Apparent Amnesia : interidentity memory functioning in dissociative identity disdorder

Dissociative identity disorder (DID) is characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual s behavior. Between 95 and 100 % of DID patients report experiences of blank spells for periods of time when other identities are in control of their behavior. In this thesis, the fundamental question of whether objective evidence for the reported interidentity amnesia in DID can be found under rigorous experimental conditions was addressed. The thesis provides a systematic exploration of interidentity amnesia in DID for both neutral as well as trauma-related information on a variety of different encoding and retrieval tasks. In order to provide an unequivocal measure of memory performance, much attention was given to the use of tasks on which simulation of amnesia-symptoms is expected to be very difficult. Also, a control group instructed to simulate DID was included. The conclusion that can be drawn is that, the patients results did not indicate amnesia but transfer of information between the identities tested. How can the discrepancy between patient s reports of interidentity amnesia and the lack of objective test results be reconciled? The DID patients experience of amnesia may result from a faulty cognitive evaluation of a recollection after intact memory retrieval. Because patients are convinced of having different identities, they construct an image of their memories being compartmentalized in their separate identities. This distortion may lead them not to use some retrieved memories, that they are convinced belong to other identities. Deciding not to use correctly retrieved information then lies at the basis of their amnesia-like behaviors. These behaviors may thus reflect the patient s appraisal of retrieved memories as ego-dystonic or ego-syntonic rather than a memory encoding and/or retrieval impairment

Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial

Background About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape. Objective To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape. Method This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual (‘watchful waiting’) between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time. Results Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time. Conclusions The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed

Early Intervention with Eye Movement Desensitisation and Reprocessing (EMDR) Therapy to Reduce the Severity of Posttraumatic Stress Symptoms in Recent Rape Victims: Study Protocol for a Randomised Controlled Trial

It is estimated that more than 40% of rape victims develops a posttraumatic stress disorder (PTSD), a statistic that is relatively high compared to other types of trauma. PTSD can affect the victims' psychological, sexual, and physical health. Therefore, there is an urgent need for early interventions to prevent the onset of PTSD in this target group. This randomised controlled trial (RCT) examines the efficacy of early Eye Movement Desensitisation and Reprocessing (EMDR) therapy aimed to reduce the severity of posttraumatic stress symptoms in victims of recent rape. Subjects (N = 34) are individuals of 16 years and older who present themselves within 7 days post-rape at one of the four participating Sexual Assault Centres in the Netherlands. The intervention consists of two sessions of EMDR therapy between day 14 and 28 post-rape, while the control group receives treatment as usual, consisting of careful monitoring of stress reactions by a case-manager across two contacts during 1-month post-rape. Baseline assessment, posttreatment assessment and follow-up assessments at 8 and 12-weeks post-rape will be used to assess the development of posttraumatic stress symptoms. In addition, the efficacy of the intervention on psychological and sexual functioning will be determined. Linear mixed model analysis will be used to explore the differences within and between the EMDR group and control group at the various time points. The results of this RCT may help the dissemination and application of evidence-based preventative treatments for PTSD after rape

De juiste kennis versterkt de zelfregie: Een reactie op de reactie van Karbouniaris en collega's

In dit artikel reageren we op de reactie van Karbouniaris en collega’s (2023). We delen het doel om de zorg voor patiënten zo effectief mogelijk maken, waarbij de patiënt optimale zelfregie heeft en kan kiezen uit een breed palet aan effectieve behandelingen. De huidige zorgstandaard voor traumagerelateerde stoornissen bevat een breder palet dan CGT en EMDR, houdt rekening met ervaringskennis van de patiënt en is gebaseerd op goed onderzoek naar effectiviteit. We zien het als taak van de behandelaar om de patiënt goed voor te lichten over de behandelingen die opgenomen staan in de zorg- standaard, inclusief de voor- en nadelen, de mate van bewezen effecten en de doelmatigheid van die behandelingen. Tegelijkertijd dient voorlichting de patiënt te beschermen tegen behandelingen die (nog) niet (voldoende) be-wezen effectief of – erger nog – schadelijk kunnen zijn. Met de juiste kennis op zak staat de patiënt het sterkst en komt zelfregie het meest tot zijn recht. Trefwoorden: zorgstandaard traumagerelateerde stoornissen, evidence-based (be)handelen, zelfregie, voorlichtin

Traumagerelateerde klachten: Een aantal populaire behandelingen onder de loep genomen.

Voor de behandeling van traumagerelateerde klachten zijn effectieve, evidence-based behandelingen beschikbaar, maar relatief weinig mensen krijgen daadwerkelijk zo'n behandeling. In plaats daarvan worden andere behandelingen gegeven die populair zijn, waaronder lichaamsgerichte behandelingen, dierondersteunde therapie, speltherapie, EMDR toegepast op vermijding, de Lovett-methode voor preverbaal trauma, geleide synthese en deprogrammeren. Wij nemen deze behandelingen onder de loep. Zijn ze effectief? Wat is het veronderstelde werkingsmechanisme ervan? En wat zijn de mogelijke risico's van deze behandelingen? In de discussie bespreken we mogelijke redenen waarom deze en vergelijkbare behandelingen in de klinische praktijk worden verkozen boven evidence-based behandelingen en een aantal redeneerfouten die aan deze keuzes bijdragen