ASSYST TREATMENT INTERVENTIONS EXPLANATION
Abstract
This paper is about the theoretical, research and clinical knowledge behind the Acute Stress Syndrome Stabilization Treatment Interventions that have been used with thousands of natural and human-provoked disaster survivors (e.g., earthquakes, hurricanes, landslides, gas explosion), Ukrania's war invasion, mass shooting victims, political riots victims, refugees/asylum seekers, and COVID-19 affected general population.
... The objective of this treatment intervention is focused on the patient's Autonomic Nervous System sympathetic branch hyperactivation regulation through the reduction or removal of the activation produced by the sensory, emotional, or physiological components of the pathogenic memories of the adverse experience(s) to achieve optimal levels of Autonomic Nervous System activation, stop the three major stress hormones [adrenaline (epinephrine), noradrenaline (norepinephrine), and cortisol] secretion, and reestablish the Prefrontal Cortex functions (e.g., processing of information); thus, facilitating the AIP-system and the subsequent adaptive processing of information [29]. ...
The statistical analysis and the clinical reports confirmed that the ASSYST-I is an effective, safe, and efficient treatment intervention to reduce PTSD, anxiety, and depression symptoms caused by pathogenic memories produced by adverse childhood experiences in the adult female general population. No adverse effects or events were reported by the participants during the treatment procedure administration or at sixty-day follow-up. None of the participants showed clinically significant worsening/exacerbation of symptoms after treatment. All participants received the intervention treatment according to the research design, fulfilling our ethical criteria.
... The objective of this treatment intervention is focused on the patient's Autonomic Nervous System sympathetic branch hyperactivation regulation through the reduction or removal of the activation produced by the sensory, emotional, or physiological components of the pathogenic memories of the adverse experience(s) to achieve optimal levels of Autonomic Nervous System activation, stop the three major stress hormones secretion, and reestablish the Prefrontal Cortex functions (e.g., processing of information); thus, facilitating the AIP-system and the subsequent adaptive processing of information [27]. ...
This multisite clinical trial had two objectives: 1) to evaluate the effectiveness, efficacy, and safety of the Acute Stress Syndrome Stabilization Individual (ASSYST-I) treatment intervention in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the adult general population with pathogenic memories over three months old, and 2) to explore the correlation coefficient between the PCL-5 total 20 items score and the PCL-5 PTSD Cluster B five intrusion symptoms score with the Anxiety and Depression variables. A total of 43 adults (39 females and 4 males) met the inclusion criteria and participated in the study. Participants' ages ranged from 20 to 78 years old (M =47.34 years). Repeated-measures ANOVA were carried out to observe the effect of the intervention on the variables across three time points (Time 1 Pre-treatment, Time 2 Post-treatment, and Time 3 Follow-up). Results showed significant effects of the ASSYST-I on PTSD, intrusion, anxiety, and depression symptoms. Findings provide evidence of the effectiveness, efficacy, and safety of the ASSYST-I in reducing posttraumatic stress, anxiety, and depression symptoms in the general adult population with non-recent pathogenic memories.
Among the expected consequences of war are the frequent and recurrent detrimental effects on the mental health of military and civilian populations. Inconceivable traumatic experiences and ongoing threats of violence and death are prevalent. Furthermore, as wars drag on, the psychological resiliency of the population declines, particularly for wars fought on a country’s soil. Following traumatic events, early psychological intervention techniques are needed to address the severe impact on victims’ mental health and psychological resiliency. Dr. Gary Quinn developed the Immediate Stabilization Procedure (ISP®) as a psychological stabilization technique to address the effects on persons exposed to wartime events and terrorist attacks in Israel. During the Russian-Ukrainian War, ISP®-trained Ukrainian psychologists provided ISP® sessions via telehealth as a psychological stabilization intervention for military and civilian personnel experiencing symptoms of acute stress reaction (ASR). Data were collected from 155 Ukrainian participants, in-country and abroad. Following a single ISP® intervention session, the levels of distress experienced by the participants related to wartime events were significantly reduced. The findings also suggest that psychological resiliency may be improved for those receiving consecutive sessions of ISP®. This study is among the first formal research reports on ISP®’s effectiveness.
During the period of COVID-19 pandemic from the start of 2020 till late 2021, mental health services—seeking and providing—have gone through various changes and adaptations. In this article, we report on EMDR psychotherapy service providers in India, and how they adapted to the changing circumstances during this time, using a narrative enquiry approach.
The statistical analysis and the clinical reports confirmed that the ASSYST-I is an effective, safe, and efficient treatment intervention to reduce PTSD, anxiety, and depression symptoms caused by pathogenic memories produced by adverse childhood experiences in the adult female general population. No adverse effects or events were reported by the participants during the treatment procedure administration or at sixty-day follow-up. None of the participants showed clinically significant worsening/exacerbation of symptoms after treatment. All participants received the intervention treatment according to the research design, fulfilling our ethical criteria.
This multisite clinical trial had two objectives: 1) to evaluate the effectiveness, efficacy, and safety of the Acute Stress Syndrome Stabilization Individual (ASSYST-I) treatment intervention in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the adult general population with pathogenic memories over three months old, and 2) to explore the correlation coefficient between the PCL-5 total 20 items score and the PCL-5 PTSD Cluster B five intrusion symptoms score with the Anxiety and Depression variables. A total of 43 adults (39 females and 4 males) met the inclusion criteria and participated in the study. Participants' ages ranged from 20 to 78 years old (M =47.34 years). Repeated-measures ANOVA were carried out to observe the effect of the intervention on the variables across three time points (Time 1 Pre-treatment, Time 2 Post-treatment, and Time 3 Follow-up). Results showed significant effects of the ASSYST-I on PTSD, intrusion, anxiety, and depression symptoms. Findings provide evidence of the effectiveness, efficacy, and safety of the ASSYST-I in reducing posttraumatic stress, anxiety, and depression symptoms in the general adult population with non-recent pathogenic memories.
Translational research highlights the potential of novel 'memory consolidation/reconsolidation therapies' to treat re-experiencing symptoms and post-traumatic stress disorder (PTSD). This systematic review and meta-analysis assessed the efficacy of so-called memory consolidation/reconsolidation therapies in randomised controlled trials (RCTs) for prevention and treatment of PTSD and symptoms of re-experiencing in children and adults (PROSPERO: CRD42020171167). RCTs were identified and rated for risk of bias. Available data was pooled to calculate risk ratios (RR) for PTSD prevalence and standardised mean differences (SMD) for PTSD/re-experiencing severity. Twenty-five RCTs met inclusion criteria (16 prevention and nine treatment trials). The methodology of most studies had a significant risk of bias. We found a large effect of reconsolidation interventions in the treatment of PTSD (11 studies, n = 372, SMD: −1.42 (−2.25 to −0.58), and a smaller positive effect of consolidation interventions in the prevention of PTSD (12 studies, n = 2821, RR: 0.67 (0.50 to 0.90). Only three protocols (hydrocortisone for PTSD prevention, Reconsolidation of Traumatic Memories (RTM) for treatment of PTSD symptoms and cognitive task memory interference procedure with memory reactivation (MR) for intrusive memories) were superior to control. There is some emerging evidence of consolidation and reconsolidation therapies in the prevention and treatment of PTSD and intrusive memories specifically. Translational research should strictly adhere to protocols/procedures describing precise reconsolidation conditions (e.g. MR) to both increase the likelihood of positive findings and more confidently interpret negative findings of putative reconsolidation agents.
Since the introduction of EMD by Dr. Shapiro in 1987, which led to the development of EMDR Therapy, clinical experiences and research contributed to a variety of protocols and procedures. While this dynamic evolution within EMDR Therapy is offering more options to treat a variety of patients suffering from various disorders, there is a greater risk of deviations from the core framework of this approach that would no longer be understood as EMDR Therapy. While research shows that following Shapiro’s standard protocols and procedural steps is important to achieve positive treatment effects, it seems prudent to define the core elements in EMDR Therapy beyond adherence to the standard protocol given the complexity of clinical demands in a variety of treatment contexts. The author proposes that best practices requires not only an adherence to the fidelity of the model, but a willingness to adapt the model in order to best meet the needs of our clients in a variety of clinical contexts. Defining the core elements that constitute EMDR Therapy offers both a structure that has been well established and offers a foundation from which clinical adaptations can be made that are within the realm of what is widely accepted as EMDR Therapy. Such a structure could also be used to define research as well as clinical applications. Additionally EMDR Therapy as a comprehensive psychotherapy approach implies that the therapeutic relationship is an important component and should be considered a core element of this methodology.
The aim objective of this field trial was to evaluate the feasibility and effectiveness of the Acute Stress Syndrome Stabilization Remote Individual (ASSYST-RI) procedure in decreasing the levels of subjective perceived disturbance produced by the psychological distress or physiological reactivity of recent adverse experiences (e.g., kidnappings, COVID-19-related distress, interpersonal violence). A total of 48 participants (39 females and 9 males) ranging in ages from 18 to 67 years old (M=37.1 years) received one-single ASSYST-RI session of 50 minutes average duration. Participation was voluntary with the participants’ verbal informed consent in accordance with the Mental Capacity Act 2005. The telemental health counseling was in compliance with the American Psychological Association (APA) Guidelines for the Practice of Telepsychology. A pre-post design was applied comparing the subjective units of disturbance (SUD) means using a within t-test analysis. Results showed significant differences with a large effect size. Pre-test (M = 8.27, SD = 1.69) and post-test (M = 1.45, SD = 1.66), Cohen’s d =3.32. This field trial provides preliminary evidence on the ASSYST-RI feasibility and effectiveness in decreasing the levels of subjective perceived disturbance produced by the psychological distress or physiological reactivity of recent adverse experiences.
The aim of this longitudinal multisite randomized controlled trial (RCT), using a treatment as usual (TAU) control group design, was to evaluate the effectiveness of the Acute Stress Syndrome Stabilization Remote for Groups (ASSYST-RG) procedure in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the general population during the COVID-19 pandemic lockdown in Mexico. A total of 63 adults (60 females and 3 males) met the inclusion criteria. Participants’ ages ranged from 21 to 73 years old (M =43.09 years). Significant differences between groups were found in all variables. Differences between groups were maintained at follow up assessment. ANOVA for repeated-measures (pre-treatment, post-treatment and follow-up) showed that the ASSYST-RG had a significant effect to reduce Posttraumatic Stress Disorder (F (2, 122) = 22.40 p <.000, ηP2 = .269). Anxiety and depression showed a significant interaction effect for time and group (F (1, 61) = 8.89, p <.00, ηP2= .127) and (F (2, 122) = 35.04, p <.001, ηP2 = .365) respectively. No adverse effects or events were reported by the participants during the procedure administration or at three months follow-up while all participants were still in lockdown. None of the participants showed clinically significant worsening/exacerbation of symptoms after the procedure. This randomized controlled trial provides evidence for the effectiveness, efficacy, feasibility, and safety of the ASSYST-RG in reducing posttraumatic stress, anxiety, and depression symptoms in the general population during the COVID-19 pandemic lockdown.
This longitudinal multicenter randomized controlled trial has three objectives 1) to evaluate the EMDR-PRECI in the remission of the PTSD Diagnosis on female minors who were victims of sexual and/or physical violence compared to treatment as usual (TAU), 2) to evaluate the effectiveness of the EMDR-PRECI in the reduction of the PTSD, anxiety, and depression symptoms of the participants compared with TAU, and 3) to expand the knowledge on the existing correlation between the PCL-5 core criteria for PTSD provisional diagnosis and the CAPS-5 PTSD clinical diagnosis on this population. The study was conducted in 2019 in the cities of Puebla, Mexico, and Mexico City, in three sites of a non-profit organization who provide services to women in vulnerable situations. A total of 32 minors met the inclusion criteria. Participants' ages ranged from 12 to 17 years old (M =15.35 years old). Participation was voluntary with the participant's and their legal guardian's consent. It is relevant to mention that 31 of the 32 participants were pregnant during treatment with an average of 24.63 weeks (6.15 months) of pregnancy. All patients in the EMDR treatment group did not meet PTSD diagnostic criteria after treatment and at 90-days-follow-up assessments, while all patients in the TAU group maintained their PTSD baseline clinical diagnosis after treatment and at 90-days-follow-up assessments. Analyses of variance (ANOVA) for repeated measurements were used for PTSD, Anxiety and Depression; t test and Cohen´s d effect size were calculated using within and between designs for the different measurements. ANOVA revealed a significant effect for time (F (2, 52) = 149.53 p <.001, η P 2 =.852), for group (F (1, 26 = 140.71, p<.001, η P 2 =.844) and Anxiety scores showed a significant effect for time (F (1, 26) = 32.89, p <.001, η P 2 =.559) and a significant interaction effect between time and group (F (1, 26) = 17.37, p <.001, η P 2 =.401) showed the decrease for the treatment group. For the depression scores significant effects were found for time (F (1, 26) = 21.77, p <. 001, η P 2 =.456. Results also showed significant interaction effects between time and group. (F (1, 26) = 6.17, p <.05, η P 2 =.192). No significant effects for TAU group were founded. The study results indicate that the administration of the EMDR-PRECI could be a feasible, cost-effective, and time-efficient therapy to address PTSD diagnosis, and PTSD, anxiety and depression symptoms in this population.
Posttraumatic stress disorder (PTSD) is characterized by intrusions, avoidance, and hyperarousal while patients of the dissociative subtype (PTSD-D) experience additional dissociative symptoms. A neurobiological model proposes hyper-inhibition of limbic structures mediated by prefrontal cortices to underlie dissociation in PTSD. Here, we tested whether functional alterations in fronto-limbic circuits are underpinned by white matter network abnormalities on a network level. 23 women with PTSD-D and 19 women with classic PTSD participated. We employed deterministic diffusion tractography and graph theoretical analyses. Mean fractional anisotropy (FA) was chosen as a network weight and group differences assessed using network-based statistics. No significant white matter network alterations comprising both frontal and limbic structures in PTSD-D relative to classic PTSD were found. A subsequent whole brain exploratory analysis revealed relative FA alterations in PTSD-D in two subcortical networks, comprising connections between the left amygdala, hippocampus, and thalamus as well as links between the left ventral diencephalon, putamen, and pallidum, respectively. Dissociative symptom severity in the PTSD-D group correlated with FA values within both networks. Our findings suggest fronto-limbic inhibition in PTSD-D may present a dynamic neural process, which is not hard-wired via white matter tracts. Our exploratory results point towards altered fiber tract communication in a limbic-thalamic circuit, which may underlie (a) an initial strong emotional reaction to trauma reminders before conscious regulatory processes are enabled and (b) deficits in early sensory processing. In addition, aberrant structural connectivity in low-level motor regions may present neural correlates for dissociation as a passive threat-response.
Unlike high intensity treatment, in which clients have face-to-face contact with a mental health specialist, clients in low-intensity treatment have limited or no contact with a specialist. Instead, their treatment is usually provided through self-help procedures, which are delivered via (guided) computer programs, books, or mHealth apps. Other treatments sometimes considered low intensity are brief treatments, group therapy, and interventions delivered by nonspecialists. Advantages include effectiveness, accessibility, efficiency, and affordability. Concerns related to safety, engagement, and adherence in self-help programs may be addressed by (asynchronous) therapist guidance. This article describes low-intensity treatments, and their relevance for eye movement desensitization and reprocessing (EMDR) therapy. Hundreds of randomized controlled trials (RCTs) have found self-help interventions to be efficacious, with many producing the same level of results as the traditional face-to-face procedure. Guided self-help cognitive behavioral therapy is recommended for the treatment of posttraumatic stress disorder in the guidelines of both the National Institute for Health and Care Excellence and International Society of Traumatic Stress Studies. Only three self-help-EMDR RCTs have been conducted. This author advocates for reconceptualizing EMDR group therapy as “guided EMDR-self-help therapy,” because it is a highly manualized, heavily scripted treatment, in which the client works independently on their own material. In this respect, it offers an excellent template for the future development of efficacious low-intensity EMDR interventions. Developing safe, easy-to-use, affordable, and readily available low-intensity interventions will make effective EMDR treatment available to many millions of people around the world.
