ARTICLE INFO

Article Type

Case Report

Authors

Behnammoghadam   M. (1 )
Rahimi Mahmoud Abad   S. (2 )
Behnammoghadam   A. (* )






(* ) Psychology Department , Psychology Faculty, Yasuj Branch, Payam-e-Noor University, Yasuj, Iran
(1 ) Critical Care Nursing Department, Nursing & Midwifery Faculty, Iranshahr University of Medical Sciences, Iranshahr, Iran
(2 ) Clinical Psychology Department, Psychology Faculty, Yasuj Branch, Islamic Azad University, Yasuj, Iran

Correspondence

Article History

Received:  October  12, 2013
Accepted:  February 22, 2014
ePublished:  April 2, 2014

BRIEF TEXT


Exposure to psychic injury probably results in post-traumatic stress disorder (PTSD) [1]. … [2, 3] If this disorder is caused due to the war, it never heals spontaneously. Therefore, therapeutic interventions should be applied quickly after injurious event in case of opportunity to develop the disorder. [4]. Therapies based on behavioral-cognitive methods relying on the exposure technics has had a great share to cure aforementioned disorder., without any side effects, Due to the problem-oriented nature of these technics, they have a good theoretical and experimental support to cure PTSD [6]. Among methods based on exposure in behavioral-cognitive approach, eye movement desensitization and reprocessing method (EMDR) has been known as one of the newest PTSD therapies. This new method, which is safe and without negative adverse effects, isn’t depend on speech therapy or pharmacotherapy, it just employs the regular and rapid eye movements of the patient [5].

Non-declared

The aim of the study was to report a successful treatment of a veteran with PTSD due to the war, using eye movement desensitization and reprocessing method.

This study is a case report.

The patient was a married 46 years old man, with four children and high school diploma working in technical part of Iran Telecommunication Company. He (25% injury) had been injured at the Iran’s west operational region through aerial bombardment. In addition, he was psychologically damaged. In his medical records PTSD was diagnosed and his psychic problem had been pointed out, also, he had undergone pharmacotherapy by a psychiatrist for 15 years; but his problem persisted. The patient got disappointed about this medication type and he cut taking the drugs.

Non-declared

To collect data 3 scales were used. Diagnosis and grading PTSD scale contains 4 groups of symptom including symptoms related to re-experience the event, disturbing thoughts and imaginations, and nightmares the disorder B criterion), avoidance symptoms (the disorder C criterion), hyper-motivation symptoms (the disorder D criterion), and associated symptoms. Scale related to mental distress, is a 11 grade-scale from zero to 10.This scale can be used in all the 4 therapetic steps (before therapy, during therapy, after therapy, and follow-up). Scale of cognitions’ validity, or meaning difference test in cognitions, which demonstrates person’s belief in a positive or negative cognition. This scale is one of the self-report tests and demonstrates the person’s evaluation of cognition of herself. This test is used in eight-grade scale between zero and 7 [6]. At the first session, a cognitive-behavioral interview was conducted with the patient. Results of the interview showed that he had severe depression from last 5 years, alongside PTSD. During the first session, the patient was evaluated with PTSD diagnosis and grading scale. Results of the above scale showed a hard disorder (total score 68). At this session the patient was asked about remembrance of the most irritating and most upsetting memories of war, which continuously repeated itself to him either in his awake, or dream. Then, the patient was asked to state the climax of that event, which was irritating. Then, the traumatic event in that occasion was his friend’s head cut off. The patient was asked to grade his own distress and mental anxiety, concerning the traumatic event, between zero and 10; and he gave the maximum score i.e. 10. After that, the patient was asked to state a short sentence on the description of the above occasion; and he described it intolerable. Then, the patient was asked to grade the level of his own belief in the sentence between zero and 7; and he gave maximum score, which meant negative cognition of the event. At the first therapy session, 12 sets of EMDR method were applied. This session lasted about 45 minutes. At the second therapy session, 8 sets of EMDR method were applied. At the third therapy session, 10 sets of EMDR method were applied. After each therapy session, the stated scales were completed again, by the patient with researcher’s aid.

During the first therapy session, the level of patient’s mental anxiety decreased down to 3 scores; and the level of belief in the stated negative cognition of the event decreased down to 3 scores. During the second therapy session, level of mental anxiety and level of belief in negative cognition of traumatic situation reached zero.‏ Therefore, while remembering the traumatic event, the patient had no mental anxiety. At the third session, the patient’s mental anxiety and his negative cognition of traumatic situation was still zero. Finally, after 3 therapy sessions, the patient reported himself one who found himself full of energy, interested in life, and wholesome. During the last session at which the patient revaluated, his mental stress level and level of negative cognition of traumatic event were still zero. The total number was 13, on re-performing the diagnosis and grading scale of PTSD due to the war; in such a case that signs related to re-experience the event, nightmares, and intrusive, disturbing, and repeating thoughts of the event reached zero; and avoidance symptoms reached 4 scores, patient’s more-arousal symptoms reached 4, and associated symptoms reached 5. Therefore, the patient showed an overall reduction in the severity of symptoms. During 6 months follow-up, the patient was still without disturbing symptoms, and his recovery process was continued.

In another study, EMDR resulted in significant decrease in mental distress and disturbing memories [6], … [7, 8] which is consistent with the results of the present study. According to the results of another study, after performing EMDR therapy method, anxiety and mental distress level of the patients in the intervention group had significantly decreased, compared with control group and at one month follow-up the therapy effectiveness of this method was lasted [9] that confirms results of the present study. Results of five years follow-up on 13 veterans with chronic PTSD, who has healed by the use of EMDR method, show that the experiment group has shown mean recovery, compared with control group [10] … [11-15] which confirm results of the present study. Comparing effectiveness of EMDR method with long-term exposure therapy on the event impact symptoms of the soldiers with chronic PTSD, have shown that both methods lead to significant reduction in the event impact symptoms; but the long-term exposure therapy is more effective recovery of the event impact symptoms [16]. These results are somewhat differs from the results of the present study. Meta-analysis study of 21 researches about PTSD patients shows that EMDR, exposure, and cognitive therapy have had higher effectiveness, respectively; but none of the issues can retain its own impact in long-term [17]. On the one hand results of the study, showing that EMDR method is effective on PTSD therapy, are consistent with the results of the present study, , on the other hand, , they are not consistent with the results of the present study as they are not confirmed long-term effectiveness of this method.

Concerning results of the present study, it is suggested that treatment of eye movement desensitization and reprocessing method be applied to heal the injured veterans with PTSD, and effectiveness of this method to be followed up long-term.. In addition, it is suggested that, concerning heal of PTSD’s symptoms in injured veterans, eye movement desensitization and reprocessing method and pharmacotherapy method to be compared with each other.

Mental conditions of the patient during interview were of the probable limitations for the study, which might affect the answering process to the questions. It is tried to control this limitation with producing friendly atmosphere.

eye movement desensitization and reprocessing method is effective to decrease PTSD symptoms due to the war.

Researchers fell grateful to the veteran who participated in the study, Prof. M. Moradi, and personnel of Shahid Rajai Psychiatric Hospital.

Non-declared

The patient participated in the study with full awareness and satisfaction.

Non-declared


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