Directieve therapie

, Volume 30, Issue 4, pp 303–328 | Cite as

Trauma, psychose, PTSS en de toepassing van EMDR

  • D.P.G VAN DEN BERG
  • B.M. VAN DER VLEUGEL
  • A.B.P. STARING
Trauma, psychose, PTSS en de toepassing van EMDR

Samenvatting In dit artikel beschrijven wij drie interacties tussen trauma, psychose en PTSS:

  1. 1.

    Veel patiënten met psychosen hebben in hun leven traumatiserende ervaringen meegemaakt. Deze traumata spelen vaak een belangrijke rol in hun psychosen en in het ontstaan hiervan.

     
  2. 2.

    Het meemaken van een psychose en de psychiatrische behandeling zijn voor veel patiënten levensechte en traumatische ervaringen, die kunnen leiden tot posttraumatische stressklachten.

     
  3. 3.

    Vaak komen psychosen en een posttraumatische stressstoornis gezamenlijk voor, waarbij er sprake is van negatieve wederzijdse beïnvloeding en voortgaande traumatisering.

     

Deze drie interacties hebben een hoge klinische relevantie. Er is in de praktijk van de zorg voor patiënten met psychosen echter weinig aandacht voor traumatisering en comorbide PTSS. Eye Movement Desensitization and Reprocessing (EMDR) is een behandelmethode die effectief is bij de behandeling van traumata en PTSS. Wij beschrijven per genoemde interactie een behandeling waarbij EMDR is ingezet. Daarna bespreken wij een aantal factoren die een EMDR-behandeling bij patiënten met psychosen kunnen bemoeilijken, zoals doorlopende traumatisering door psychotische klachten, cognitieve beperkingen, moeite met oogbewegingen, belemmeringen door antipsychotische medicatie en verminderde affectieve expressie. Wij sluiten het artikel af met het advies om in de zorg voor mensen met psychosen aandacht te hebben voor trauma en comorbide PTSS, en patiënten hier ook voor te behandelen.

Abstract In this article we describe three interactions between trauma, psychosis and PTSD:

  1. 1.

    Many patients suffering from psychosis have been traumatized. This trauma often plays an important role in their psychosis and the onset thereof.

     
  2. 2.

    Having a psychosis and being treated in a psychiatric hospital are traumatic experiences for a lot of patients, and can lead to posttraumatic stress symptoms; and

     
  3. 3.

    Often psychoses and post-traumatic stress disorder occur jointly, reciprocally influencing one another and leading to ongoing traumatization.

     

These interactions have a great clinical relevance. In the practice of care for patients with psychosis however there is little attention for traumatization and co-morbid PTSD. EMDR is a treatment approach that is effective in treating traumas and PTSD. Per interaction mentioned above we describe a treatment in which EMDR was used. After this we discuss certain factors that may complicate an EMDR treatment in patients with psychosis, such as ongoing traumatization by psychotic symptoms, cognitive impairments, difficulty with eye movements, barriers due to anti-psychotic medication, and diminished emotional expression.

We end the article with the advise to be aware of the high prevalence of trauma and co-morbid PTSD in the care for patients with psychosis and to treat patients for these complaints.

Referenties

  1. American Psychiatric Association (APA; 2000). Diagnostic and Statistical Manual of Mental Disorders(4th ed., text revision). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Andrade, J., Kavanagh, D., & Baddeley A (1997). Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36,209–223.PubMedCrossRefGoogle Scholar
  3. Bebbington, P., Bhugra, D., Brugha, T., Singleton, N., Farrell, M., Jenkins, R., et al. (2004). Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. The British Journal of Psychiatry, 185(3), 220–226.PubMedCrossRefGoogle Scholar
  4. Bendall, S., Jackson, H., Hulbert, C., & McGorry, P. (2007). Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin, 34(3), 568–579.PubMedCrossRefGoogle Scholar
  5. Bendall, S., McGorry, P., & Krstev, H. (2006). The trauma of being psychotic: an analysis of posttraumatic stress disorder in response to acute psychosis. In: W. Larkin & A.P. Morrison (Eds.), Trauma and psychosis: New directions for theory and therapy(pp. 59–100). London: Routledge.Google Scholar
  6. Bora, E., Yücel, M., & Pantelis, C. (2009). Cognitive impairment in schizophrenia and affective psychoses: implications for DSM-V criteria and beyond. Schizophrenia Bulletin, 36,36–42.PubMedCrossRefGoogle Scholar
  7. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry, 162, 214–227.PubMedCrossRefGoogle Scholar
  8. Broeke, E. ten, Jongh, A. de & Oppenheim, H.J. (2008) (red.). Praktijkboek EMDR: Casusconceptualisatie en specifieke patiëntengroepen.Amsterdam: Harcourt Publishers.Google Scholar
  9. Butler, R., Mueser, K., Sprock, J., & Braff, D. (1996). Positive symptoms of psychosis in posttraumatic stress disorder. Biological Psychiatry, 39(10), 839–844.PubMedCrossRefGoogle Scholar
  10. Chen, L., Murad, M., Paras, M., Colbenson, K., Sattler, A., Goranson, E., et al. (2010). Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis. Mayo Clinical Proceedings, 85(7), 618–629.CrossRefGoogle Scholar
  11. Elklit, A., & Shevlin, M. (2010). Female Sexual Victimization Predicts Psychosis: A Case-Control Study Based on the Danish Registry System. Schizophrenia Bulletin, 1–6.Google Scholar
  12. Elofsson, U.O.E., Von Schéele, B., Theorell, T., & Söndergaard, H.P. (2008). Physiological correlates of eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 22,622–634.PubMedCrossRefGoogle Scholar
  13. Escher, S.D.M. & Romme, M.A.J. (2006). Trauma and hearing voices. In: W. Larkin & A.P. Morrison (Eds.), Trauma and psychosis: New directions for theory and therapy(pp. 162–192). London: Routledge.Google Scholar
  14. Foussias, G. & Remington, G. (2010). Negative symptoms in schizophrenia: avolition and Occam' s razor. Schizophrenia Bulletin, 36,359–369.PubMedCrossRefGoogle Scholar
  15. Frueh, B.C., Grubaugh, A.L., Cusack, K.J., Kimble, M.O., Elhai, J.D., & Knapp, R.G. (2009). Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: A pilot study. Journal of Anxiety Disorders, 23, 665–675.PubMedCrossRefGoogle Scholar
  16. Gaag, M. van der, Valmaggia, L.R., Meer, C.R. van, & Slooff, C.J. (2005). Gedachten uitpluizen: Vaardigheden oefenboek. Cognitieve gedragstherapie bij achterdocht en stemmen. Oegstgeest: Stichting Cognitie en Psychose, www.gedachtenuitpluizen.nl.
  17. Gard, D.E., King, A.M., Gard, M.G., Horan, W.P., & Green, M.F. (2007). Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophrenia Research, 93, 253–260.PubMedCrossRefGoogle Scholar
  18. Goodman, L., Rosenberg, S.D., Mueser, K.T., & Drake, R.E. (1997). Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions. Schizophrenia Bulletin, 23(4), 685–696.PubMedCrossRefGoogle Scholar
  19. Goodman, L., Thompson, K., Weinfurt, K., Corl, S., Acker, P., Mueser, K., et al. (1999). Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress, 12(4), 587–599.PubMedCrossRefGoogle Scholar
  20. Gunter, R.W. & Bodner, G.E. (2008). How eye movements affect unpleasant memories: support for a working-memory account. Behaviour Research and Therapy, 46, 913–931.PubMedCrossRefGoogle Scholar
  21. Hamner, M., Frueh, B., Ulmer, H., Huber, M., Twomey, T., Tyson, C., et al. (2000). Psychotic features in chronic posttraumatic stress disorder and schizophrenia: comparative severity. The Journal of Nervous and Mental Disease, 188(4), 217–221.PubMedCrossRefGoogle Scholar
  22. Hardy, A., Fowler, D., Freeman, D., Smith, B., Steel, C., Evans, J., et al. (2005). Trauma and hallucinatory experience in psychosis. The Journal of Nervous and Mental Disease, 193(8), 501–507.PubMedCrossRefGoogle Scholar
  23. Honig, A., Romme, M., Ensink, B., & Ensink, S. (1998). Auditory hallucinations: a comparison between patients and nonpatients. The Journal of Nervous and Mental Disease, 186(10), 1–9.CrossRefGoogle Scholar
  24. Hout, M. van den, Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121–130.PubMedCrossRefGoogle Scholar
  25. Husted, J.A., Ahmed, R., Chow, E.W., Brzustowicz, L.M., & Bassett, A.S. (2010). Childhood trauma and genetic factors in familial schizophrenia associated with the NOS1AP gene. Schizophrenia Research, 121(1), 187–192.PubMedCrossRefGoogle Scholar
  26. Janssen, I., Krabbendam, L., Bak, M., Hanssen, M., Vollebergh, W., Graaf, R. de, et al. (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109(1), 38–45.PubMedCrossRefGoogle Scholar
  27. Jones, S.R. (2010). Do we need multiple models of auditory verbal hallucinations? Examining the phenomenological fit of cognitive and neurological models. Schizophrenia Bulletin, 36(3), 566–575.PubMedCrossRefGoogle Scholar
  28. Jongh, A. de & Broeke, E. ten (2006). Handboek EMDR: een geprotocolleerde behandelmethode voor de gevolgen van psychotrauma.Amsterdam: Harcourt publishers.Google Scholar
  29. Kessler, R., Chiu, W., Demler, O., & Walters, E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.PubMedCrossRefGoogle Scholar
  30. Kingdon, D. & Turkington, D. (1991). The use of cognitive behavior therapy with a normalizing rationale in schizophrenia: Preliminary report. The Journal of Nervous and Mental Disease, 179(4), 207–211.PubMedCrossRefGoogle Scholar
  31. Kilpatrick, D., Saunders, B., Amick-McMullan, A., Best, C., Veronen, L.J., & Resnick, H.S. (1989). Victim and crime factors associated with the devel- opment of crime-related post-traumatic stress disorder. Behavior Therapy, 20, 199–214.CrossRefGoogle Scholar
  32. Krebs, M.O., Bourdel, M.C., Cheriff, Z.R., Bouhours, P., Lôo, H., Poirier, M.F., & Aranado, I. (2010). Deficit of inhibition motor control in untreated patients with schizophrenia: further support from visually guided saccade paradigms. Psychiatry Research, in press.Google Scholar
  33. Lee, K.H. & Williams, L.M. (2000). Eye movement dysfunction as a biological marker of risk for schizophrenia. Australia and New-Zealand Journal of Psychiatry, 34, S91–100.Google Scholar
  34. Lee, C.W., Taylor, G., Drummond, P.D., & Wiley, J. (2006). The Active Ingredient in EMDR: Is It Traditional Exposure or Dual Focus of Attention? Clinical Psychology, 107, 97–107.Google Scholar
  35. Lommen, M.J. & Restifo, K. (2009). Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder. Community Mental Health Journal, 45(6), 485–496.PubMedCrossRefGoogle Scholar
  36. MacCulloch, M.J. & Feldman, P. (1996). Eye movement desensitization treatment utilises the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: a theoretical analysis. British Journal of Psychiatry, 169, 571–579.PubMedCrossRefGoogle Scholar
  37. McGorry, P., Chanen, A., McCarthy, E., Riel, R., McKenzie, D., Singh, B., et al. (1991). Posttraumatic Stress Disorder Following Recent-Onset Psychosis An Unrecognized Postpsychotic Syndrome. The Journal of Nervous and Mental Disease, 179(5), 253–258.PubMedCrossRefGoogle Scholar
  38. Meyer, I., Muenzenmaier, K., Cancienne, J., et al. (1996). Reliability and validity of a measure of sexual and physical abuse among women with serious mental illness. Child Abuse and Neglect, 20, 213–219.PubMedCrossRefGoogle Scholar
  39. Meyer, H., Taiminen, T., Vuori, T., Aeijaelae, A., & Helenius, H. (1999). Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalisation in schizophrenic and delusional patients. The Journal of Nervous and Mental Disease, 187,343–352.PubMedCrossRefGoogle Scholar
  40. Mizrahi, R., Kiang, M., Mamo, D.C., Arenovich, T., Bagby, R.M., Zipursky, R.B., et al. (2006). The selective effect of antipsychotics on the different dimensions of the experience of psychosis in schizophrenia spectrum disorders. Schizophrenia Research, 88(1-3), 111–118.PubMedCrossRefGoogle Scholar
  41. Morrison, A. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29(3), 257–276.Google Scholar
  42. Morrison, A.P., Frame, L., & Larkin, W. (2003). Relationships between trauma and psychosis: A review and integration. British Journal of Clinical Psychology, 42(4), 331–353.PubMedCrossRefGoogle Scholar
  43. Mueser, K.T., Goodman, L.B., Trumbetta, S.L., Ro senberg, S.D., Osher, F.C., Vidaver, R., et al. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66(3), 493–499.PubMedCrossRefGoogle Scholar
  44. Mueser, K. T., Lu, W., Rosenberg, S.D., & Wolfe, R. (2010). The trauma of psychosis: Posttraumatic stress disorder and recent onset psychosis. Schizophrenia Research, 116(2-3), 217–227.PubMedCrossRefGoogle Scholar
  45. Mueser, K., Rosenberg, S.D., Goodman, L., & Trumbetta, S. (2002). Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophrenia research, 53(1-2), 123–143.PubMedCrossRefGoogle Scholar
  46. Mueser, K.T., Rosenberg, S.D., Xie, H., Jankowski, M.K., Bolton, E.E., Lu, W., et al. (2008). A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76, 259–271.PubMedCrossRefGoogle Scholar
  47. Ogden, P.K.M. & Pain, C. (2006). Trauma and the body. New York: WW Norton & Company.Google Scholar
  48. Perkonigg, A., Kessler, R.C., Storz, S., & Wittchen, H.U. (2000). Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101(1), 46–59.PubMedCrossRefGoogle Scholar
  49. Read, J., Bentall, R., & Fosse, R. (2009). Time to abandon the bio-bio-bio model of psychosis: Exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic. Epidemiologia e psichiatria sociale, 18(4), 299–310.PubMedGoogle Scholar
  50. Read, J., Hammersley, P., & Rudegeair, T. (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment, 13(2), 101–110.CrossRefGoogle Scholar
  51. Read, J., Haslam, N., Sayce, L., et al. (2006). Prejudice and schizophrenia. A review of the ‘mental illness is an illness like any other’ approach. Acta Psychiatrica Scandinavica, 114, 303–318.PubMedCrossRefGoogle Scholar
  52. Read, J., Os, J., Morrison, A., & Ross, C. (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112(5), 330–350.PubMedCrossRefGoogle Scholar
  53. Read, J., Perry, B.D., Moskowitz, A., & Connolly, J. (2001). The contribution of early traumatic events to schizophrenia in some patients: A traumagenic neurodevelopmental model. Psychiatry, 64(4), 319–345.PubMedCrossRefGoogle Scholar
  54. Read, J., Rudegeair, T., & Farrelly, S. (2006). Relationship between child abuse and psychosis. In: W. Larkin and A.P. Morrison (Eds.), Trauma and psychosis: New directions for theory and therapy(pp 23–57). London: Routledge.Google Scholar
  55. Reilly, J.L., Lencer R., Bishop, J.R., Keedy, S., & Sweeney, J.A. (2008). Pharmacological treatment effects on eye movement control. Brain and Cognition, 68,415–435.PubMedCrossRefGoogle Scholar
  56. Richtlijnherziening van de Multidisciplinaire richtlijn Angststoornissen (eerste revisie 2010). Richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen patiënten met een angststoornis. www.ggzrichtlijnen.nl.
  57. Romme, M., & Escher, A. (1989). Hearing voices. Schizophrenia Bulletin, 15(2), 209–216.PubMedGoogle Scholar
  58. Rothbaum, B.O., Foa, E.B., Riggs, D.S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5(3), 455–475.CrossRefGoogle Scholar
  59. Shaw, K., McFarlane, A., & Bookless, C. (1997). The phenomenology of traumatic reactions to psychotic illness. The Journal of Nervous and Mental Disease, 185(7), 434–441.PubMedCrossRefGoogle Scholar
  60. Siegel, D. (1999). The developing mind. New York: The Guilford Press.Google Scholar
  61. Sloan, P. (1988). Post-traumatic stress in survivors of an airplane crashlanding: A clinical and exploratory research intervention. Journal of Traumatic Stress, 1(2), 211–229.CrossRefGoogle Scholar
  62. Stampfer, H.G. (1990). ‘Negative symptoms’: a cumulative trauma stress disorder? The Australian and New Zealand journal of psychiatry, 24(4), 516–528.PubMedCrossRefGoogle Scholar
  63. Wilbarger, P. & Wilbarger, J. (1997). Sensory defensiveness and related social/ emotional and neurological problems. Van Nuys, CA: Wilbarger.Google Scholar

Copyright information

© Bohn, Stafleu van Loghum 2010

Authors and Affiliations

  • D.P.G VAN DEN BERG
    • 1
  • B.M. VAN DER VLEUGEL
    • 2
  • A.B.P. STARING
    • 3
  1. 1.werkzaam bij het Early Detection and Intervention Team van ParnassiaDen HaagThe Netherland
  2. 2.GGZ Noord-Holland NoordAlkmaarThe Netherland
  3. 3.cognitief gedragstherapeut VGCt bij Bavo-Europoort, O3 OnderzoekcentrumErasmus MC, RotterdamThe Netherland

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