short-term psychodynamic therapies for soma5c symptom...
TRANSCRIPT
Short-termPsychodynamicTherapiesforSoma5cSymptomDisorders
AllanAbbassMD,FRCPCProfessor&ProgramDirector
CentreforEmo:onsandHealthwww.istdp.caDalhousieUniversity,Halifax,Canada
Allan Abbass 2017 1
Reference Materials n Reaching through Resistance. n Detailed manual on ISTDP
psychodiagnosis and treatment with case examples
n www.allanabbass.com n Available on Amazon: http://a.co/3UGMWx0 n Somatization article in JFP:
http://bit.ly/2yC9TLf n Graded Format article: http://bit.ly/2gVT7iB
2
n Hidden from View: A clinician’s guide to Psychophysiological Disorders
n Written with H Schubiner a Mindbody expert internist
n How to educate, provide first and second line treatments and basic ISTDP methods.
n Coming out end of 2017-early 2018
n Psychophysiologic Press
Allan Abbass 2017
n Evidence
n 5diagnosablemechanismsofSoma:cSymptomForma:on
n Treatmentpathways
Allan Abbass 2017 3
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 2017 4
IntensiveShort-termDynamicPsychotherapy:Davanloo(+Malan)
n Withinthecontextofformingtherapeu:caXachmentàunprocessedfeelingsaboutpreviousaXachmentsareac:vated
n Thisallowsonetodirectlydiagnoseunconsciousemo:onalcontributorstosoma:csymptomsstemmingfromaXachmenttrauma
n Treatment:handlingavoidantresponses,buildingreflec:vecapacityandenablingthesoma:cexperienceofunprocessedfeelingsaboutaXachmenttrauma.
Allan Abbass 2017 5
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
6 Allan Abbass 2017
ISTDPvsMindfulnessbasedStressReduc7onforChronicPainChavooshietal,2015
Allan Abbass 2017 7
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 2017 8
BOND With
Parents PAIN FEAR
Rage, Remorse about the Rage
Diffuse Symptoms Character disorder
Allan Abbass 2017 9
Currentperson
Therapist/Doctor
Pastperson
Allan Abbass 2017 10
UnconsciousAnxiety
UnconsciousDefense
UnconsciousFeelings
Allan Abbass 2017 11
UnconsciousAnxiety
UnconsciousDefense
UnconsciousImpulses&Feelings
1.FocusonFeelingsorDefenses
2.Monitorresponses
Allan Abbass 2017 12
MainpaSernsandtreatment
n Voluntarymusclestenseup,defendanddetachn HELPTOSOMATICALLYEXPERIENCETHEFEELINGS
n Goflatwithsmoothmuscleanxietyn Goflatwithmotorconversionn Goflatwithcogni:veperceptualdisrup:on
n BUILDCAPACITYTHEFEELTHEFEELINGS:anxietyshiKstovoluntarymuscles
n THENEXPERIENCETHEFEELINGSAllan Abbass 2017 13
1.StriatedMuscleUnconsciousAnxiety
n HandsClenchn Arms,Shoulders,Neckn Intercostal:Sighn Abdomen,backn LegsandFeet
àFibromyalgia,tremor,:cs,headache,chestpain,abdominalwallpainn SeewithIntellectualiza:onaboutfeelingsAllan Abbass 2017 14
2.SmoothMuscleUnconsciousAnxiety
n Gastrointes:naln BloodVesselsn Airwaysn Bladderà AbdominalPain,IrritableBowelSyndrome,Dyspepsia,Migraine
à AbsenceofStriatedmuscleanxietyà Mediatedby(unconscious)Repressionoffeelings
Allan Abbass 2017 15
3.Cogni7ve-perceptualDisrup7on
n Dissocia:on,losingtrackofthoughts,poormemory,fain:ng
n Visualblurring,blindnessn Dysfunc:onofothersensesn Hallucina:onsinall5senses:CanperceivePain
n àNeurologicalpresenta:onsn SeenwithProjec:onoffeelingsandimpulses
Allan Abbass 2017 16
4.MotorConversion
n Muscleweaknessn àNeurologyConsulta:onandEmergencyDepartments
n SeenwithRepression
Allan Abbass 2017 17
UnconsciousAnxiety
StriatedMuscleAnxietyIsola:onofAffect
SevereRepression
ModerateRepression
MildRepression
ConsciousFeelings Threshold to experiencing impulse/feelings
Allan Abbass 2017 18
UnconsciousAnxiety
StriatedMuscleAnxietyIsola:onofAffect
ConsciousFeelings
1.Pressuretofeelingsortodefenses2.Riseincomplextransferencefeelingsandanxiety3.Intellectualrecaptobringisola:onofaffect
1
3 2
3 2
1
Allan Abbass 2017 19
5.Sympathysymptomsn Guiltaboutragecausesthesamesymptomsasapersonunconsciouslywantedtoinduceinanother.
n CommonExamples:n StranglingàChokingn Headdamageàheadache
n Greaterthan1000videotapecaseexamples
Allan Abbass 2017 20
Soma7cpathwaysofimpulsesandfeelings
n Love:warmthinchestandurgetoembracen Grief:tearsandthoughtsoflossn Rage:upwardheatandenergytochestthenhandsthenneckandhead:urgetodoviolence
n Guilt:dis:nctwavesofpainfulfeelingwithupperbodypainandthoughtsofremorse
Allan Abbass 2017 21
Inhibitory Forces Go Down
Somatic Rage Goes up same system
AMA Atlas online Allan Abbass 2017 22
Conclusionn AXachmenteffortsmobilizefeelingsaboutoldaXachments
n Theseunprocessedfeelingscanac:vateaspectrumofsoma:csymptoms
n Thisprocesscanbediagnoseddirectlyn Experiencingthefeelingscanreduceorremovethesymptomsandneedtosuffer(characterchange)
n Diagnos:candtreatmentimplica:onsforpsychosoma:cdisturbances
Allan Abbass 2017 23