enable personality integration is detailed.

Annoyance, type and duration of postannoyance activity, and aggression: The "cathartic effect."

A series of experiments was conducted to elucidate the conditions conductive to a decrease in aggression following annoyance. The potential capacity of expression of aggression to bring about a reduction in the amount of subsequent aggression was of particular interest. This empirical concern was supplemented by tests of several influential and competing theoretical concepts dealing with the cathartic aspects of human aggressive behavior. Given the failure of such concepts to account for major portions of the data, an integrative theoretical model was proposed. experiment 1 evaluated the usefulness of the hydraulic, self-arousal, and dissipation of anger concepts in accounting for the earlier demonstrations of the cathartic effect. In a 2 x 3 x 2 design, half of the subjects were annoyed by a confederate, while the other half were treated neutrally. During the next stage (the interpolated period), a third of all subjects gave "shocks" to the confederate, another third simply waited, while the remaining third worked on mathematical problems. Orthogonal to the first two facotrs was the duration of the interpolated period (7 to 13 min). The main dependent measure was the number of shocks administered to the confederate in the final stage of the experiment. It was found that annoyed subjects gave more shocks than nonannoyed ones did, and that only the former were substantially affected by other manipulations. In the case of the annoyed wait and annoyed math subjects, the anger dissipation hypothesis correctly predicted that the mere passage of time would decrease the amount of subsequent aggression, presumably due to the action of homeostatic processes. The self-arousal hypothesis correctly predicted that the annoyed math subjects would give fewer shocks than the annoyed wait ones would. Since the subjects were engaged in an absorbing activity, the likelihood of their arousing themselves by ruminations about the preceding annoying incident was minimized, and the amount of subsequent aggression reduced. Yet, when annoyed subjects had given the confederate a moderate number of shocks in the interpolated period, they subsequently gave him fewer shocks than the 7-min annoyed wait and annoyed math subjects; this was the only outcome predicted correctly by the hydraulic model. In contrast, when a large number of shocks had been administered in the interpolated period, the amount of subsequent aggression was relatively high. The interpretation of the latter result in terms of an "adaption effect" was tested by further experiments.

Post-traumatic stress disorder following myocardial infarction

The evaluation of Post-Traumatic Stress Disorder (PTSD) following myocardial infarction in four patients is described. The authors outline principles of the therapeutic interventions performed to alter the disorder and alleviate patients' incapacitation. Also discussed are the reasons that may be at the root of the omission of the diagnosis of PTSD for this patient population.

An empirical study on the "cathartic effect" of attempted suicide

A cathartic effect of attempted suicide has been suggested, but few data are available to validate the concept. In this study we report on the relation between presuicidal and postsuicidal mood conditions in a group of 25 hospitalized suicide attempters and 50 control patients who were depressed but not suicidal. A significant decrease in depression was demonstrated to occur in the suicidal patients within a few days of hospitalization. This was not the case in depressed patients without prior suicide attempts. The drop in depression ratings can, therefore, be attributed to the suicide attempt. Possible explanatory factors are discussed. These findings indicate that the diagnosis of a suicide attempt in the absence of depression can only be reliably made on the basis of data pertaining to the presuicidal mood condition.

The facilitation of aggression by aggression: Evidence against the catharsis hypothesis

Nnety male subjects were either attacked or treated in a more neutral manner by a male confederate. On a subsequent maze-learning task, one third of the subjects shocked the confederate, one third observed as the experimenter shocked the confederate, and one third waited for a period of time during which the confederate was not shocked. Finally, all subjects shocked the confederate as part of a code-learning task. Subjects who had been attacked and had shocked the confederate during the maze task delivered shocks of greater intensity on the code task did subjects in the other two conditions, and the former subjects also experienced a greater reduction in diastolic blood pressure than did the latter. The results contradict the hypothesis of aggression catharsis and are discussed in terms of feelings of restraint against aggressing that a subject experiences after committing an aggressive act.

Gender-related differences in non-epileptic attacks: a study of patients' cases in the literature

Gender-related differences for disorders of consciousness other than true epilepsy usually point to a larger number of women suffering especially from non-epileptic attacks or pseudoseizures. Recently, sexual abuse has been suggested as a possible cause for this increased prevalence in women. It has, however, not been very clear if women have a different phenomenology of these type of seizures from men. In the present study, patients' cases as published in the literature are analysed in a detailed way, using a working classification by Betts et al to look for gender-specificity. Of the 62 cases, 76% concern women and 24% men; a percentage comparable to those published elsewhere. Ages range from 14 to 77 years-of-age, but 89% of patients are younger than 40. Sexual abuse was proven in 18 cases, all women. The phenomenology of the attacks was divided into tonic-clonic type and complex partial type of attack, or a combination of the two. Also, special types of attacks (swoons, tantrums, abreactive attacks and forthright simulation) were looked for. Males tended to suffer especially from tonic-clonic type seizures (80% of cases), while in women as many tonic-clonic type as complex partial type attacks were observed. Special types of attacks were observed at the same frequency in both sexes. The group of sexual abuse victims did not differ from the total group of women in this respect. The clinically more impressive nature of a tonic-clonic-type attack, that is more easily suspected to be 'real', might make this type of seizure a more male form of acting out. A prospective study on the incidence and phenomenology of pseudo-epileptic seizures in the general population is suggested to answer the new questions raised in this survey.

The influence of the wives on the treatment outcome of alcoholics: a follow-up study at two years

The literature on the role of the wife of the alcoholic in his illness and its management has been critically reviewed by Bailey (1961). She points out that research findings are contradictory and that a unitary view of the wife's role is unwarranted. Kogan and Jackson (1964) have demonstrated within-group differences among alcoholics' wives with regard to their perception of their husbands' illness, and have suggested that such differences may have important prognostic implications. Rae and Forbes (1966) have offered a psychometric dichotomy based on the M.M.P.I. which appeared to distinguish a group of wives whose attitudes to their husbands' illness were supportive and realistic, in contrast to a group whose attitudes appeared to be the reverse. These latter wives were characterized by the M.M.P.I. as having the Psychopathic Deviate scale as a prominent feature of their personality profile. There have been no follow-up studies to assess the influence of the wife on her husband's response to treatment, and the present research attempts to assess this and to relate clinical variables to the psychometric characteristics of the marital partners.

Psychiatric nurse as therapist

Under supervision five nurse-therapists have treated phobic patients as successfully as have psychiatrists and psychologists using similar psychological treatments in comparable psychiatric populations. Nurses have also had good results in other neurotic disorders. Intensive training is required. Nurse-therapists find their work rewarding, but the present Salmon gradings make no provision for their advancement should they retain their clinical function. Results suggest that the use of selected psychiatric nurses as skilled therapists can ease the current critical shortage of treatment personnel in psychiatry.

Multiple personality disorder in childhood

Multiple Personality Disorder (M.P.D.) has been diagnosed in adults and adolescents at an almost exponential rate over the last 10 years in contrast to the previous 100 years. Childhood M.P.D., a more recently recognized entity, has been identified both by retrospective patient reports and actual child case reports, of which we were able to note 12 in total, 4 of which may be more accurately described as "incipient M.P.D." Given the apparently rapid response to treatment compared to adults and the high morbidity caused by the adult form of the disorder, the authors recommend a "high index of suspicion" and the use of screening questionnaires to detect cases of M.P.D. in high risk populations of children. Although the natural history of M.P.D. is not known, early identification and treatment could lower the number of cases of childhood M.P.D. that become established as adult cases and decrease the associated morbidity of the disorder in both children and adults. More research is needed to establish prevalence, etiology and effective treatment methods.