Treatment of posttraumatic stress symptoms with EMDR in a patient with aphasia after stroke: A case report
Doel / introductie
Posttraumatic stress disorder (PTSD) is highly prevalent in patients with acquired brain injury (ABI). Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for posttraumatic stress symptoms. However, empirical research on the applicability and effectiveness of EMDR in patients with ABI, and more specifically in patients with aphasia after ABI, in which the applicability of EMDR may be extra challenging, is scarce.
Opzet en methode
This case study describes how EMDR was used in the treatment of chronic posttraumatic stress symptoms with intrusions of repeated verbal abuse and emotional neglect during childhood in a 55-year-old female with aphasia after a stroke, 10 years before. All DSM-5 criteria for PTSD were fulfilled, except criterion A, due to the nature of the events. Self-confidence was self-rated on a Visual Analogue Scale (0-10) pre- and posttreatment. During treatment the Subjective Units of Disturbance (SUD), the intensity of distress experienced while thinking of a traumatic memory, was repeatedly measured on a Visual Analogue Scale (0-10). Posttreatment the patient and spouse were asked about the burden of intrusions, difficulties sleeping and mood at the time and this was repeated at follow-up after a year. Adjustments in the EMDR standard protocol are elucidated.
Resultaten
The intervention consisted of three EMDR sessions treating three traumatic target memories. Because of severe difficulties in expressing language, the spouse was involved in treatment and measurements, and elements of the ‘Storytelling’ and ‘Blind to therapist’ methods of EMDR were used in addition to the standard protocol. The SUD’s of the traumatic memories were 8 or 9 at the start of treatment, and 0 or 1 at the end. Self-confidence was rated as 3 pretreatment and as 7 posttreatment. After completing EMDR, the patient reported having no more intrusions and difficulty sleeping and improvements in mood, congruent with observations of the spouse. These improvements were maintained after a year.
Conclusie / Discussie
Findings show the possibilities for EMDR in patients with acquired brain injury and aphasia, and encourage further investigation into the application of EMDR for treating symptoms of posttraumatic stress in this population.
In samenwerking met: Maastricht Universiteit & Expertisecentrum Hersenletsel Limburg
Meer info: Ellen Janssen, Epj.janssen@ggzoostbrabant.nl
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