研究生: |
謝馨儀 |
---|---|
論文名稱: |
EMDR介入PTSD治療歷程與效果之個案研究 |
指導教授: | 鄔佩麗 |
學位類別: |
碩士 Master |
系所名稱: |
教育心理與輔導學系 Department of Educational Psychology and Counseling |
論文出版年: | 2011 |
畢業學年度: | 99 |
語文別: | 中文 |
論文頁數: | 151 |
中文關鍵詞: | 眼動減敏與歷程更新治療 、創傷後壓力疾患 |
英文關鍵詞: | EMDR, PTSD |
論文種類: | 學術論文 |
相關次數: | 點閱:544 下載:82 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
EMDR是一項緣起於西方國家的新興治療方法,目前已有許多研究證實其對創傷之療效,然而臺灣地區缺乏相關研究,故本研究試圖應用EMDR於國內之臨床心理治療實務、進行一個探索性的個案研究,藉此瞭解PTSD案主在參與EMDR治療過程中的經驗,以及評估PTSD案主在接受EMDR介入過程及治療前後的差異,企盼國內應用EMDR的起點自此開啟。
本研究之PTSD案主在接受美國總會認可之EMDR治療師參與治療,於結案後,由研究者邀請成為研究參與者。研究者於EMDR治療結案後四個月及六個月,與研究參與者及其太太進行訪談、並進行觀察,並在徵得研究者參與者同意之情況下,蒐集治療過程中的相關紀錄以及案主自我觀察紀錄。研究者將PTSD案主於接受EMDR介入前後之歷程撰寫成為一治療案例,並且將有關資料進行整合與分析,歸結出 PTSD 案主在參與 EMDR 治療過程中的經驗,以及 PTSD 案主在接受EMDR 介入過程及治療前後的差異,並進一步討論PTSD案主使用精神用藥之影響。
本研究之整理與發現如下:
一、本案例之PTSD案主與太太共同參與前後為期四個月、共計19次的療程,期間透過EMDR處理了三項創傷事件,案主的身心狀況獲得大部分的舒緩,因此結束EMDR療程,在後續的追蹤亦發現案主的身心適應狀況相當穩定,並無嚴重的復發情形。
二、本案例之PTSD案主在參與EMDR治療過程中的認知想法轉換為正向、情緒感受則消除了負向情緒;案主在EMDR治療過程中的生理感受較不敏銳,但在治療結束時皆能進入放鬆之狀態。
三、經歷嚴重發病及EMDR治療之後,本案例之PTSD案主大多數的症狀已經解除,在身心警覺度和生活功能方面,相較於發病前的程度是有差別的;然而在面對生活中的壓力源時,案主能夠運用EMDR治療過程學習到的新技巧進行自我安撫以恢復身心狀態的平衡。
四、本案例顯示出EMDR的介入以及精神藥物造成PTSD案主的身心症狀改善情況是二者相輔相成造成的效果; EMDR治療師與案主所建立的信任關係開啟了案主穩定接受身心合併治療之契機。
針對上述研究結果,研究者進行以下討論:(1) 案主「發病」後的生理症狀及求助管道,反應出國人的壓力反應及求助行為;(2) 本案例之EMDR介入過程,協助案主正視與處理創傷議題,且介入過程符合創傷療癒之原則與策略;(3) EMDR之介入,有效協助臺灣地區案主解除情緒和生理症狀,並造成認知上的轉換,顯示EMDR具跨文化之效用,且案主之改善情況符合國際創傷性壓力研究學會治療指導手冊所提醒治療目標新興之關注面向;(4) EMDR合併藥物治療,打破案主生心理的惡性循環;(5) EMDR介入與案主自陳之進步情形,療效呈現一致上升的現象。
研究者針對研究結果及相關討論,建立一則以EMDR介入治療PTSD之邏輯模型,並進一步提出有關實務及研究上的建議,以供後續參考。
Regarded as one newer therapy originated from Western countries, Eye Movement Desensitization and Reprocessing (EMDR) has been proven efficient by numerous researches. However, due to the fact that there is not much related research in Taiwan, this study aims at a psychological therapy practice applying EMDR in Taiwan for the future exploration. Via a client’s positive result from the therapy and the comparison before and after the intervention of EMDR to the Post Traumatic Stress Disorder (PTSD) therapy, it is anticipated that EMDR will be practiced more in the psychotherapeutic field and thus dispersed in Taiwan.
The researcher invited the interviewee for this study after the closure of his therapy with an EMDR therapist certified in the USA. The researcher interviewed the interviewee and his wife after the closure of the therapy had passed four months and six months respectively. With the interviewee’s permission, all related records to the process and the interviewee’s self-observation are collected as the reference material for this study. The case description developed by the researcher contains the process before and after the intervention of the EMDR therapy. The research has also collaborated pertinent materials to analyze the interviewee’s experience during the process of therapy and to distinguish all differences before and after the intervention of the EMDR therapy, as well as to discuss the effects caused by psychiatric medication to the interviewee.
The procedure and the findings of this study are listed as follow:
1. The interviewee and his wife had totally been through a four month therapy with nineteen sections, in which three traumas the interviewee had experienced were targeted by the EMDR therapy. During the therapy, the interviewee stably adjusted and benefited a lot. In the follow-up tracking, the interviewee was found to have adapted and recovered well afterward.
2. Also during the therapy, the interviewee’s cognition turned positive along with the ease of the negative motions. The interviewee was insensitive but could usually relax himself when the section came to an end.
3. After the interviewee went through the severe morbidity and underwent the intervention of the EMDR therapy, most of the interviewee’s symptoms were eased even though the aspects of physical arousal and daily functions differed from those before the morbidity. However, when facing the source of pressure, the interviewee could adopt new skills learned from the EMDR therapy to comfort and balance himself both mentally and physically.
4. The case study has revealed that that the interviewee’s improvement is an effect mutually caused by the intervention of EMDR and the psychiatric medication; the key to the success of this case should be attributed to the trust established between the EMDR therapist and the interviewee that serves as a critical turning point for the interviewee to accept the combined treatment from psychological and pharmaceutical therapies.
Based on the result mentioned above, the researcher has proposed the following discussions:
1. The interviewee’s physical condition and consultation channel reflect the Taiwanese people’s reactions to pressure and help-seeking behaviors.
2. The intervention of EMDR helps the interviewee face and deal with the trauma, and the process of the intervention meets the principles and strategies of the trauma remedy.
3. The intervention of EMDR not only effectively helps the clients in Taiwan ease emotional and physical symptoms, but also significantly leads to the clients’ cognitive transformation. This explains that EMDR contains cross-cultural effects. In addition, the improvements seen on the interviewee meet the treatment goal and the new issues mentioned in Practice Guidelines for the International Society for Traumatic Stress Studies.
4. The combination of the interventions of EMDR and medication breaks the vicious stress cycle between the interviewee’s body and mind.
5. The interventions of EMDR and the self claims by the interviewee have shown the consistent positive effect.
Based on the study result and pertinent discussions, the researcher has established a logic model for the intervention of EMDR to the PTSD therapy and proposed further academic and clinical suggestions for future study.
【中文部份】
王智弘(1994)。諮商與心理治療研究的倫理問題。輔導學報,17,95-121。
李元華(2008)。眼動在眼動減敏訊息再處理法中的療效機制探討:干擾自然眼動對回憶的影響(未出版之碩士論文)。國立臺灣大學,臺北市。
林式穀(2008)。精神藥物手冊(二版)。臺北市:合記。
邱憶惠(1999)。個案研究法:質化取向。教育研究,7,113-127。
陳致豪(2003)。眼動減敏訊息再處理法中「眼動」與「正向認知」成分對於懼蟑症之療效(未出版之碩士論文)。國立臺灣大學,臺北市。
陳淑惠(2010)。災後災民長期心理輔導/災後歷程的心理反應。國家災害防救科技中心演講,國家災害防救科技中心。
張春興(2001)。現代心理學。臺北市:東華。
曾文星、徐靜(1974)。社會、文化與心理衛生。臺北市:水牛。
鄔佩麗(2008)。危機處理與創傷治療。臺北市:學富。
鄔佩麗(2009)。EMDR訓練工作坊。EMDR訓練工作坊,國立臺灣師範大學。
鄔佩麗(2010)。EMDR訓練工作坊。EMDR訓練工作坊,國立臺南大學。
楊淑瑜(主編)(2004)。實用精神科治療藥物指南。臺北市:康復之友聯盟。
鄭泰安(1996)。華人常見的心理症與社會心理問題。載於曾文星(主編),華人的心理與治療(271-293頁)。臺北市:桂冠。
【英文部分】
Adúriz, M. E., Bluthgen, C., & Knopfler, C. (2009). Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences. International Journal of Stress Management, 16(2), 138-153. doi: 10.1037/a0014719
American Psychiatry Association. (2000). Quick Reference to the Diagnostic Criteria from DSM-IV-TR. Washington D. C. and London, UK.
孔繁鐘(編譯)(2007)。精神疾病診斷準則手冊DSM-Ⅳ-TR。臺北市:合記。
Boudewyns, P. A., & Hyer, L. A. (1996). Eye movement desensitization and reprocessing (EMDR) as treatment for post-traumatic stress disorder (PTSD). Clinical Psychology and Psychotherapy, 3, 185-195.
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227.
Brown, S., & Shapiro, F. (2006). EMDR in the treatment of borderline personality disorder. Clinical Case Studies, 5, 403-420.
Cahill, S. P., Rothbaum, B. O., Resick, P.A. & Follette, V. M. (2009) Cognitive-behavioral therapy for adults. In Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds), Effective treatments for PTSD: Practice guidelines for the international society for traumatic stress studies(2nd Ed.)(pp. 139-222). New York, NY: Guilford Press.
Carlson, J., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muraoka, M. Y. (1998). Eye movement desensitization and reprocessing (EMDR). Treatment for combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
Devilly, G. J., & Spence, S. H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder. Journal of Anxiety Disorders, 13(1-2), 131-157.
Devilly, G. J., Spence, S. H., & Rapee, R. M. (1998). Statistical and reliable change with eye movement desensitization and reprocessing: Treating trauma within a veteran population. Behavior Therapy, 29, 435-455.
DiGiorgio, K. E., Arnkoff, D. B., Glass, C. R., Lyhus, K. E., & Walter, R. C. (2004). EMDR and theoretical orientation: A qualitative study of how therapists integrate eye movement desensitization and reprocessing into their approach to psychotherapy. Journal of Psychotherapy Integration, 14(3), 227-252. doi: 10.1037/1053-0479.14.3.227
Edmond, T., & Rubin, A. (2004). Assessing the long-term effects of EMDR: Results from an 18-month follow-up study with adult female survivors of CSA. Journal of Child Sexual Abuse, 13, 69-86.
Edmond, T., Rubin, A., & Wambach, K. (1999). The effectiveness of EMDR with adult survivors of childhood sexual abuse. Social Work Research, 23, 103-116.
Edmond, T., Sloan, L., & MacCarty, D. (2004). Sexual abuse survivors’ perceptions of the effectiveness of EMDR and eclectic therapy: A mixed-methods study. Research on Social Work Practice, 14, 259-272.
Feske, U. & Goldstein, A. J. (1997). Eye movement desensitization and reprocessing treatment for panic disorder: A controlled outcome and partial dismantling study. Journal of Consulting and Clinical Psychology, 65(6), 1026-1035.
Foa, E. B., Keane, T. M., & Friedman, M. J. (Eds) (2000). Effective treatments for PTSD: Practice guidelines for the international society for traumatic stress studies. New York, NY: Guilford Press.
楊筱華、李開敏、陳美琴、許玉來、董淑鈴(譯)(2005)。有效治療創傷後壓力疾患:國際創傷性壓力研究學會治療指引。臺北市:心理。
Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds) (2009a). Effective treatments for PTSD: Practice guidelines for the international society for traumatic stress studies(2nd Ed.). New York, NY: Guilford Press.
Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2009b). Introduction. In Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds), Effective treatments for PTSD: Practice guidelines for the international society for traumatic stress studies(2nd Ed.)(pp. 1-20). New York, NY: Guilford Press.
Foster, S. & Lendl, J. (1996). Eye movement desensitization and reprocessing: Four case studies of a new tool for executive coaching and restoring employee performance after setbacks. Consulting Psychology Journal: Practice and Research, 48(3), 155-161.
Friedman, M. J., Davidson, J. R. T., & Stein, D. J. (2009). Psychopharmacotherapy for Adults. In Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds), Effective treatments for PTSD: Practice guidelines for the international society for traumatic stress studies(2nd Ed.)(pp. 245-268). New York, NY: Guilford Press.
Goldstein, A. J., de Beurs, E., Chambless, D. L., & Wilson, K. A. (2000). EMDR for panic disorder with agoraphobia: Comparison with waiting list and credible attention-placebo control conditions. Journal of Consulting and Clinical Psychology, 8(6), 947-956. doi: I0.1037//OD22-006X.68.6.947
Grant, M. (2009). Change your brain, change your pain. Australia: BookPOD.
Grant, M. & Threlfo, C. (2002). EMDR in the treatment of chronic pain. Journal of Clinical Psychology, 58, 1505-1520
Greenwald, R. & Shapiro, F. (2010). What is EMDR? Commentary by Greenwald and invited response by Shapiro. Journal of EMDR Practice and Research, 4, 170-179. doi: 10.1891/1933-3196.4.4.170
Gupt, M, & Gupta, A. (2002). Use of eye movement desensitization and reprocessing (EMDR) in the treatment of dermatologic disorders. Journal of Cutaneous Medicine and Surgery, 6, 415-421.
Heppner, P. P., Wampold, B. E., & Kivlighan, D.M. (2008). Research design in Counseling(3rd ed.). Belmont, CA: Thomson Brooks/Cole.
劉淑慧、田秀蘭、陳淑琦、張勻銘、黃莉惟、陳慧甄(譯)(2009)。諮商研究法。臺北市:學富。
Hogeberg, G., Pagani, M., Sundin, O., Soares, J., Aberg-Wistedt, A., Tarnell, B., et al. (2007). On treatment with eye movement desensitization and reprocessing of chronic post-traumatic stress disorder in public transportation workers-A randomized controlled trail. Nordic Journal of Psychiatry, 16, 54-61.
Ironson, G., Freund, B., Strauss, J. L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community based of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113-128.
Jensen, J. A. (1994). An investigation of eye movement desensitization and reprocessing as a treatment for posttraumatic stress disorder symptoms of Vietnam combat veterans. Behavior Therapy, 25, 311-325.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 53(12), 1048-1060.
Korn, D. L., & Leeds, A. M. (2002). Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex posttraumatic stress disorder. Journal of Clinical Psychology, 58(12), 1465-1487.
Lee, C. W., Gavriel, H., Drummond, P., Richards, J., & Greewald, R. (2002). Treatment of PTSD: Stress inoculation training with prolonged exposure compared to EMDR. Journal of Clinical Psychology, 58, 1071-1089.
Lee, C., Taylor, G., & Drummond, P. D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13,97-107.
Leeds, A. M. (2009). A guile to the standard EMDR protocols for clinicians, supervisors, and consultants. New York, NY: Springer Publishing Company.
Marcus, S. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315.
Marcus, S., Marquis, P., & Sakai, C. (2004). Three- and six-month follow up of EMDR treatment of PTSD in an HMO setting. International Journal of Stress Management, 11, 195-208.
McCullough, L. (2002). Exploring change mechanisms in EMDR applied to “small t trauma” in short term dynamic psychotherapy: Research question and speculations. Journal of Clinical Psychology, 58, 1465-1487.
Muris, P., Merckelbach, H., Holdrinet, I., & Sijsenaar, M. (1998). Treating phobic children: Effects of EMDR versus exposure. Journal of Consulting and Clinical Psychology, 66(1), 193-198.
Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., et al. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-traumatic stress disorder. Clinical Psychology and Psychotherapy, 9, 299-318.
Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2008). Handbook of clinical psychopharmacology for therapists(5th ed.). Oakland, CA: New Harbinger Publications.
Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59.
Rogers, S., Silver, S. M., Goss, J., Obenchain, J., Willis, A., & Whitney, R. (1999). A single session, group study of exposure and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam War Veterans: Preliminary data. Journal of Anxiety Disorders, 13, 119-130.
Rothbaum, B. O. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.
Rothbaum, B. O., Astin, M. C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18, 607-616.
Scheck, M. M., Schaeffer, J. A., & Gillette, C. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.
Schiraldi, G. R. (2000). The post-traumatic stress disorder sourcebook: A guide to healing, recovery, and growth. Lincolnwood, IL :Lowell House.
馮翠霞(譯)(2002)。創傷後壓力調適。臺北市:五南。
Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2008). EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82.
Schubert, S., & Lee, C. W. (2009). Adult PTSD and its treatment with EMDR: A review of controversies, evidence, and theoretical knowledge. Journal of EMDR Practice and Research, 3, 117-132. doi: 10.1891/1933-3196.3.3.117
Shapiro, F. (2007). EMDR and Case Conceptualization from an Adaptive Information Processing Perspective. In Shapiro, F., Kaslow, F. W., & Maxfield, L. (Eds.), Handbook of EMDR and family therapy processes(pp. 1-34). Hoboken, NJ: John Wiley & Sons.
Shapiro, F., Kaslow, F. W., & Maxfield, L. (Eds.) (2007). Handbook of EMDR and family therapy processes. Hoboken, NJ: John Wiley & Sons.
Shapiro, F. & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Journal of Clinical Psychology, 58(8), 933-946.
Shapiro, R. (Eds.) (2009a). EMDR Solutions Ⅱ: for depression, eating disorders, performances, and more. New York, NY: Norton & Company.
Shapiro, R. (2009b). Introduction to assessment and treatment of depression with EMDR. In Shapiro, R. (Eds.), EMDR Solutions Ⅱ: for depression, eating disorders, performances, and more(pp. 9-20). New York, NY: Norton & Company.
Shapiro, R. (2009c). Attachment-based depression: Healing the “hunkered-down”. In Shapiro, R. (Eds.), EMDR Solutions Ⅱ: for depression, eating disorders, performances, and more(pp. 90-105). New York, NY: Norton & Company.
Sprang, G. (2001). The use of eye movement desensitization and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. Research on Social Work Practice, 11, 300-320.
Spates, C. R., Koch, E., Cusack, K., Pagoto, S., & Waller, S. (2009). Eye movement desensitization and reprocessing. In Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (Eds), Effective treatments for PTSD: Practice guidelines for the international society for traumatic stress studies(2nd Ed.)(pp. 279-305). New York, NY: Guilford Press.
Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodnicuk, J. (2003). Comparative efficacy speed, and adverse affects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338.
ven der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. H., Hopper, E. K., Korn, D. L., & Simpson, W. (2007). A randomized clinical trail of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68, 37-46.
ven Etten, M., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: A meta-analysis. Clinical and Psychotherapy, 5, 126-144.
Wilson, S. A., Becker, L. A., & Tinker, R. H. (1995). Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937.
Wilson, S. A., Becker, L. A., & Tinker, R. H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for post-traumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.
Yin, R. K. (1994). Case study research. Thousand Oaks, CA: Sage Publications.
尚榮安(譯)(2001)。個案研究。臺北市:弘智。
Yin, R. K. (2003). Case study research: Design and Methods(3rd ed.). Thousand Oaks, CA: Sage Publications.
周海濤、李永賢、張蘅(譯)(2009)。個案研究設計與方法。臺北市:五南。
Zabukovec, J., Lazrove, S., & Shapiro, F. (2000). Self-healing aspects of EMDR: The therapeutic change process and perspectives of integrated psychotherapies. Journal of Psychotherapy Integration, 10, 189-206.