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A Meta-Analysis for the Efficacy of Hypnotherapy in Alleviating PTSD Symptoms

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Abstract

A systematic review and meta-analysis of the efficacy of hypnotherapy in the treatment of PTSD used literature searches to obtain 47 articles. However, only 6 were experiments testing the efficacy of hypnosis-based treatments. A fixed-effects meta-analysis was applied to postintervention assessment results and 4-week follow-ups. A large effect in favor of hypnosis-based (especially manualized abreactive hypnosis) treatment was found for the studies that reported the posttest results (d = 1.17). The temporal stability of the effect remains strong, as reflected by the 4-week follow-up assessments (d = 1.58) and also by long-term evaluations (e.g., 12 months). Hypnosis appears to be effective in alleviating PTSD symptoms.

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... PTSD sebagai kondisi yang melemahkan dan mempengaruhi kualitas hidup individu, sehingga intervensi kesehatan yang diharapkan dapat menghilangkan gejala yang relevan sangat diperlukan. (Rotaru and Rusu, 2016) PTSD juga merupakan gangguan serius, kompleks dan sering diikuti dengan gangguan jiwa kronis jika terpapar stres lebih berat, yang timbul sebagai respon berkepanjangan terhadap kejadian atau situasi yang menimbulkan stress. Gejala khas mencakup tiga gejala utama yaitu episode ketika bayangan kejadian traumatik terulang (reexperience) atau dalam mimpi (flashback), cenderung menghindari tempat, orang, atau hal lain yang mengingatkan mereka tentang peristiwa traumatik (avoidance), dan mudah peka terhadap pengalaman kehidupan normal (hyperarousal) sebagai suatu kewaspadaan yang meningkat. ...
... Beberapa penelitian hasilnya menunjukan dampak positif pada pengurangan gejala PTSD dalam jangka pendek dan jangka panjang. (Rotaru and Rusu, 2016). ...
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Buku Ini Membahas Anatomi dan Fisiologi Sistem Neurologi, Lega dan Etik Pada Pelaksanaan Terapi Komplementer Hipnoterapi, Teknik Dalam Tindakan Hipnoterapi, Manfaat Dalam Pelaksanaan Hipnoterapi, Strategi dalam Pelaksanaan Hipnoterapi, Proses dan Tahapan Hipnoterapi, Aplikasi Hipnoterapi Pada Kasus Nyeri Kepala dan Pusing, Aplikasi Hipnoterapi Pada Kasus Pada Proses Persalinan,Sistem Dokumentasi Dalam Hipnoterapi, Aplikasi Hipnoterapi Pada Kasus PTSD.
... These positive benefits have been consistently shown to continue over at least six to twelve months. According to Rotaru et al. [4], Cowen [5], Barabasz [6], Gina et al. (2006) and others the research outcomes are demonstrating the effectiveness of hypnotherapy and calling for further research to determine the clinical range of hypnotherapy. Hypnosis appears to be effective also in alleviating PTSD symptoms (Rotaru et al. [4]). ...
... According to Rotaru et al. [4], Cowen [5], Barabasz [6], Gina et al. (2006) and others the research outcomes are demonstrating the effectiveness of hypnotherapy and calling for further research to determine the clinical range of hypnotherapy. Hypnosis appears to be effective also in alleviating PTSD symptoms (Rotaru et al. [4]). Metaanalysis clearly indicates that hypnotherapy is highly effective also in treatment of psychosomatic disorders (Flammer et al. [7]). ...
Article
Hypnosis is empirically well studied in its biological foundations and its therapeutic effectiveness. It is a recognised healing method in Austria, Switzerland and Germany. With the use of imaging techniques, it can be clearly shown that brain areas responsible for attention, visual imagination, critical evaluation and self-awareness change in their activity through hypnosis in such a way that the state of hypnotic trance differs markedly from both sleep and waking consciousness. The effects of hypnosis on the immune system as well as on affects have been confirmed. Basically, a fundamental distinction must be made between “therapeutic hypnosis”, hypnosis for therapeutic purposes, and “show hypnosis”, such as is shown in various entertainment performances. Therapeutic hypnosis” is in turn divided into different forms, namely “hypnotic psychotherapy”, “hypnotherapy” and “hypnosis”.
... These methodological and clinical criticisms, coupled with suboptimal outcomes and attrition rates, have catalyzed the examination of a range of alternatives with a range of promise. Multiple trials have supported increased physical activity (including yoga (Ong Gaffney, Gulden, Jennings, & Page, 2023) and aerobic exercise (Björkman & Ekblom, 2022)), as well as hypnotherapy (Abramowitz, Barak, Ben-Avi, & Knobler, 2008;Rotaru & Rusu, 2016). At least one randomized clinical trial showed some improvements from music therapy (Beck et al., 2021). ...
Article
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Though several treatments effectively address the pervasive impact of trauma, they do not achieve complete symptom resolution for all clients, inspiring the search for alternatives. Internal Family Systems (IFS) therapy has grown popular, especially in informal psychedelic-assisted treatments (PAT). Compared to stereotypes of empirically validated, exposure-based treatments, IFS has novel facets with widespread appeal. The model encourages improved quality of interactions among multiple, naturally arising “parts” or subpersonalities potentially generated by traumatic experience. The body of IFS literature is extensive, enthusiastic, and thought-provoking. Outcome data for applying the model to Post-Traumatic Stress Disorder are limited. Attempts to operationalize and falsify the theory's assumptions and proposed mechanisms will likely prove challenging. Nevertheless, the model's popularity underscores a problem with perceptions of the empirically-supported treatments. Contemplating ethical ways to present the IFS approach given the state of relevant research, we note strategies that would apply to recommendations for PAT of any type. These strategies include detailed psychoeducation about empirically-supported treatments, candid description of the experimental nature of alternatives, frequent assessments of improvement, and detailed monitoring of potential iatrogenic effects. Drawing on facets of IFS to improve perceptions of the empirically validated treatments might provide an efficient way to appeal to more clients, decrease drop out, and increase gains as we await results of empirical investigations of IFS-influenced PAT. These steps can allow clients to choose an approach consistent with their own impressions of a credible intervention, potentially leading to better outcomes.
... While these results were positive, there was low supporting PTSD treatment evidence, resulting in the VA/ DoD (2017) conclusion not to support. A small metaanalysis (Rotaru & Rusu, 2016) combined hypnosis with other therapies found hypnotherapy could be additionally helpful in mitigating PTSD symptoms (not recommended at this time as main treatment due to insufficient evidence). ...
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BACKGROUND Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem. AIMS Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes. METHODS Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations. RESULTS Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored. CONCLUSIONS Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.
... The efficacy of hypnosis was supported for post-menopausal hot flashes in an RCT [109] and for neurodegenerative disorders, such as amyotrophic lateral sclerosis, in a longitudinal study [110]. Meta-analyses indicated the efficacy of hypnosis for obesity [111], depression [112], post-traumatic stress disorder [113], and anxiety associated with medical procedures [9,93]. Additionally, reviews offered preliminary evidence of the benefits of hypnosis for smoking cessation [114,115] and varied dermatological problems such as pruritus [5,116]. ...
Article
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Background and purpose: Hypnosis, a mind-body treatment dating back to early human history, has regained attention in the last decade, with research suggesting its effectiveness for varied physiological and psychological ailments such as distress, pain, and psychosomatic disorders. However, myths and misconceptions have prevailed among the general public and clinicians, hindering the adoption and acceptance of hypnosis. It is important to distinguish myths from facts and discern what is hypnosis and what is not to enhance the understanding, acceptance, and adoption of hypnotic interventions. Methods: This narrative review traces the history of myths surrounding hypnosis in contrast to the evolution of hypnosis as a treatment modality. In addition to comparing hypnosis to other interventions with similar procedures and features, the review unravels misconceptions that have impeded the adoption and acceptance of hypnosis in clinical and research settings and presents evidence to demystify this intervention. Results: This review examines the roots of myths while presenting historical facts and evidence that support hypnosis as a treatment modality and alleviate misconceptions depicting it as mystical. Further, the review distinguishes hypnotic and non-hypnotic interventions with overlapping procedures and phenomenological features to enhance our understanding of hypnotic techniques and phenomena. Conclusion: This review enhances the understanding of hypnosis in historical, clinical, and research contexts by disproving related myths and misconceptions to promote the adoption of hypnosis in clinical and research contexts. Further, this review highlights knowledge gaps requiring further investigations to steer research toward an evidence-based practice of hypnosis and optimise multimodal therapies embedding hypnosis.
... Thus, use of these self-regularly practices might result in reductions in symptoms of depression, anxiety, or PTSD, without the aid of substances. Evidence supporting the beneficial effects of HYP and MM alone or in combination with other treatment modalities on these psychological function domains continues to grow (Banks et al., 2015;Goldberg et al., 2019;Hammond, 2010;Hofmann et al., 2010;Rotaru & Rusu, 2016;Shih et al., 2009;Valentine et al., 2019). In support of improved emotion regulation as a potential mechanism underlying reduced cannabis use are findings from a recent systematic review and meta-analysis that examined the effects of cannabis use on experimental pain among healthy adults. ...
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Purpose/objective: To examine the impact of three behavioral interventions for chronic pain on substance use. Research method/design: Participants were 328 Veterans with chronic pain receiving care at one of two Veterans Affairs Medical Centers in the northwest United States. Participants were randomly assigned to one of three 8-week manualized in-person group treatments: (a) hypnosis (HYP), (b) mindfulness meditation (MM), or (c) active education control (ED). Substance use frequency was assessed using 10 individual items from the WHO-ASSIST, administered at baseline prior to randomization and at 3- and 6-month posttreatment. Results: Baseline substance use (i.e., any use) in the past 3 months was reported by 22% (tobacco), 27% (cannabis), and 61% (alcohol) of participants. Use of all other substances assessed was reported by < 7% of participants. Results showed that MM, as compared to ED, significantly reduced risk of daily cannabis use by 85% and 81% at the 3- and 6-month posttreatment follow-ups, respectively, after adjusting for baseline use. HYP, as compared to ED, significantly reduced risk of daily cannabis use by 82% at the 6-month posttreatment follow-up after adjusting for baseline use. There was no intervention effect on tobacco or alcohol use at either posttreatment follow-up. Conclusions/implications: HYP and MM for chronic pain may facilitate reductions in cannabis use, even when reducing such use is not a focus of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... S številnimi nadzorovanimi študijami, metaanalizami in sistematičnimi pregledi literature (glej pregled metaanaliz v Pajntar, Areh in Možina, 2013;pa tudi Matthews, Conti in Starr, 1998;Lynn in dr., 2000;Nash, 2000;Bongartz, Flammer in Schwonke, 2002;Parker in Parker, 2003;Montgomery in dr., 2002;Flammer in Bongartz, 2003;Sachse, 2004;Lynn in Kirsch, 2006;Revenstorf, 2006;Nash in Barnier, 2008;Wais in Revenstorf, 2008;Tefikow in dr., 2013;Sapp, 2014;Jensen in dr., 2015;Revenstorf in Peter, 2015;Rotaru in Rusu, 2016;Milling in drugi., 2018) so znanstveno potrjeni zdravilni učinki hipnoterapije in hipnopsihoterapije, tako pri odraslih kot otrocih, pri širokem spektru medicinskih bolezni in stanj (npr. poškodbe, rak, opekline, tinitus, in duševnih težav, kot so npr. ...
Chapter
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Prikazana je uporaba hipnoze v psihoterapiji. Kljub temu da se je zgodovina psihoterapije pred okoli 250 leti začela s hipnozo, je danes pozabljena kraljica psihoterapije. V teoretičnem delu članka so prikazane različne definicije in teorije hipnoze ter hipnopsihoterapije, miti in predsodki hipnozi in dejstva o hipnopsihoterapiji, hipnotični pojavi v vsakdanjem življenju, ki lahko služijo kot izhodišče za hipnopsihoterapijo ter prispevek nevroznanosti k razumevanju hipnoze. V praktičnem delu je opisana hipnopsihoterapevtska seansa za lajšanje glavobola.
... For example, the use of welldefined practices, protocols, and/or rituals is the basis of practices related to hypnosis [137,138], meditation [139,140], and psychedelics [23,141] in historical and contemporary Box 3. Clinical findings Hypnosis Hypnosis has been increasingly proposed to patients (chronic pain, oncology, severely burned, phobic, during surgery, etc.) as a means to re-engage their cognitive resources and capacities to modulate pain and emotional distress and to improve their treatment and recovery of well-being [159][160][161]. The main clinical application of hypnosis concerns acute and chronic pain relief [113,114]; however, positive effects have also been observed for the treatment of depressive [162], anxiety [121,163], and post-traumatic stress disorder symptoms [164], as well as for smoking cessation [165]. Historically, hypnosis has been used in conjunction with other psychotherapeutic interventions (e.g., psychoanalysis and cognitive-behavioural therapy), as well as with mindfulness-based interventions [166] and psychedelics [18]. ...
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No contemporary unifying framework has been provided for the study of non-ordinary states of consciousness (NSCs) despite increased interest in hypnosis, meditation, and psychedelics. NSCs induce shifts in experiential contents (what appears to the experiencer) and/or structure (how it appears). This can allow the investigation of the plastic and dynamic nature of experience from a multiscale perspective that includes mind, brain, body, and context. We propose a neurophenomenological (NP) approach to the study of NSCs which highlights their role as catalysts of transformation in clinical practice by refining our understanding of the relationships between experiential (subjective) and neural dynamics. We outline the ethical implications of the NP approach for standard conceptions of health and pathology as well as the crucial role of experience-based know-how in NSC-related research and application.
... B. die kognitive Verhaltenstherapie mit der Hypnotherapie gekoppelt wird (Kirsch et al., 1995). Zudem wurde die Wirksamkeit der Hypnotherapie bei diversen Störungsbildern, darunter Posttraumatische Belastungsstörung, Angststörungen und chronischen Schmerzen ebenfalls metaanalytisch bestätigt (Bongartz et al., 2002;Rotaru & Rusu, 2016). Diese Störungsbilder sind oft mit Veränderungen im Immunsystem assoziiert. ...
Article
Zusammenfassung. Theoretischer Hintergrund: Mit Hypnose können positive immunmodulierende und therapeutische Effekte bei psychischen sowie somatischen stress-assoziierten Erkrankungen erzielt werden. Fragestellung: Diese Arbeit beschäftigt sich mit immunologischen Veränderungen durch Hypnose und zeigt potentielle zukünftige Forschungsfelder zu biomolekularen Wirkfaktoren von Hypnose auf. Methode: Es werden empirische Befunde zur Wirkung von Hypnose auf Parameter des Immunsystems zusammengefasst. Ergebnisse: Hypnose führt zu einer Anpassungsreaktion des Immunsystems in Form von Veränderungen in der Anzahl von Immunzellen und Zytokinen. Schlussfolgerung: Ein spannendes neues Forschungsfeld liegt in der Untersuchung der Wirkmechanismen von Hypnose auf das Immunsystem sowie dessen Interaktion mit dem Stresssystem und dem Energiemetabolismus.
... This was initially mainly for anesthesia [6], however it is still widely used to treat other symptoms occurring during hospital treatment. Numerous studies demonstrate the effectiveness of hypnosis to treat pain of various etiologies [7][8][9], post-traumatic stress disorder, [10] to reduce the stress effects of patients who are preparing for and undergoing surgery [11]. Furthermore, it is also used in the treatment of both depression [12] and anxiety disorders [13,14], which coexist in patients undergoing surgical treatment. ...
Article
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Artykuł prezentuje zastosowanie technik terapii ericksonowskiej, ze szczególnym uwzględnieniem metafor, podczas leczenia pacjentów Kliniki Chirurgii Onkologicznej i Rekonstrukcyjnej. Terapia ta opiera się na założeniach Miltona H. Ericksona — skoncentrowaniu na zasobach, na przyszłości, wprowadzaniu zmian małymi krokami, pożytkowaniu wszystkiego, co wnosi pacjent oraz szczególnie zindywidualizowanym sposobie pracy. Podejście to jest skuteczne w warunkach oddziału, na którym pacjenci konfrontują się z wieloma niewiadomymi podczas leczenia i gdzie elastyczność oraz otwartość na zmiany są szczególnie cenne. Operacje zmieniające wygląd zmieniają też obraz ciała i co za tym idzie — poczucie tożsamości. Utrata dotychczasowego obrazu siebie niesie za sobą długoterminowe skutki. Korzystanie z psychoterapii od początku tych zmian daje szansę na łagodzenie bolesnych konsekwencji ponoszonych strat. Przedstawione opisy pracy z lękiem, bólem czy rezygnacją są przykładami na holistyczne podejście do leczenia. Chorzy uzyskując ulgę w cierpieniu psychicznym są bardziej wytrwali w długotrwałym leczeniu i zmotywowani do zdrowienia. Uzyskują ponadto wsparcie i informacje, o co trzeba się zatroszczyć, by w pełni powrócić do zdrowia.
... The call for the use of hypnotherapy can be confirmed by several studies. Rotaru and Rusu (2016) tender that although systematic desensitization and other Cognitive Behavioral techniques seems the preferred approaches for dealing with PTSD symptoms, the effect of hypnosis is not only promising as a value-added technique to these classic treatments, but can also be considered as a valuable treatment per se. Along the same line of argument Taylor and Genkov (2020) indicate that evidence supports the use of hypnotherapy not only as a complementary treatment to traditional methods used in the treatment of persistent pain, but they also highlight the potential of hypnotherapy to be recommended as a non-pharmacological first-line treatment for persistent pain. ...
Article
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The aim of this qualitative study was to explore and describe South African registered psychologists’ account of their patients’ myths regarding hypnotherapy. A social constructivist approach was employed to explore the descriptions of eight psychologists. This article converges on myths of participants’ patients and where they originate from, as described by the participants. Psychologists were selected by means of chain referral sampling and engaged in one semi-structured interview. Data were analyzed by means of thematic analysis (TA), and participants elaborated on their experience of patients’ myths and the possible origins thereof. Furthermore, conclusions were drawn across themes, which contributed to the findings. The most important finding indicated that while hypnotherapy is of great value, misconceptions stemming largely from unscientific applications contribute to patients’ reluctance in utilizing this mechanism. The article concludes with a discussion of the implications, limitations and strengths of the study, as well as recommendations for future research.
... Recent meta-analyses yielded large and highly statistically significant effect sizes (i. e., the average effect size > 1.1, p. < .001) in the reduction of PTSD symptoms (O'Toole, Solomon, & Bergdahl, 2016;Rotaru & Rusu, 2016). The efficacy may be attributed, consistent with the phase-oriented approach principles, to adapting specific hypnotherapeutic strategies to targeted symptoms at different stages of therapy. ...
Article
Hypnosis has long been successfully used in the treatment of trauma and related disorders. In this paper, I describe a hypnosis-informed approach to PTSD using mindfulness. The Mindfulness-Based Phase-Oriented Traumatic Therapy (MB-POTT) follows the phase-oriented tradition that was originally proposed by Pierre Janet, later expanded by Daniel Brown and Erika Fromm using clinical hypnosis. MB-POTT comprises four distinct, yet recursive, stages: (1) therapeutic alliance building and symptom stabilization, (2) formation of a narrative about the trauma, (3) re-creation of meaning of life after trauma, and (4) future symptom management. In explaining these categories, I delineate the nature of mindfulness, both similarities and dissimilarities to hypnosis, with an emphasis on techniques that resemble hypnotic approaches (e.g., ego state therapy, ego-strengthening). Finally, I provide a case study in which MB-POTT was implemented with a client who suffered from PTSD after a near-fatal industrial accident.
... A diverse array of recent literature supports the use of hypnosis in the treatment of psychological trauma, ranging from case studies that demonstrate successful incorporation of hypnosis as part of integrative treatments (e.g. Moss, 2017;Spiegel, 2015), to articles underscoring the advantages of alert inductions with traumatized troops (Eads & Wark, 2015), to meta-analytic evidence of the long-term efficacy of hypnotherapy for posttraumatic stress disorder (Rotaru & Rusa, 2016). Pierre Janet has been recognized for developing hypnotic techniques for working with the trauma-related psychopathology well over a hundred years ago (van der Hart, Brown, & van der Kolk, 1989). ...
Article
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Although metanalytic evidence exists to support the long-term efficacy of hypnotic interventions in the treatment of trauma, assertions that hypnosis may induce trauma or exacerbate existing posttraumatic reactions through activating dissociative processes seem to persist in some circles. While multiple studies have established that hypnotic induction produces dissociative phenomena, what has not yet been clearly explicated is the degree to which varieties of dissociative phenomena differentially elicited by hypnotic induction tend to skew toward the pathological or nonpathological end of the continuum of dissociation. The authors of the current study explore the connection between hypnotic susceptibility and facets of dissociation, employing the Harvard Group Scale of Hypnotic Susceptibility: A (HGSHS:A) and the State Scale of Dissociation (SSD). A significantly greater change in state dissociation was observed in their hypnosis condition as compared with a novel control condition (t (82) = 3.235, p =.002, d =.70), confirming that a relationship appears to exist between hypnosis and dissociation. A discussion of the differential effect of hypnosis on SSD subscales follows, specifically indicating less activation of the more putatively pathological facets, namely identity confusion and identity alteration. This finding may serve to assuage some concerns around the potential for iatrogenesis in working with traumatized patients.
... What is fairly well established in the research literature is that several types of problematic dissociative reactions and states are related to a history of trauma (Powers, Cross, Fani, & Bradley, 2015;Stein et al., 2013). Partly due to this observed correspondence, various authors have suggested that hypnotherapy is either the treatment of choice for posttraumatic stress disorder (PTSD) and other trauma-related disorders, or a tool that is a useful adjunct to other forms of trauma-informed treatment (Lynn & Cardeña, 2007;Rotaru & Rusu, 2016;Spiegel, 2003Spiegel, , 2016. ...
Article
In considering the applicability of hypnosis to treating Complex PTSD (C-PTSD) we examine the relationship between trauma, hypnosis, and dissociation, the latter being a common response to traumatization that is particularly salient in C-PTSD. We then provide an overview of the nature of C-PTSD, which research is beginning to demonstrate is considerably more prevalent than the more circumscribed PTSD syndrome depicted in the DSM. Building on this foundation, we discuss the reasons why hypnotically structured treatment is particularly well suited for C-PTSD, explaining how each of the major aspects of this syndrome can be addressed within a hypnotic framework.
... There is also much in the aforementioned hypnotic literature addressing the treatment of trauma. Many authors have written about the efficacy of using hypnotically mediated psychotherapeutic interventions in the treatment of post-traumatic stress (Ibbotson & Williamson, 2010;Kingsbury, 1992;Leung, 1994;Lynn & Cardena, 2007;Lynn, Malakataris, Condon, Maxwell, & Cleere, 2012;O'Toole, Solomon, & Bergdahl, 2016;Rotaru & Rusu, 2016;Spiegel, 1988Spiegel, , 1993Spiegel, , 2003Spiegel & Cardena, 1990;Vermetten & Christensen, 2010). Lynn and Cardeña (2007) in their review of the evidence for the use of hypnosis in the treatment of posttraumatic stressful conditions found that hypnotically mediated clinical interventions have utility in the treatment of posttraumatic conditions. ...
Article
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This article addresses the prevalence of posttraumatic stress arising from serious illness and injury. Its purpose is to underscore the importance of assessment and treatment of this population. The article reviews literature about patient stress responses to intensive care experiences and hospitalization. Above all, serious illness and injury hamper the individual's ability to maintain their ongoing lifestyle and interpersonal relationships; the experience raises the specter of vulnerability and mortality and can obstruct the experience of a familiar "self". Issues to be assessed and areas to be addressed therapeutically using hypnosis are suggested.
... reviewed subsequent meta-analyses and concluded that hypnotic interventions typically yielded outcomes superior to comparison conditions (e.g., no treatment, usual treatment, wait-list comparisons) in studies of chronic pain and hypnotically induced analgesia, irritable bowel syndrome, psychosomatic disorders, surgical or medical patients, nausea and vomiting in chemotherapy patients, and needlerelated pain and distress in children and adolescents. Additional metaanalyses have reported (a) favorable results for hypnosis in treating depression (Milling, Valentine, McCarley, LoStimolo, 2018), anxiety (Valentine, Milling, Clark, & Moriarity, 2019), obesity (Milling, Gover, & Moriarty, 2018), and posttraumatic stress disorder (Rotaru & Rusu, 2016); (b) mixed results (no significant differences from sham interventions) in treating insomnia (Lam et al., 2015); or (c) preliminary positive findings in treating smoking (see Green & Lynn, 2019). ...
Article
We present 21 prominent myths and misconceptions about hypnosis in order to promulgate accurate information and to highlight questions for future research. We argue that these myths and misconceptions have (a) fostered a skewed and stereotyped view of hypnosis among the lay public, (b) discouraged participant involvement in potentially helpful hypnotic interventions, and (c) impeded the exploration and application of hypnosis in scientific and practitioner communities. Myths reviewed span the view that hypnosis produces a trance or special state of consciousness and allied myths on topics related to hypnotic interventions; hypnotic responsiveness and the modification of hypnotic suggestibility; inducing hypnosis; and hypnosis and memory, awareness, and the experience of nonvolition. By demarcating myth from mystery and fact from fiction, and by highlighting what is known as well as what remains to be discovered, the science and practice of hypnosis can be advanced and grounded on a firmer empirical footing. This article is protected by copyright. All rights reserved.
... Hypnotherapy treatments have demonstrated efficacy for a number of conditions (Jensen, et al., 2017). There is indication from the existing systematic reviews that the strongest empirical support is for use of hypnosis treatments in pain management (Abbott, et al., 2017), irritable bowel syndrome (Schaefert, et al. 2014, Webb, et al., 2007, insomnia, several stress-related medical conditions (Lever, 1988) and PTSD symptoms (Rotaru and Rusu, 2016). Limited and sometimes inconclusive evidence from literature reviews suggests that hypnotic treatments may also be effective for a wide variety of other problems and conditions such as depression (Alladin and Alibhai, 2007) and anxiety (Hammond, 2010;Coelho, Canter and Ernst, 2007;Jensen, et. ...
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A systematic review was conducted on the effectiveness of hypnotherapy on anxiety disorders. Aim: The aim of the proposed project was to systematically review the relevant evidence for the effectiveness of hypnotherapy interventions used for treatment of anxiety disorders. Background: Anxiety disorders represent one of the major groups of disorders seen in psychiatry and in medicine generally, having a high prevalence and often an early onset. Anxiety disorders appear to be continually increasing in prevalence and pose a significant morbidity burden. The treatment may be sometimes expensive and time-consuming. Medication is known to have unpleasant side-effects. Hypnotherapy treatments have demonstrated efficacy for several conditions and there has been increasing interest in providing hypnotherapy in healthcare settings as there is more awareness among the general population of alternative and complementary therapies. Hypnotherapy may potentially provide an alternative to medication in the treatment of anxiety disorders, especially regarding children and young adults. Method: A systematic review of randomised and non-randomised experimental studies investigating the effectiveness of hypnotherapy on anxiety disorders that were published from January 2007 to April 2018 was conducted. The population included in the review were children and adults with any anxiety disorder. Intervention was any type of hypnotherapy delivered by trained or untrained individuals from any background. The comparison conditions were: relaxation, cognitive behavioural therapy, systematic desensitisation, active interventions such as CBT, psychological therapy, placebo and waiting list. The main outcome was any change in symptoms of anxiety measured by any validated scale or assessment. The secondary outcome was any other positive or adverse health effect. The systematic review methods were followed, including a clearly stated set of objectives with pre-defined eligibility criteria for studies, systematic searching of the literature, duplicate screening, data extraction, quality assessment and a systematic presentation of the findings. A second reviewer was involved in the search and quality assessment stages. A protocol was written and submitted prior to conducting the study. Results: The current systematic search discovered 3 randomised controlled trials. All controlled trials used active groups (placebo or other intervention), one study utilised inactive control (treatment as usual). All of the included studies were published in hypnotherapy journals. The mean sample size was 107 (range 32-226). In total, 320 participants were included. Two of the included studies investigated the effectiveness of hypnotherapy in the treatment of Post-Traumatic Stress Disorder (PTSD), one study included participants with anxiety disorders and mixed anxiety depressive disorders. Participants who had PTSD experienced diverse traumatic events: combat exposure or being exposed to terrorist activity. The results of these studies all reported significant difference in the measured outcomes favouring hypnotherapy compared to a control group. The results overall were inconclusive due to methodological quality of the studies, mostly due to problems with randomisation and blinding. Conclusions: The current systematic review concludes that the evidence regarding the effectiveness of hypnotherapy in the treatment of anxiety disorders is insufficient, mainly due to methodological quality and the volume of research from which to draw definitive inferences. More high-quality research is needed to assess the effectiveness of hypnotherapy in anxiety disorders.
... Spectra from non-rejected 2-second epochs will be used to compute an average spectrum for the recording session. The sum of power (microvolts 2 ) will be computed for delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and gamma (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) bands. These values will then be converted to relative power (i.e. the proportion of summed power in the band divided by the total power of the entire spectrum (from 1 to J o u r n a l P r e -p r o o f 40Hz). ...
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Objectives: To describe the protocol of a randomized controlled trial to evaluate the effectiveness and mechanisms of three behavioral interventions. Methods: Participants will include up to 343 Veterans with chronic pain due to a broad range of etiologies, randomly assigned to one of three 8-week manualized in-person group treatments: (1) Hypnosis (HYP), (2) Mindfulness Meditation (MM), or (3) Education Control (EDU). Projected outcomes: The primary aim of the study is to compare the effectiveness of HYP and MM to EDU on average pain intensity measured pre- and post-treatment. Additional study aims will explore the effectiveness of HYP and MM compared to EDU on secondary outcomes (i.e., pain interference, sleep quality, depression and anxiety), and the maintenance of effects at 3- and 6-months post-treatment. Participants will have electroencephalogram (EEG) assessments at pre- and post-treatment to determine if the power of specific brain oscillations moderate the effectiveness of HYP and MM (Study Aim 2) and examine brain oscillations as possible mediators of treatment effects (exploratory aim). Additional planned exploratory analyses will be performed to identify possible treatment mediators (i.e., pain acceptance, catastrophizing, mindfulness) and moderators (e.g., hypnotizability, treatment expectations, pain type, cognitive function). Setting: The study treatments will be administered at a large Veterans Affairs Medical Center in the northwest United States. The treatments will be integrated within clinical infrastructure and delivered by licensed and credentialed health care professionals.
... The feeling of automaticity has been described by two constructs, involuntariness and effortlessness, that correlate with standard measures of hypnotizability (Polito, Barnier, & Woody, 2013). In parallel with the investigation of this essential phenomenon, clinical effects of hypnosis are becoming more and more recognized for a variety of conditions, including pain management (Jensen, Day, & Miró, 2014;Jensen & Patterson, 2014), headaches and migraines (Hammond, 2007), irritable bowel syndrome (Schaefert, Klose, Moser, & Hauser, 2014), and in the treatment of stress and anxiety (Nunns et al., 2018;Provencal, Bond, Rizkallah, & El-Baalbaki, 2018), including symptoms of posttraumatic stress disorders (Rotaru & Rusu, 2016). Training can further be devised to enhance the feeling of automaticity (Schweiger Gallo, Pfau, & Gollwitzer, 2012), and clinical suggestion of automaticity may in turn improve therapeutic effect of hypnosis (Kirsch & Lynn, 1999). ...
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The feeling of automaticity reported by individuals undergoing a hypnotic procedure is an essential dimension of hypnosis phenomenology. In the present study, healthy participants rated their subjective experience of automaticity and resting-state arterial spin labelling (ASL) scans were acquired before and after a standard hypnotic induction (i.e., “neutral hypnosis”). The increase in perceived automaticity was positively associated with activity in the parietal operculum (PO) and seed-based coactivation analysis revealed additional associations in the anterior part of the supracallosal cingulate cortex (aMCC). This is consistent with the role of these regions in perceived self-agency and volition and demonstrates that these effects can be evidenced at rest, in the absence of overt motor challenges. Future studies should further examine if/how these changes in brain activity associated with automaticity might facilitate the responses to suggestions and contribute to clinical benefits of hypnosis.
... At the same time, we were aware that anxiety can have various causes, and therefore, treatments may also vary. Recently, Rotaru and Rusu (2016) conducted a systematic review of the efficacy of hypnosis in relieving anxiety and found that the results reported in six papers reflected a positive influence of hypnosis on the long-term reduction of symptoms. Hence, hypnosis itself may cause a decrease in anxiety without memory implantation. ...
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This paper is devoted to the mechanism of the positive construction of autobiographical memory. Positive construction consists of the spontaneous transformation of memories in the direction of the subjective enhancement of self-competence in past activities to anticipate improvement over time. We speculated that trait anxiety may indicate a failure to exhibit this mechanism that results in a deficit of affirmative self-esteem. We hypothesised that the implantation of positive self-defining memories in anxiety-evoking domains would decrease trait anxiety. One hundred twenty adults recollected three negative self-defining memories. Then, half of the participants imagined episodes of desired behaviour that differed from the originally recollected ones either in discussion or in hypnosis. Thirty participants experienced a hypnotic state without any references to memories, and the rest formed the control group. Subjects from the “Memory Implantation in Hypnosis” group became unable to distinguish the originally reported memories from the imagined ones, exhibited decreased trait anxiety scores after a 4-month delay, and reported enhanced self-esteem. In contrast, the participants from the “Hypnosis with no reference to the past” group exhibited decreased scores at a short delay but later returned to their original scores. These findings highlight the power of cured episodic-like autobiographical memory for updating the self.
... As admirable as the The Scientific Committee of Conference Psychotherapies for Anxiety and Depression: Benefits and Costs position statement may be, it too may suffer from a philosophical bias -one that favors Cognitive Behavioral Therapy (CBT), Interpersonal Therapy and Brief Dynamic Psychotherapy-based interventions as opposed to other psychological treatments. The authors fail to consider meta-analytic research that demonstrates efficacy and effectiveness of hypnotherapy, cognitive hypnotherapy, and virtual reality exposure (VRE) therapy for the treatment of anxiety disorders, specific phobias and posttraumatic stress disorder (PTSD; Golden, 2009;Pull, 2005;Rotaru & Rusu, 2016). In many instances these benefits are comparable to those after CBT treatment (Safir, Wallach, & Bar-Zvi, 2012). ...
... Although, some progress has been made in defining biomarkers to predict the potential response to current treatments (Colvonen et al., 2017), new drugs or therapeutic strategies are required. Few new drug candidates and other treatments such as transcranial magnetic brain stimulation and hypnotherapy (Rotaru and Rusu, 2016) are currently been tested (Trevizol et al., 2016). ...
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Posttraumatic stress disorder (PTSD), chronic psychological stress, and major depressive disorder have been found to be associated with a significant decrease in glial fibrillary acidic protein (GFAP) immunoreactivity in the hippocampus of rodents. Cotinine is an alkaloid that prevents memory impairment, depressive-like behavior and synaptic loss when co-administered during restraint stress, a model of PTSD and stress-induced depression, in mice. Here, we investigated the effects of post-treatment with intranasal cotinine on depressive- and anxiety-like behaviors, visual recognition memory as well as the number and morphology of GFAP + immunoreactive cells, in the hippocampus and frontal cortex of mice subjected to prolonged restraint stress. The results revealed that in addition to the mood and cognitive impairments, restraint stress induced a significant decrease in the number and arborization of GFAP + cells in the brain of mice. Intranasal cotinine prevented these stress-derived symptoms and the morphological abnormalities GFAP + cells in both of these brain regions which are critical to resilience to stress. The significance of these findings for the therapy of PTSD and depression is discussed.
... Hypnosis has also been shown to have some value in providing additional support prior to and during medical or surgical interventions (Cheseaux, de Saint Lager, & Walder, 2014;Kravits, 2013;Montgomery, David, Winkel, Silverstein, & Bovbjerg, 2002;Potié, Roelants, Pospiech, Momeni, & Watremez, 2016;Schnur, Kafer, Marcus, & Montgomery, 2008;Tefikow et al., 2013) and in the management of dental phobias and treatments, especially among children (Potter,Coulthard,Brown,& Walsh,262 PAUL ANDREW ENTWISTLE 2013; Oberoi, Panda, & Garg, 2016). Adult emotional and behavioral disorders have also proved amenable to hypnosis approaches including depression (Chapman, 2013;Yapko, 2013), attention-deficit/hyperactivity disorder (ADHD) (Hiltunen et al., 2014), anorexia (Roy, 2014), anxiety management (Johnson, Johnson, Barton, & Elkins, 2016), trauma (Cardeña, 2000;Lynn & Cardeña, 2007); and in psychosomatic disorders including posttraumatic stress disorder (PTSD) (Abramowitz & Bonne, 2013;Alladin & Amundson, 2016;Brown & Fromm, 2013;Flammer & Alladin, 2007;Moene, Spinhoven, Hoogduin, & Dyck, 2003;Rotaru & Rusu, 2016). Children are particularly good hypnotic subjects because of the amount of time they naturally spend in spontaneous, role-playing awake hypnosis (Hunt & Ernst, 2011;Kohen & Kaiser, 2014;Kohen & Olness, 2012;Kuttner & Jensen, 2014;Stanton, 2011) and, therefore, can benefit from adjuvant hypnosis therapy in many health situations (Chester et al., 2016;Mizrahi et al., 2016;Oberoi et al., 2016;Whorwell, 2013). ...
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Despite the continued debate and lack of a clear consensus about the true nature of the hypnotic phenomenon, hypnosis is increasingly being utilized successfully in many medical, health, and psychological spheres as a research method, motivational tool, and therapeutic modality. Significantly, however, although hypnotherapy is widely advertised, advocated, and employed in the private medical arena for the management and treatment of many physical and emotional disorders, too little appears to be being done to integrate hypnosis into primary care and national health medical services. This article discusses some of the reasons for the apparent reluctance of medical and scientific health professionals to consider incorporating hypnosis into their medical practice, including the practical problems inherent in using hypnosis in a medical context and some possible solutions.
... In addition to advances in basic research in the neuroscience of hypnosis, there was a consensus agreement by the symposium participants that there have been important developments in our understanding of the efficacy of hypnosis for treating a variety of clinical conditions. This research has been summarized in a number of influential systematic reviews and metaanalyses, which show the strongest empirical support (to date) for the use of hypnosis treatments for pain (Patterson and Jensen 2003;Hammond 2007;Tome-Pires and Miro 2012), irritable bowel syndrome (Schaefert et al. 2014), and post-traumatic stress disorder (PTSD) symptoms (Rotaru and Rusu 2016). Limited evidence -to be confirmed by larger scale clinical trials -suggests that hypnotic treatments may also be effective for a wide variety of other problems and conditions such as depression (Alladin and Alibhai 2007), anxiety (Hammond 2010), and problem smoking ). ...
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This article summarizes key advances in hypnosis research during the past two decades, including (i) clinical research supporting the efficacy of hypnosis for managing a number of clinical symptoms and conditions, (ii) research supporting the role of various divisions in the anterior cingulate and prefrontal cortices in hypnotic responding, and (iii) an emerging finding that high hypnotic suggestibility is associated with atypical brain connectivity profiles. Key recommendations for a research agenda for the next decade include the recommendations that (i) laboratory hypnosis researchers should strongly consider how they assess hypnotic suggestibility in their studies, (ii) inclusion of study participants who score in the middle range of hypnotic suggestibility, and (iii) use of expanding research designs that more clearly delineate the roles of inductions and specific suggestions. Finally, we make two specific suggestions for helping to move the field forward including (i) the use of data sharing and (ii) redirecting resources away from contrasting state and nonstate positions toward studying (a) the efficacy of hypnotic treatments for clinical conditions influenced by central nervous system processes and (b) the neurophysiological underpinnings of hypnotic phenomena. As we learn more about the neurophysiological mechanisms underlying hypnosis and suggestion, we will strengthen our knowledge of both basic brain functions and a host of different psychological functions.
... Hypnotherapy. The results of two recent meta-analyses, one 36 including six studies (N = 391) and another 37 including four studies (N = 160), provided some evidence that hypnotherapy techniques could produce large effect sizes in the treatment of adults with PTSD. ...
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Posttraumatic stress disorder (PTSD) is a distressing and disabling disease of great public health significance that is often associated with substantial psychiatric and medical comorbidity. It commonly goes unreported and untreated and many cases become chronic in course. Unfortunately, only a minority of patients with chronic PTSD achieves remission. Indeed, it is unusual for patients with PTSD to achieve complete symptom remission after receiving monotherapy with medications or psychotherapy. However, great advances in the prevention and treatment of PTSD have been made in the last quarter century since it was first recognized as a distinct diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders, third edition. This article discusses the current state-of-the-art prevention and treatment interventions for PTSD, including pharmacotherapies, psychotherapies, and nonpharmacological somatic treatments in active duty military personnel and veterans, adult civilians, and children and adolescents.
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Sleepiness and personality traits have been controversially reported as associated to individual hypnotizability level i.e. receptiveness to hypnotic suggestions and behave accordingly. In this study, we further investigate the relationship between the level of general daytime sleepiness and personality traits with the level of hypnotizability. Seventy-eight healthy young volunteers (34 women) completed the fast assessment of general daytime sleepiness and personality with the Epworth Sleepiness Scale and the 10-item Big Five Inventory respectively, and underwent hypnotic evaluation through the Harvard Group Scale of Hypnotic Susceptibility Form A (HGSHS:A). Main findings revealed a correlation between sleepiness and hypnotizability levels, and no influence of personality traits. Interestingly, women exhibited higher levels of hypnotizability compared to men. Taken together, these results suggest that sleepiness assessment might be considered as a predictive tool to hypnotic suggestions, which would offer practical insight for enhancing hypnosis intervention efficacy.
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Introduction Documented use and investigation of hypnosis spans centuries and its therapeutic use has received endorsement by multiple medical associations. We conducted a comprehensive overview of meta-analyses examining the efficacy of hypnosis to provide a foundational understanding of hypnosis in evidence-based healthcare, insight into the safety of hypnosis interventions, and identification of gaps in the current research literature. Methods In our systematic review, meta-analyses of randomized controlled trials on the efficacy of hypnosis in patients with mental or somatic health problems compared to any control condition published after the year 2000 were included. A comprehensive literature search using Medline, Scopus, PsycINFO, The Cochrane Library, HTA Database, Web of Science and a manual search was conducted to identify eligible reviews. Methodological quality of the included meta-analyses was rated using the AMSTAR 2 tool. Effect estimates on various outcomes including at least three comparisons (k ≥ 3) were extracted and transformed into a common effect size metric (Cohen’s d). If available, information on the certainty of evidence for these outcomes (GRADE assessment) was obtained. Results We included 49 meta-analyses with 261 distinct primary studies. Most robust evidence was reported for hypnosis in patients undergoing medical procedures (12 reviews, 79 distinct primary studies) and in patients with pain (4 reviews, 65 primary studies). There was a considerable overlap of the primary studies across the meta-analyses. Only nine meta-analyses were rated to have high methodological quality. Reported effect sizes comparing hypnosis against control conditions ranged from d = −0.04 to d = 2.72. Of the reported effects, 25.4% were medium (d ≥ 0.5), and 28.8% were large (d ≥ 0.8). Discussion Our findings underline the potential of hypnosis to positively impact various mental and somatic treatment outcomes, with the largest effects found in patients experiencing pain, patients undergoing medical procedures, and in populations of children/adolescents. Future research should focus on the investigation of moderators of efficacy, on comparing hypnosis to established interventions, on the efficacy of hypnosis for children and adolescents, and on identifying patients who do not benefit from hypnosis. Clinical Trial Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023395514, identifier CRD42023395514
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Hypnosis is an ancient mind-body intervention that has regained interest with the surge of research in the last decade documenting its clinical validity. Yet, theoretical controversies and misconceptions prevail among theorists, clinicians, and the general public, impeding the understanding, acceptance, replication, and use of hypnosis. Providing adequate information, which dispels misconceptions and promotes more balanced views, is warranted to facilitate the implementation and adoption of hypnosis in clinical and research settings. This review re-examines the conceptualisation of hypnosis throughout history and the theoretical controversies surrounding it while highlighting their meeting points and clinical implications. Despite dichotomies, a broad agreement appears across theoretical approaches regarding hypnotic analgesia effects, key components, and vocabulary. Further, theories highlight key factors of hypnotic responding. For instance, social theories highlight social and contextual variables, whereas state theories highlight biopsychosocial mechanisms and individual factors. Based on theories, the terms hypnotherapy or clinical hypnosis are recommended to refer to the therapeutic use of hypnosis in psychotherapeutic and medical contexts, respectively. This review concludes with a model that integrates various theories and evidence and presents hypnosis as a complex multifaceted intervention encompassing multiple procedures, phenomena, and influencing factors. This review intends to deepen our understanding of hypnosis, and promote its more rapid adoption and adequate implementation in research and clinical contexts, in addition to steering research towards evidence-based hypnotic practice. The review can have important research and clinical implications by contributing to advancing knowledge regarding hypnotic procedures, phenomena, and influencing factors.
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Hypnotherapy is used in clinical settings to treat mental and physical health-related conditions. Hypnotic response can be measured through hypnotizability scales to help interventionists personalize treatment plans to suit the patients' individualized hypnotic abilities. Examples of these scales are the Elkins Hypnotizability Scale (EHS) and the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C). According to the previous literature, these scales have good discriminating ability and internal consistency (α = 0.85) in collegiate samples, but the psychometric properties of the EHS for a targeted clinical population have not been determined yet. This study assessed said properties, and results showed adequate reliability of the EHS in a targeted clinical sample and strong convergent validity of the EHS to the SHSS:C. The authors conclude that the EHS is a strong and useful measure of hypnotizability that is pleasant, safe, brief, and sensible to individualities in hypnotic ability found in diverse clinical samples.
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Findings from the Task Force for Efficacy Standards in Hypnosis Research hypnosis clinician survey provide new insight into current practice trends in clinical hypnosis internationally. The clinician-focused survey highlighted several interesting imbalances between hypnosis research evidence and its practice applications. Inconsistencies arose in clinician experiences of adverse events in treatment, reported conditions treated using hypnosis, and for what conditions hypnosis is considered most effective. This commentary aims to better elucidate the differences noted and offers recommendations for training and teaching hypnosis. Potential areas for improvement involve the monitoring and inquiry of adverse events posthypnosis, approaches for identifying and working with individuals who have trauma-related symptoms in hypnosis, and potential methods for supporting clinician competency development in hypnosis.
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Background Posttraumatic Stress Disorder (PTSD) is a serious psychological trauma disorder. Treatment of psychological trauma tends to focus on patients' memory. Clinical Spiritual-Hypnosis Assisted Therapy is a culturally sensitive treatment that combines elements of psychodynamic hypnosis, cognitive–behavioral and humanistic therapies. Methods The current interventional single-blind randomized control study assessed the biobehavioural effectiveness of spiritual-hypnosis on cortisol and PTSD symptomatology in adults with childhood trauma. Participants were divided into spiritual hypnosis ( n = 15) and a control group ( n = 14) that received fluoxetine . This study used PCL-C & CTQ to screen the presence and severity of PTSD symptoms. Results Spiritual hypnosis was significantly better than fluoxetine at reducing PTSD symptoms, while both treatments had similar effects on cortisol modification. Conclusions Spiritual-Hypnosis Assisted Therapy for PTSD patients with childhood trauma appears to have a noteworthy effect in reducing PTSD clinical symptoms and results in a comparable to the pharmacological treatment modification of the HPA axis cortisol markers.
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This paper explains objectives for construction and presents the validation of Holotropic Work Short and Long-Term Changes Survey (HWSLCS), which monitor short and long- term psychological changes after holotropic self- exploratory work and/or holotropic psychotherapies (holotropic work). The whole survey is congruent with the theoretical frame of S. Grof and his extended cartography of psyche (Grof, S. 1975, 2000). The main purpose of HWSLCS is to inexpensively and in relatively short time collect a large amount of relevant phenomenological data through which the comprehensive validation of holotropic work can be done. Direct correlations between different aspects of holotropic work can be obtained, the importance of this aspects and flow of the whole holotropic process caused by the particular holotropic event can be monitored.
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Although hypnosis has played a part in psychotherapy for a long time, it is not yet seen as an evidence-based therapy and is absent from many practice guidelines when it comes to the treatment of psychiatric disorders. At present, the applications and methods of hypnotherapy are poorly understood and other methods of psychotherapy tend to be favoured. This review article aims to introduce the role of hypnotherapy and its application for certain common psychiatric presentations, as well as examine its efficacy by summarising recent evidence from high-quality outcome studies and meta-analyses.
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Participo desta publicação contribuindo com a percepção da saúde mental e a relação com o trabalho
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An evidence-based guide for laypeople on psychological, medical, complementary and lifestyle interventions for anxiety disorders.
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ADHD is a highly heterogeneous disorder, characterized by multifactorial etiological risk factors, a different severity of symptoms, and a different impact of the neuropsychological impairments on the functioning of the individual. Moreover, comorbidity with other psychiatric conditions is frequent, so all these aspects can lead to a variety of cognitive and behavioral profiles. The phenotypic heterogeneity in ADHD is also coupled with the heterogeneity of response to treatment, and in order to provide specific and targeted interventions, it should be mandatory to address all dimensions (i.e., inattention, impulsivity, hyperactivity, emotional dysregulation) that appeared most affected when the patient asked for help.
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Among the Trauma- and Stressor-Related Disorders classified in DSM-5, Post-Traumatic Stress Disorder (PTSD) is one of the most frequently reported in people with ADHD and vice versa. As their clinical presentation overlaps for some features, it is very challenging for the clinician to recognize ADHD in individuals suffering from PTSD. PTSD is not so uncommon. In fact, there is evidence indicating a higher likelihood for developing a PTSD after some traumatic life events such as chronic illnesses, relationship problems, and unemployment in respect to after severe traumas such as accidents, physical and sexual assaults, and robbery.
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Post-traumatic stress disorder is a debilitating condition that can develop after exposure to any potentially traumatic event (natural disaster, physical assault, and car accident). This study focused on four pediatric patients presenting with an early stress response after a motor vehicle accident who were offered early therapeutic and a preventive management by hypnotherapy shortly after exposure to the traumatic event. All patients improved after one or several sessions of hypnosis. The results indicate that hypnotherapy can immediately help patients during the early period following a traumatic event.
Article
Chronischer psychosozialer und traumatischer Stress sind zentrale Risikofaktoren für die Entwicklung psychosomatischer Erkrankungen. Eine Schlüsselrolle in der gemeinsamen Ätiologie psychischer und komorbide-auftretender körperlicher Erkrankungen wird dabei Veränderungen in der Regulation der neuroendokrinen Stressantwort, erhöhten Entzündungsprozessen und oxidativem Stress, dem schädlichen Überschuss an freien Sauerstoffradikalen, zugeschrieben. Angesichts der hohen Prävalenz von psychosozialem und traumatischem Stress über alle Gesellschaftsschichten hinweg ist es für die psychotherapeutische Praxis von großer Bedeutung, auch dessen molekulartoxische Folgen besser zu verstehen und in moderne Behandlungskonzepte zu integrieren. Es gilt, Interventionsmöglichkeiten auf psychobiologischer Ebene zu identifizieren, die stressassoziierte ­biomolekulare Veränderung im Körper rückgängig machen können. In diesem Beitrag soll deshalb insbesondere die Rolle von entspannungs- und achtsamkeitsbasierter Verfahren wie Entspannungstechniken, z.B. Hypnose, Mediation oder Yoga, betrachtet werden, die neben der Symptomreduktion auf klinischer Ebene auch die biomolekularen Veränderungen nach psychosozialem und traumatischem Stress reduzieren und so der gesundheitlichen Belastung entgegenwirken können. Obwohl entspannungs- und achtsamkeitsbasierte Verfahren im psychotherapeutischen Setting schon seit langem in unterschiedlichem Umfang eingesetzt werden, zeigt die aktuelle Studienlage, dass regelmäßig praktizierte entspannungs- und achtsamkeitsbasierte Verfahren eine bislang unterschätzte Interventionsmöglichkeit in der Psychotherapie sein könnten, die es zukünftig häufiger und gezielter in die gesamtkörperliche Behandlung stress- und traumaassoziierter Erkrankungen zu integrieren gilt.
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Post-traumatic stress disorder is a psychophysiological disorder, characterized by chronic sympathetic nervous system activation; persisting perceptual/sensory vigilance for threats; recurrent distressing memories of the event, including intrusive memories, flashbacks lived as if in the present moment, and nightmares; and a persisting negative emotional state including fear and shame. The psychophysiological basis for this disorder calls for psychophysiologically based interventions. This chapter presents the case narrative of a 29-year-old national guardsman, exposed to combat trauma, and later to civilian trauma in public safety work. His treatment followed the Pathways model, comprised of multi-modal interventions, beginning with self-directed behavioral changes, then the acquisition of skills (including self-hypnosis), and finally professional treatment including clinical hypnosis and EMDR.
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Im Auftrag der Milton Erickson Gesellschaft für Klinische Hypnose erfolgt jährlich eine Literatursuche zu randomisierten kontrollierten Studien (randomized controlled trials; RCTs) und Meta-Analysen, die sich mit der Wirksamkeit von klinischer Hypnose und Hypnotherapie befassen. Im Jahr 2016 wurden zwölf randomisierte bzw. quasi-randomisierte Studien mit klinischen Stichproben gefunden, die den Einsatz von Hypnose mit einer Kontrollgruppe verglichen, und zwei weitere, die hypnotherapeutische und kognitiv-behaviorale Elemente kombiniert evaluierten. Zusammen mit den Ergebnissen aus den 2016 publizierten Meta-Analysen mehren sich die Belege für einen möglichen Zusatznutzen von Hypnose in der Behandlung von somatischen Syndromen, in dem Sinne, dass sich auch die psychische Begleitsymptomatik verbessert. Gerade für gestörten Schlaf als sekundäre Ergebnisvariable könnte es lohnen, dies me ta-analytisch, z.B. in onkologischen oder gynäkologischen Studien zu überprüfen. Ein Blick auf die derzeit laufenden oder jüngst abgeschlossenen RCTs lässt außerdem auf weitere Ergebnisse zur Wirksamkeit der Hypnose bei Schlafproblemen hoffen.
Chapter
Sleep disturbance is quite common in patients with post-traumatic stress disorder (PTSD), as a symptom of the underlying disorder; as a part of comorbid anxiety, depression, or chronic pain disorder; or as an independent sleep disorder diagnosis. Chronic sleep disturbance from any cause is associated with poorer daytime functioning as well as medical comorbidities and thus critical to address. Insomnia, the most common sleep symptom, is a state of hyperarousal linked to central changes in metabolism and electroencephalographic activity and peripheral mechanisms such as autonomic activation. This physiological state when combined with inadvertent behavioral conditioning (e.g., checking the bedside clock) can become a chronic condition. In patients with PTSD, insomnia can be even more severely chronic given how the associated heightened hypervigilance and nightmares further disrupt sleep. Abnormalities in the brain’s default mode network (DMN) have been implicated in both PTSD, combat trauma (even without PTSD), childhood trauma, and insomnia. The DMN is a network of interconnected brain regions which is most active during low-demand tasks such as daydreaming and self-absorbed thinking and when not attending to outside stimuli. One of the under-recognized treatment modalities for insomnia in patients with PTSD is hypnosis. This chapter will review the empirical evidence on the effectiveness of hypnosis for insomnia and PTSD and summarize the neurobiological substrates underlying the hypnotic state, including changes in the DMN.
Article
Posttraumatic stress disorder is a psychophysiological disorder, characterized by the following: chronic sympathetic nervous activation; persisting perceptual/sensory vigilance for threats; recurrent distressing memories of the event, including intrusive memories, flashbacks lived as if in the present moment, and nightmares; and a persisting negative emotional state including fear and shame. The psychophysiological basis for this disorder calls for psychophysiologically based interventions. This article presents the case narrative of a 29-year-old national guardsman, exposed to combat trauma and later to civilian trauma in public safety work. His treatment followed the Pathways model, comprised of multimodal interventions, beginning with self-directed behavioral changes, then the acquisition of skills (including self-hypnosis), and finally professional treatment including clinical hypnosis and EMDR.
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A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group. (C) 1989 by the American Psychological Association
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BACKGROUND: Guided by previous explorations of historical and cultural influences on the occurrence of PTSD, the aim of the present study was to investigate the contributions of war victimisation (in particular, World War II) and other civil trauma on the prevalence of PTSD, as mediated by cultural value orientation. Secondary data analysis was performed for 12 European countries using data, including PTSD prevalence and number of war victims, crime victims, and natural disaster victims, from different sources. Ten single value orientations, as well as value aggregates for traditional and modern factors, were investigated. RESULTS: Whilst differences in PTSD prevalence were strongly associated with war victim rates, associations, albeit weaker, were also found between crime victims and PTSD. When cultural value orientations, such as stimulation and conformity as representatives of modern and traditional values, were included in the multivariate predictions of PTSD prevalence, an average of approximately 80% of PTSD variance could be explained by the model, independent of the type of trauma exposure. CONCLUSION: The results suggest that the aftermath of war contributes to current PTSD prevalence, which may be explained by the high proportion of the older population who directly or indirectly experienced traumatic war experiences. Additional findings for other types of civil trauma point towards an interaction between value orientation and country-specific trauma rates. Particularly, being personally oriented towards stimulation appears to interact with differences in trauma prevalence. Thus, cultural value orientation might be viewed not only as an individual intrinsic process but also as a compensatory strategy after trauma exposure.
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The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013) modified the diagnostic criteria for posttraumatic stress disorder (PTSD), including expanding the scope of dysfunctional, posttrauma changes in belief (symptoms D2-persistent negative beliefs and expectations about oneself or the world, and D3-persistent distorted blame of self or others for the cause or consequences of the traumatic event). D2 and D3 were investigated using a national sample of U.S. adults (N = 2,498) recruited from an online panel. The prevalence of D2 and D3 was substantially higher among those with lifetime PTSD than among trauma-exposed individuals without lifetime PTSD (D2: 74.6% vs 23.9%; D3: 80.6% vs 35.7%). In multivariate analyses, the strongest associates of D2 were interpersonal assault (OR = 2.39), witnessing interpersonal assault (OR = 1.63), gender (female, OR = 2.11), and number of reported traumatic events (OR = 1.88). The strongest correlates of D3 were interpersonal assault (OR = 3.08), witnessing interpersonal assault (OR = 1.57), gender (female, OR = 2.30), and number of reported traumatic events (OR = 1.91). The findings suggested the expanded cognitive symptoms in the DSM-5 diagnostic criteria better capture the cognitive complexity of PTSD than those of the DSM-IV.
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A single 5-6 hours manualized abreactive ego state therapy session has recently been subjected to two placebo-controlled investigations meeting evidence-based criteria. Ego state therapy was found to be a highly effective and durable treatment for posttraumatic stress disorder. Apparently, ego state therapy works because it is emotion focused, activates sub-cortical structures, and because the supportive, interpretive therapist reconstructs the patient's personality to be resilient and adaptive. In this article the author reviews the treatment procedures and presents the findings of both studies.
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Abstract Using manualized abreactive Ego State Therapy (EST), 30 subjects meeting DSM-IV-TR and Clinician-Administered PTSD Scale (CAPS) criteria were exposed to either 5-6 hours of treatment or the Ochberg Counting Method (placebo) in a single session. EST emphasized repeated hypnotically activated abreactive "reliving" of the trauma and ego strengthening by the cotherapists. Posttreatment 1-month and 3-month follow-ups showed EST to be an effective treatment for PTSD. Using the Davidson Trauma Scale, Beck Depression II, and Beck Anxiety Scales, EST subjects showed significant positive effects from pretreatment levels at all posttreatment measurement periods in contrast to the placebo treatment. Most of the EST subjects responded and showed further improvement over time.
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Abstract Using abreactive Ego State Therapy (EST), 36 patients meeting DSM-IV-TR and PTSD checklist (PCL) criteria were exposed to either 5-6 hours of manualized treatment or placebo in a single session. EST emphasizes repeated hypnotically activated abreactive "reliving" of the trauma experience combined with therapists' ego strength. Both the placebo and EST treatment groups showed significant reductions in PTSD checklist scores immediately posttreatment (placebo: mean 17.34 points; EST: mean 53.11 points) but only the EST patients maintained significant treatment effect at 4-week and 16- to 18-week follow-ups. Abreactive EST appears to be an effective and durable treatment for PTSD inclusive of combat stress injury and acute stress disorder.
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The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994 DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual's responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
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The Publication Manual of the American Psychological Association (American Psychological Association, 2001, American Psychological Association, 2010) calls for the reporting of effect sizes and their confidence intervals. Estimates of effect size are useful for determining the practical or theoretical importance of an effect, the relative contributions of factors, and the power of an analysis. We surveyed articles published in 2009 and 2010 in the Journal of Experimental Psychology: General, noting the statistical analyses reported and the associated reporting of effect size estimates. Effect sizes were reported for fewer than half of the analyses; no article reported a confidence interval for an effect size. The most often reported analysis was analysis of variance, and almost half of these reports were not accompanied by effect sizes. Partial η2 was the most commonly reported effect size estimate for analysis of variance. For t tests, 2/3 of the articles did not report an associated effect size estimate; Cohen's d was the most often reported. We provide a straightforward guide to understanding, selecting, calculating, and interpreting effect sizes for many types of data and to methods for calculating effect size confidence intervals and power analysis.
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This article reviews the evidence for the use of hypnosis in the treatment of posttraumatic conditions including posttraumatic stress disorder and acute stress disorder. The review focuses on empirically supported principles and practices and suggests that hypnosis can be a useful adjunctive procedure in the treatment of posttraumatic conditions. Cognitive-behavioral and exposure-based interventions, which have the greatest empirical support, are highlighted, and an illustrative case study is presented.
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Many combat veterans with posttraumatic stress disorder (PTSD) have an olfactory component to their traumatic memories that might be utilized by a technique called hypnotherapeutic olfactory conditioning (HOC). Thirty-six outpatients with chronic PTSD, featuring resistant olfactory-induced flashbacks, were treated with six 1.5-hour sessions using hypnosis. The authors used the revised Impact of Events Scale (IES-R), Beck Depression Inventory, and Dissociative Experiences Scale as outcome measures. Significant reductions in symptomatology were recorded by the end of the 6-week treatment period for the IES-R, as well as for the Beck Depression Inventory and the Dissociative Experiences Scale; 21 (58%) of the subjects responded to treatment by a reduction of 50% or more on the IES-R. Improvement was maintained at 6-month and 1-year follow-ups. Use of medication was curtailed. HOC shows potential for providing benefit to individuals suffering from PTSD with olfactory components.
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The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble post-traumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a conditioned stimulus (CS), analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters.
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A large-scale study of the effectiveness of psychotherapeutic methods for the treatment of posttraumatic stress disorders was conducted. The sample consisted of 112 persons suffering from serious disorders resulting from traumatic events (bereavement, acts of violence, and traffic accidents) that had taken place not more than 5 years before. Trauma desensitization, hypnotherapy, and psychodynamic therapy were tested for their effectiveness in comparison with a waiting-list control group. The results indicated that treated cases were significantly lower in trauma-related symptoms than the control group.
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In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual’s responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
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In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage. Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R. The scale demonstrated good test-retest reliability (r = 0.86), internal consistency (r = 0.99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects. The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.
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Hypnotic techniques for the treatment of posttraumatic conditions were often used by the clinical pioneers of the end of the 19th century and by military therapists treating soldiers during the 20th century's conflagrations. More recently, hypnosis has also been used with survivors of sexual assault, accidents, and other traumas, and with various groups, including children and ethnic minorities. Nonetheless, there have been almost no systematic studies on the efficacy of hypnosis for posttraumatic disorders. This state of affairs is especially disappointing considering that: hypnosis can be easily integrated into therapies that are commonly used with traumatized clients; a number of PTSD individuals have shown high hypnotizability in various studies; hypnosis can be used for symptoms associated with PTSD; and hypnosis may help modulate and integrate memories of trauma. Hypnotic techniques may indeed be efficacious for posttraumatic conditions, but systematic group or single-case studies need to be conducted before reaching that conclusion.
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For more than 20 years, the Impact of Event Scale (IES) has been widely used as a measure of stress reactions after traumatic events. To review studies that evaluated the IES's psychometric properties. Literature review. The results indicated that the IES's two-factor structure is stable over different types of events, that it can discriminate between stress reactions at different times after the event, and that it has convergent validity with observer-diagnosed post-traumatic stress disorder. The use of IES in many psychopharmacological trials and outcome studies is supportive of the measure's clinical relevance. The IES is a useful measure of stress reactions after a range of traumatic events, and it is valuable for detecting individuals who require treatment.
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The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.
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This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N=87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n=69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress.
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The research showing how exposure to extreme stress affects brain function is making important contributions to understanding the nature of traumatic stress. This includes the notion that traumatized individuals are vulnerable to react to sensory information with subcortically initiated responses that are irrelevant, and often harmful, in the present. Reminders of traumatic experiences activate brain regions that support intense emotions, and decrease activation in the central nervous system (CNS) regions involved in (a) the integration of sensory input with motor output, (b) the modulation of physiological arousal, and (c) the capacity to communicate experience in words. Failures of attention and memory in posttraumatic stress disorder (PTSD) interfere with the capacity to engage in the present: traumatized individuals "lose their way in the world." This article discusses the implications of this research by suggesting that effective treatment needs to involve (a) learning to tolerate feelings and sensations by increasing the capacity for interoception, (b) learning to modulate arousal, and (c) learning that after confrontation with physical helplessness it is essential to engage in taking effective action.
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The relative efficacy of different psychological treatments for chronic post-traumatic stress disorder (PTSD) is unclear. To determine the efficacy of specific psychological treatments for chronic PTSD. In a systematic review of randomised controlled trials, eligible studies were assessed against methodological quality criteria and data were extracted and analysed. Thirty-eight randomised controlled trials were included in the meta-analysis. Trauma-focused cognitive-behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), stress management and group cognitive-behavioural therapy improved PTSD symptoms more than waiting-list or usual care. There was inconclusive evidence regarding other therapies. There was no evidence of a difference in efficacy between TFCBT and EMDR but there was some evidence that TFCBT and EMDR were superior to stress management and other therapies, and that stress management was superior to other therapies. The first-line psychological treatment for PTSD should be trauma-focused (TFCBT or EMDR).
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Hypnotherapy is claimed to be effective in treatment of psychosomatic disorders. A meta-analysis was conducted with 21 randomized, controlled clinical studies to evaluate efficacy of hypnosis in psychosomatic disorders. Studies compared patients exclusively treated with hypnotherapy to untreated controls. Studies providing adjunctive standard medical care in either treatment condition were also admitted. Hypnotherapy was categorized into classic (n = 9), mixed form (n = 5), and modern (n = 3). Results showed the weighted mean effect size for 21 studies was d(+) = .61 (p = .0000). ANOVA revealed significant differences between classic, mixed, and modern hypnosis. Regression of outcome on treatment dose failed to show a significant relationship. Numerical values for correlation between suggestibility and outcome were only reported in three studies (mean r = .31). The meta-analysis clearly indicates hypnotherapy is highly effective in treatment of psychosomatic disorders.
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Clinicians have gained considerable knowledge about psychopathology and treatment but this knowledge is poorly systematized and hard to transmit. One way to organize clinical knowledge is to circumscribe a limited area and describe within it the interactions between personality dispositions, states of disorder, and treatment techniques. This report models such an approach by limiting disorder to stress response syndromes, personality to obsessional and hysterical neurotic styles, and treatment to focal dynamic psychotherapy. Within this domain, an information processing approach to working through conflicted ideas and feeling is developed. The result is a series of assertions about observable behavior and nuances of technique. Since these assertions are localized conceptually, they can be checked, revised, refuted, compared, or extended into other disorders, dispositions, and treatments.
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Having an accurate estimate of the prevalence of posttraumatic stress disorder (PTSD) is critically important for projecting health care needs for veterans now and in coming years. However, prevalence studies in US veterans have produced widely varying estimates, due in large part to lack of representative samples of the entire population, including those who deployed to war zones as well as the large proportion with service not involving war zone deployment. The article by Wisco et al in this issue of the Journal of Clinical Psychiatry provides the most comprehensive estimate to date of PTSD prevalence in a national veteran sample, as well as other important findings on trauma exposure, risk factors, and comorbidities useful to clinicians, researchers, and health care administrators. © Copyright 2014 Physicians Postgraduate Press, Inc.
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IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
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Article
The purpose of the present study was to review systematically, research exploring the relationship between self-concepts and paranoia in psychosis. A literature search was performed by two independent raters in relevant databases (MedLine, PsychInfo and Web of Science) and articles meeting the inclusion criteria were cross-referenced. Following scrutiny according to inclusion criteria, eighteen studies were selected for review. A narrative synthesis of findings, in which methodological variability is discussed, is presented relative to three key areas: the nature of the relationship between paranoia and self-concepts; the association between paranoia and discrepancies in self-concepts; the nature of the relationship between paranoia and self-concepts when other, dimensional aspects of these constructs are taken into account. The systematic literature review indicated relatively consistent findings, that paranoia is associated with more negative self-concepts when measured cross-sectionally. Results are somewhat more mixed in regards to research on paranoia and self-concept discrepancies. Studies investigating dimensional aspects of self-concepts and paranoia yield findings of particular interest, especially in regards to the association indicated between instability of self-concepts and paranoia. Limitations in research and of the present systematic review are discussed. Clinical and theoretical implications of findings are outlined and possible directions for future research are suggested.
Article
To assess the dimensional structure, reliability, and validity of the Dutch version of the SCL-90 responses of normal nonpatients and 703 noninstitutionalized phobics were factor analyzed separately. The SCL raw scores were subjected to a principal components analysis with varimax rotation to simple structure, resulting in 3 clinically meaningful factors for the normals: hostility, somatization, and agoraphobia. In addition, a 4th factor emerged for the phobics social inadequacy. The 3- and 4-factor solutions were highly stable across populations (normals vs phobics). Moreover, because of relatively high item–total correlations and validational findings, a unitary index of psychological discomfort, psychoneuroticism, was useful. In both groups of Ss, internal consistency of factored scales and global distress index proved satisfactory, while evidence for discriminant validity of the SCL was found in nonsignificant to low correlations with biographical data on the one hand and differential correlational patterns with these data on the other. Whether the SCL-90 does measure the more transient states of psychopathology has to be examined more fully. (61 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Provides 3 hypotheses to explain how forms of posttraumatic stress disorder (PTSD), which appear to be so intrinsically maladaptive, survived the process of natural evolution. These hypotheses are that (1) posttraumatic behavior was once adaptive, (2) peritraumatic hypnosis confers specific advantages, and (3) traumatic affect fuels continuing evolution. It is argued that the characteristic forms of posttraumatic psychology probably evolved to enable humankind to adapt to specific environments in which external threats occurred in repetitive but relatively stereotyped form, serving much like learned instincts, becoming progressively pathological only in rapidly changing complex societies like many in today's world. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptoms of PTSD and general psychological symptoms (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2–.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.
Article
This is a review and meta-analysis of school-based intervention programs targeted at reducing symptoms of posttraumatic stress disorder (PTSD). Nineteen studies conducted in 9 different countries satisfied the inclusionary criteria. The studies dealt with various kinds of type I and type II trauma exposure. Sixteen studies used cognitive-behavioral therapy methods; the others used play/art, eye movement desensitization and reprocessing, and mind-body techniques. The overall effect size for the 19 studies was d = 0.68 (SD = 0.41), indicating a medium-large effect in relation to reducing symptoms of PTSD. The authors' findings suggest that intervention provided within the school setting can be effective in helping children and adolescents following traumatic events.
Article
The efficacy of hypnosis in the treatment of depressive symptoms was subjected to a meta-analysis. Studies were identified using Google Scholar and 6 electronic databases: PubMed, Cochrane Library, PsiTri, PsychLit, Embase, and the Cochrane Depression, Anxiety and Neurosis Review Group (CCDAN). The keywords used were (a) hypnosis, (b) hypnotherapy, (c) mood disorder, (d) depression, and (e) dysthymia. Six studies qualified and were analyzed using the Comprehensive Meta-Analysis software package. The combined effect size of hypnosis for depressive symptoms was 0.57. Hypnosis appeared to significantly improve symptoms of depression (p < .001). Hypnosis appears to be a viable nonpharmacologic intervention for depression. Suggestions for future research are discussed.
Article
Recent innovations in posttraumatic stress disorder (PTSD) research have identified new treatments with significant potential, as well as novel enhancements to empirically-validated treatments. This paper reviews emerging psychotherapeutic and pharmacologic interventions for the treatment of PTSD. It examines the evidence for a range of interventions, from social and family-based treatments to technological-based treatments. It describes recent findings regarding novel pharmacologic approaches including propranolol, ketamine, prazosin, and methylenedioxymethamphetamine. Special emphasis is given to the description of virtual reality and D-cycloserine as enhancements to prolonged exposure therapy.
Article
The aim of this study was to assess the effectiveness of a spiritual-hypnosis assisted therapy (SHAT) for treatment of posttraumatic stress disorder (PTSD) in children. All children, age 6-12 years (N=226; 52.7% females), who experienced the terrorist bomb blasts in Bali in 2002, and subsequently were diagnosed with PTSD were studied, through a longitudinal, quasi-experimental (pre-post test), single-blind, randomized control design. Of them, 48 received group SHAT (treatment group), and 178 did not receive any therapy (control group). Statistically significant results showed that SHAT produced a 77.1% improvement rate, at a two-year follow up, compared to 24% in the control group, while at the same time, the mean PTSD symptom score differences were significantly lower in the former group. We conclude that the method of spiritual-hypnosis is highly effective, economic, and easily implemented, and has a potential for therapy of PTSD in other cultures or other catastrophic life-threatening events.
Article
A short scale for the measurement of hypnotic responsiveness was constructed for use with patients for whom the standard scales might prove too long, too uninteresting, or too tiring. Five items were selected: moving hands together, a dream, age regression, a posthypnotic suggestion, and posthypnotic amnesia. A sample of 111 university undergraduates, selected from the full range of scores (0–10) on a shortened 10-point version of the Harvard Group Scale of Hypnotic Susceptibility, Form A, was given the 5-point clinical scale and the 12-point Stanford Hypnotic Scale, Form C in balanced order. There were no order effects. A reliability estimate for the clinical scale was obtained from the product-moment correlation between the total scores on the two scales. This correlation was .72. The clinical scale requires approximately 20 minutes for administration.
Article
Clinicians have gained considerable knowledge about psychopathology and treatment, but this knowledge is poorly systematized and hard to transmit. One way to organize clinical knowledge is to circumscribe a limited area and describe within it the interactions between personality dispositions, states of disorder, and treatment techniques. This report models such an approach by limiting disorder to stress response syndromes, personality to obsessional and hysterical neurotic styles, and treatment to focal dynamic psychotherapy. Within this domain, an information processing approach to working through conflicted ideas and feeling is developed. The result is a series of assertions about observable behavior and nuances of technique. Since these assertions are localized conceptually, they can be checked, revised refuted, compared, or extended into other disorders, dispositions, and treatments.
Article
PTSD is a common disorder with high comorbidity and a tendency toward chronicity, which responds slowly to treatment and, in many patients, may not totally resolve even with long-term treatment. For most persons with PTSD, a combined approach to treatment is beneficial, at least in the acute stages of the illness. Pharmacotherapy is an important component of treatment during the acute stages of the illness and may be necessary on a long-term basis for many patients. Because the data from controlled trials of pharmacotherapy are limited, it is not possible to present a unified approach or develop a consensus that is well supported by research findings. What has emerged from the available data is that antidepressants, particularly those with serotoninergic properties, are helpful for core PTSD symptoms when given at higher dose levels for at least 5 to 8 weeks. The TCAs as a group appear to be effective in amelioration of the intrusive symptoms and of anxiety and depressive symptoms, while having little effect on avoidance symptoms. Initial data from studies of the SSRIs suggests that they may have greater efficacy than other drugs in the treatment of avoidance and numbing symptoms and may effect enough overall global improvement in PTSD symptoms that some patients will no longer meet the diagnostic criteria. The hyperarousal symptoms may respond somewhat to antidepressants, but should symptoms continue to be disabling, buspirone or benzodiazepines may be indicated. In choosing a benzodiazepine, those less likely to have distressing withdrawal symptoms, such as clonazepam and chlordiazepoxide, should be considered. Clonazepam, with its serotoninergic properties, may prove to be a particularly efficacious drug. For some patients, phenelzine may be a good choice because it has proven efficacy for the intrusive PTSD symptoms, for depressive symptoms, and for some symptoms of autonomic arousal, such as panic attacks. Other agents to be considered for alleviation of hyperarousal symptoms are lithium, anticonvulsants, and clonidine. In addressing the symptoms of poor impulse control, lithium, beta-blocking drugs, and carbamazepine may be helpful. Brief psychotic episodes should respond to a neuroleptic, although psychoticlike dissociative spells may be nonresponsive.
Article
Personality functions in different dimensions: perceptual, cognitive, and affective (emotional). It can be manifested in different areas--overt (conscious), covert (unconscious), or in some relative degree of each. Personality segments can operate independently of one another, as in multiple personalities or with varying degrees of mutual dependence and intercommunication, as in normal "ego states." Therapeutic interventions will be more efficient if focused within the problem dimension, area, or segment. The essence of Alexander and French's "corrective emotional experience" was a restructuring of the patient through release and interpretation within the "emotional" sphere. When their concept is extended to other dimensions of personality functions, such as behavioral, perceptual, and cognitive, it allows interventions to be more specifically focused in the regions that are most relevant. In this paper we present specific techniques using this extended concept. Rapid and significant change followed in the patient so treated.
Article
Ego-state therapy has been cited in the literature as a promising tool for the treatment of patients who suffer from the effects of past trauma experiences. In this paper, I review various methods to activate ego states and to uncover traumatic experiences and their related internal conflicts in sexually abused patients with posttraumatic symptoms. I also discuss ego-state-therapy techniques that promote the integration and resolution of trauma. Three clinical case examples illustrate the use of ego-state therapy with posttraumatic patients. I suggest ways in which ego-state-therapy methods can be useful with some of the symptomatology specific to this population. The effectiveness of ego-state therapy is also explored in dealing with certain features of posttraumatic conditions that can complicate treatment, including dissociation and fragmentation, cognitive and perceptual distortion, and rigidification of personality and behavior.
Article
To test the feasibility of creating a valid and reliable checklist with the following features: appropriate for assessing both randomised and non-randomised studies; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting, internal validity (bias and confounding) and power, but also for external validity. A pilot version was first developed, based on epidemiological principles, reviews, and existing checklists for randomised studies. Face and content validity were assessed by three experienced reviewers and reliability was determined using two raters assessing 10 randomised and 10 non-randomised studies. Using different raters, the checklist was revised and tested for internal consistency (Kuder-Richardson 20), test-retest and inter-rater reliability (Spearman correlation coefficient and sign rank test; kappa statistics), criterion validity, and respondent burden. The performance of the checklist improved considerably after revision of a pilot version. The Quality Index had high internal consistency (KR-20: 0.89) as did the subscales apart from external validity (KR-20: 0.54). Test-retest (r 0.88) and inter-rater (r 0.75) reliability of the Quality Index were good. Reliability of the subscales varied from good (bias) to poor (external validity). The Quality Index correlated highly with an existing, established instrument for assessing randomised studies (r 0.90). There was little difference between its performance with non-randomised and with randomised studies. Raters took about 20 minutes to assess each paper (range 10 to 45 minutes). This study has shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies. It has also shown that it is possible to produce a checklist that provides a profile of the paper, alerting reviewers to its particular methodological strengths and weaknesses. Further work is required to improve the checklist and the training of raters in the assessment of external validity.
Article
The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
Article
The long-term benefits of cognitive behaviour therapy (CBT) for trauma survivors with acute stress disorder were investigated by assessing patients 3 years after treatment. Civilian trauma survivors (n=87) were randomly allocated to six sessions of CBT, CBT combined with hypnosis, or supportive counselling (SC), 69 completed treatment, and 53 were assessed 2 years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician-Administered PTSD Scale. In terms of treatment completers, 2 CBT patients (10%), 4 CBT/hypnosis patients (22%), and 10 SC patients (63%) met PTSD criteria at 2-years follow-up. Intent-to-treat analyses indicated that 12 CBT patients (36%), 14 CBT/hypnosis patients (46%), and 16 SC patients (67%) met PTSD criteria at 2-year follow-up. Patients who received CBT and CBT/hypnosis reported less re-experiencing and less avoidance symptoms than patients who received SC. These findings point to the long-term benefits of early provision of CBT in the initial month after trauma.
Article
Psychological treatments can reduce symptoms of post traumatic stress disorder (PTSD). Trauma focused treatments are more effective than non-trauma focused treatments. This review concerns the efficacy of psychological treatment (excluding eye movement desensitisation and reprocessing) in the treatment of PTSD. There is evidence that individual trauma focused cognitive-behavioural therapy (TFCBT), stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There is some evidence that individual TFCBT is superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more effective than other therapies. There is insufficient evidence to show whether or not psychological treatment is harmful. Trauma focused cognitive behavioural therapy should be considered in individuals with PTSD.
Article
Psychotherapy has been found to be an effective treatment of post-traumatic stress disorder (PTSD), but meta-analyses have yielded inconsistent results on relative efficacy of psychotherapies in the treatment of PTSD. The present meta-analysis controlled for potential confounds in previous PTSD meta-analyses by including only bona fide psychotherapies, avoiding categorization of psychotherapy treatments, and using direct comparison studies only. The primary analysis revealed that effect sizes were homogenously distributed around zero for measures of PTSD symptomology, and for all measures of psychological functioning, indicating that there were no differences between psychotherapies. Additionally, the upper bound of the true effect size between PTSD psychotherapies was quite small. The results suggest that despite strong evidence of psychotherapy efficaciousness vis-à-vis no treatment or common factor controls, bona fide psychotherapies produce equivalent benefits for patients with PTSD.