Short-term Psychodynamic Therapies for Soma5c Symptom ...al2898/columbia_psychosomatics...Short-term...
Transcript of Short-term Psychodynamic Therapies for Soma5c Symptom ...al2898/columbia_psychosomatics...Short-term...
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Short-termPsychodynamicTherapiesforSoma5cSymptomDisorders
AllanAbbassMD,FRCPCProfessor&ProgramDirector
CentreforEmo:onsandHealthwww.istdp.caDalhousieUniversity,Halifax,Canada
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Reference Materials n Reaching through Resistance.
Detailed manual on ISTDP psychodiagnosis and treatment with case examples
n www.reachingthroughresistance.com Available on Amazon:
http://a.co/3UGMWx0 n Graded Format article on
capacity building: http://bit.ly/2gVT7iB Article on Resistance http://reachingthroughresistance.com/wp-content/uploads/2015/02/PsychodynamicPsychiatry2016.pdf
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n Hidden from View: A clinician’s guide to Psychophysiological Disorders
n Written with a Mindbody expert internist Howard Schubiner and written for doctors
n How to educate, provide first and second line treatments and basic ISTDP methods.
n Coming out end of 2017-early 2018
n www.unlearnyourpain.com
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n Evidence
n 5diagnosablemechanismsofSoma:cSymptomForma:on
n Treatmentpathways
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Direct Assessment and Treatment of Emotional Factors in Psychosomatic Conditions: Dr. Allan Abbass Director of the Centre for Emotions and Health at Dalhousie University in Halifax, Canada Allan is a leading teacher and researcher in the area of Short-Term Psychotherapy, and author of Reaching through Resistance: Advanced Psychotherapy Techniques, 2015. Thursday, December 7th, 2017 8:30 am – 5:00 pm Breakfast and Lunch is Provided Helen Wood Hall Auditorium School of Nursing Auditorium 1W-304 255 Crittenden Blvd., Rochester, NY 14620 Online Registration and Additional CME Course Information http://www.cvent.com/d/jtq885
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Meta-analysisofShortTermPsychodynamicPsychotherapyforSoma7cDisorders
Abbass,Kisely&Kroenke,2009
23Studies:broadrangeofcondi:onsn MediumtoLargeEffectSizesvscontrolsincreasedover:me
n Emo:onalExperiencingmoreeffec:vethanInsightfocusedmodels(ES:0.60to1.31)
n Weareprocessofupda:ngthisreview:expect40+studiesAllan Abbass MD 2017 5
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IntensiveShort-termDynamicPsychotherapy:Davanloo(+Malan)
n Withinthecontextofformingtherapeu:caXachmentàunprocessedfeelingsaboutpreviousaXachmentsareac:vated
n Thisallowsonetodirectlydiagnoseunconsciousemo:onalcontributorstosoma:csymptomsstemmingfromaXachmenttrauma
n Treatment:handlingavoidantresponses,buildingreflec:vecapacityandenablingthesoma:cexperienceofunprocessedfeelingsaboutaXachmenttrauma.
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IntensiveShort-termDynamicPsychotherapyinSoma7cSymptomDis.
n 15publishedoutcomestudiesn 7RandomizedControlledTrials8CaseSeriesn Costreduc:on>>>treatmentcostn UrethralSyndrome/PelvicPain,BackPain,Func:onal
MovementDisorders,ChronicHeadache,Pseudoseizures,ChronicPain(3RCTs)IrritableBowelSyndrome,MixedMUS(2studies),AtopicDerma::s,Bruxism,Func:onalNeurologicaldisorders
n Effectsaremediumtolargeandsustainedinfollow-up(TownandDriessen2013)
n OutperformedMindfulness-basedStressReduc:onforChronicPain
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ISTDPvsMindfulnessbasedStressReduc7onforChronicPainChavooshietal,2015
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TotalDoctorandHospitalCosts/pa7ent:N=890
$0.00
$2,000.00
$4,000.00
$6,000.00
$8,000.00
$10,000.00
$12,000.00
$14,000.00
1 yr Pre 1 yr Post 2 yr Post 3 yr Post
Case
Control
NormalPopula:onCosts
17Xcostoffset
Abbass,etal2015,JPsychiatricResearch Allan Abbass MD 2017 9
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PseudoseizuresN=28,3.6sessionsofISTDPRusselletal,2016
0
5000
10000
15000
20000
25000
1 yr pre 1 yr post 2 yr post 3 yr post 4 yr post
ISTDP
0
200
400
600
800
1000
1200
1 yr pre 1 yr post 2 yr post 3 yr post 4 yr post
ISTDPHospital Costs Doctor Costs
Normal Population
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BOND With
Parents
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BOND With
Parents PAIN FEAR
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BOND With
Parents PAIN FEAR
Rage, Guilt about the Rage
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BOND With
Parents PAIN FEAR
Rage, Remorse about the Rage
Diffuse Symptoms Character disorder
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Currentperson
Therapist/Doctor
Pastperson
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UnconsciousAnxiety
UnconsciousDefense
UnconsciousFeelings
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UnconsciousAnxiety
UnconsciousDefense
UnconsciousImpulses&Feelings
1.FocusonFeelingsorDefenses
2.Monitorresponses
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MainpaVernsandtreatment
n Voluntarymusclestenseup,defendanddetachn HELPTOSOMATICALLYEXPERIENCETHEFEELINGS
n Goflatwithsmoothmuscleanxietyn Goflatwithmotorconversionn Goflatwithcogni:veperceptualdisrup:on
n BUILDCAPACITYTHEFEELTHEFEELINGS:anxietyshiKstovoluntarymuscles
n THENEXPERIENCETHEFEELINGSAllan Abbass MD 2017 18
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1.StriatedMuscleUnconsciousAnxiety
n HandsClenchn Arms,Shoulders,Neckn Intercostal:Sighn Abdomen,backn LegsandFeet
àFibromyalgia,tremor,:cs,headache,chestpain,abdominalwallpainn SeewithIntellectualiza:onaboutfeelingsAllan Abbass MD 2017 19
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2.SmoothMuscleUnconsciousAnxiety
n Gastrointes:naln BloodVesselsn Airwaysn Bladderà AbdominalPain,IrritableBowelSyndrome,Dyspepsia,Migraine
à AbsenceofStriatedmuscleanxietyà Mediatedby(unconscious)Repressionoffeelings
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3.Cogni7ve-perceptualDisrup7on
n Dissocia:on,losingtrackofthoughts,poormemory,fain:ng
n Visualblurring,blindnessn Dysfunc:onofothersensesn Hallucina:onsinall5senses:CanperceivePain
n àNeurologicalpresenta:onsn SeenwithProjec:onoffeelingsandimpulses
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4.MotorConversion
n Muscleweaknessn àNeurologyConsulta:onandEmergencyDepartments
n SeenwithRepression
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UnconsciousAnxiety
StriatedMuscleAnxietyIsola:onofAffect
SevereRepression
ModerateRepression
MildRepression
ConsciousFeelings Threshold to experiencing impulse/feelings
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UnconsciousAnxiety
StriatedMuscleAnxietyIsola:onofAffect
ConsciousFeelings
1.Pressuretofeelingsortodefenses2.Riseincomplextransferencefeelingsandanxiety3.Intellectualrecaptobringisola:onofaffect
1
3 2
3 2
1
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5.Sympathysymptomsn Guiltaboutragecausesthesamesymptomsasapersonunconsciouslywantedtoinduceinanother.
n CommonExamples:n StranglingàChokingn Headdamageàheadache
n Greaterthan1000videotapecaseexamples
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Soma7cpathwaysofimpulsesandfeelings
n Love:warmthinchestandurgetoembracen Grief:tearsandthoughtsoflossn Rage:upwardheatandenergytochestthenhandsthenneckandhead:urgetodoviolence
n Guilt:dis:nctwavesofpainfulfeelingwithupperbodypainandthoughtsofremorse
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Inhibitory Forces Go Down
Somatic Rage Goes up same system
AMA Atlas online Allan Abbass MD 2017 27
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Conclusionn AXachmenteffortsmobilizefeelingsaboutoldaXachments
n Theseunprocessedfeelingscanac:vateaspectrumofsoma:csymptoms
n Thisprocesscanbediagnoseddirectlyn Experiencingthefeelingscanreduceorremovethesymptomsandneedtosuffer(characterchange)
n Diagnos:candtreatmentimplica:onsforpsychosoma:cdisturbances
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