ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Naderi   Y. (*)
Moradi   A.R. (1)
Hasani   J. (2)
Noohi   S. (3)






(*) Psychiatry & Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
(1) “Cognitive Sciences Institute” and “Psychology Department, Psychology Faculty", Kharazmi University, Tehran, Iran
(2) Psychology Department, Psychology & Education Faculty, Kharazmi University, Tehran, Iran
(3) “Behavioral Sciences Research Center” and “Psychology Department, Medical Faculty”, Baqiyatallah University of Medical Sciences, Tehran, Iran

Correspondence

Article History

Received:  May  4, 2015
Accepted:  June 21, 2015
ePublished:  August 25, 2015

BRIEF TEXT


… [1-18] Since experimental avoidance and no facing with the fears in patients with PTSD are the main factors of disease survival [19], providing the best conditions for complete facing might lead to a reform in the treatment processes of PTSD.

Different studies confirm the main role of emotion regulation strategies in etiology, escalation, and continuance of PTSD [10-12].

The aim of this study was to investigate the effectiveness of treatment based on the emotional schemas on the cognitive regulation strategies of the patients with PTSD.

This is an experimental study with single subject multiple based line method.

Patients with PTSD who referred to clinics of the hospitals in Tehran (Iran) between September and November 2013 were studied.

6 male patients aged between 44 and 55 years (mean age 46.00±2.48years) were selected through Available Sampling Method.

PTSD was diagnosed based on a Psychiatrist’s affirmation and it was confirmed via a structured diagnostic interview based on DSM-IV-TR. The inclusion criteria were diagnostic criteria of PTSD, at least guidance school confirmation, and the patient’s written consent. The exclusion criteria were psychosis criteria and drug-dependence disorder. The patients having been randomly assignment to 3 therapeutic methods, 2 patients received medication composed treatment and EST. The latter was based on the theoretical treatment model based on Leahy Emotional Schemas [6]. There were 10 treatment sessions, one session a week (Table 1). 2 patients received both medication composed treatment and CBT. There were 10 CBT sessions, one session a week. 2 patients received medication treatment only. The medications each patient (6 patients) received in equal doses were fluoxetine, alprazolam, and sertraline. Each patient consumed the medications up to the end of follow up stage. Leahy Emotional Schemas Scale (LESS) has 50 items scored by Likert’s 5-Scale and its reliability has been confirmed [20]. The short form of Cognitive Emotion Regulation Questionnaire (CERQ) [21] has 9 sub-scales identifying 9 cognitive emotion regulation strategies. Its Persian version (CERQ-P) [22] has 18 questions. Each sub-scale has 2 parameters scored from 1 (never) to 5 (always) based on Likert’s Scale. … [23, 24] Revised impact of Event Scale (IES-R) has 22 items investigating the frequency of the post trauma symptoms, avoidance, too arousal, and disturbing symptoms in separated sub-scales during the recent week. Its validity has been confirmed [25]. The patients having been randomly assigned to three treatment methods, EST and CTB were done by a clinical psychologist and medical treatment was done by a psychiatrist. All the patients received two combined treatment methods and all the patients received only medication treatment were studied by LESS, CERQ, and IES-R 5 and 3 times, respectively. Data was analyzed, using Index of Effect, Cohen, Process Changes, and Slope Changes indices for each patient. The change process of emotion schemas intensity (positive and negative) and emotion regulation strategies were shown on the diagrams during the sessions. … [26, 27]

All the patients (n=6) were male, high school diploma, and with MDD. All of them, except one patient, were married. There was no difference between the demographic characteristics of the patients (Table 2). There were 63% recovery (changes of process) in IES and 38% score decrease (slope) in the first patient after EST. In addition, changeability level was 5.36 in IES. There was a considerable effect of EST on reduction of the scores of emotion schemas of patients received the treatment. In addition, there was a considerable effect of EST on the reduction of the scores of the patients in the schemas. The patients’ score reduction percentage showed the effectiveness of EST on the patients’ emotion schemas (Table 3). Patient with an experience of EST gained a considerable reduction in the intensity of the negative emotion schemas, than other groups. There was not any considerable change in the mean score of medication and CBT composed treatment and only medication treatment groups after 3 months. This was more truly about only medication treatment. In addition to the visual reviewing of the diagrams, the effectiveness and the size of impact factor showed a considerable reduction in the negative emotion schemas of patient received EST (Diagram 1a). Considering the equality of the base lines of the patients in the scores of positive emotion schemas after the intervention and in the follow up stage, there was a more effectiveness level of EST on increasing the positive emotion schemas (Diagram 1b). In the base line, the patients used the maladaptive cognitive regulation strategies approximately equally. At the treatment start, the scores of patients, who received EST, gradually decreased. However, there was not such a case in patients who received two other treatment methods. There were approximately reverse results from the adaptive strategies. Before treatment, all the groups, approximately, used the adaptive strategies relatively weak. Nevertheless, after the treatment course, the scores of patients received EST were considerably higher than other groups (Diagrams 1c and 1d).

All the subjects in the baseline were similar and in a low level of utilization of emotional regulation strategies. The result is consistent with the studies showing problems in patients with PTSD to regulate their own emotions [10-12]. There was a direct correlation between modulation of emotional regulation strategies and more success in reducing the symptoms of PTSD. The result is consistent with some studies [28]. Treatment based on the emotion schemas made training and adjusting the emotion regulation strategies a main role in the treatment of PTSD. The result is consistent with some studies showing that adaptive emotion regulation training for patients with PTSD results in a higher effectiveness of the exposure techniques and better treatment outcomes [28, 29]. … [30]

More factors affecting the dependent variable should be controlled in the future studies.

Small sample size, lack of any control on the effective factors on the independent variables, evaluation and treatment done by one person only, and short term follow up were of the limitation for the present study.

Besides adjusting the emotion schemas of the patient, the new treatment based on the emotion schemas can reverse the patients’ utilization level of the emotion cognitive regulation strategies.

The staff of the hospital is appreciated.

Non-declared

Ethical permissions were taken from the patients, and all of them participated voluntarily.

The researchers themselves funded the study. No organization has funded the research.

TABLES and CHARTS

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