Effective Treatment of Veterans with PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches
Introduction
The United States army has participated in many multinational missions worldwide since the Second World War. Most of the soldiers deployed went through and continue to undergo potentially traumatizing events that had not been part of their experience. From the time the Second World War and the Gulf War ended, events like recovering semi-decayed bodies from mass graves, the dangers of being injured, and even death from suicide bombers and planted explosive devices severely affected the mental health of the soldiers and ability to continue serving in the military. For this reason, research into trauma-related disorders like Post-Traumatic Stress have been intensified. PTSD is a devastating and debilitating psychiatric disorder that may develop after a patient has experienced a life-threatening situation (APA, 2013). A population at significantly increased risk for PTSD in veterans who have experienced combat or other life-threatening events. According to the National Center for PTSD (2018), the prevalence of PTSD is between 11% and 30% for veterans, depending on the service era. The prevalence is the greatest in veterans who served in the Vietnam War. In the study, “Effective Treatment of Veterans with PTSD: Comparison between Intensive Daily and Weekly EMDR Approaches,” Hurley (2018) evaluates the effectiveness of Eye Movement Desensitization And Reprocessing (EMDR) in treating veteran patients with PTSD.
Designed by F. Shapiro in 1988, EMDR is a therapeutic technique with over three decades of research and established evidence-based benefit in treating PTSD (Shapiro, 1989). This therapy involves focusing on the sound or hand movements while the affected individual talks about the traumas they underwent. Negative thoughts, feelings, and behaviors result from unprocessed memories. By having a patient focus on bilateral stimulation, they will surface traumatic memories and become less distressed by those images. Shapiro developed an eight-stage process for EMDR, which is completed over a series of 60-90 minutes. In this study, Hurley (2018) aims to determine whether EMDR therapy administered twice daily is as effective as EMDR therapy administered weekly for 18–20 sessions and whether the treatment outcome persists (Hurley, 2018).
Background
In this study, 30 veterans were randomly assigned to two groups of 15. Participants were screened by mental health providers and met tested positive for PTSD. One group was treated with EMDR daily, and the other group was treated with EMDR weekly, with Both groups having the same number of total sessions. Both the weekly and daily EMDR groups were treated with the standard EMDR protocol established in 2005. In the daily intensive treatment group, the most distressing memories were targeted during the morning sessions. The afternoon sessions targeted residual materials remaining from the morning session and helped the participants attain stability and calmness before ending the day. An essential difference between the two treatment groups is that the group that took daily sessions had an extended closing period to ensure the client's self-regulation and stability. The weekly treatment group did not receive this as this group's treatment schedule was not intense (Hurley, 2018). There were three points in the study where all participants were evaluated. They were first evaluated pre-treatment, post-treatment, and 1-year follow-up.
State of the Science
The study addressed the first question of whether EMDR therapy administered twice daily has a positive effect on veterans' PTSD symptoms. This study demonstrated that daily intensive EMDR and weekly EMDR produced statistically significant PTSD symptom reduction (Hurley, 2018). Additionally, the results also showed the following changes in The Impact of Event Scale-Revised (IES-R) scores. IES-R was mainly designed as a measure of post-traumatic stress disorder. In the daily intensive treatment group, the mean IES-R score changed from 53.20 to 17.40. In the group that took weekly treatment, the mean IES-R score changed from 51.80 to 16.07 (Hurley, 2018). This provided evidence for the second research question. The therapy administered twice daily provides equivalent outcome results as administered weekly for 18–20 sessions, as measured by the IES-R. Based on the study results, it was concluded that both daily intensive and weekly EMDR produced approximately equal outcome results.
Significance to Clinical Psych Practice
PTSD is a highly prevalent disorder precisely in veterans. It is essential that screening and close monitoring be done in this population since they are at a greater risk. EMDR has proven to be the most effective means of treating PTSD; therefore, it is essential to note that both nursing students and active nurses can help combat the growing menace. Nurses also note that many of the techniques utilized in EMDR can be performed even if a nurse isn't trained in EMDR. Many of the techniques integral to EMDR, such as mindful breathing, body scanning, and appropriate history taking, can be incorporated by a nurse into their clinical practice. Nurses screening for PTSD can use structured interviews, self-report measures, and multiscale personality entries. The most recommended criteria are structured interviews, which can assess all other associated disorders.
Recommendations/Nursing Considerations
It is challenging to diagnose PTSD because the symptoms are closely related to other psychological disorders. However, with proper training, nurses and other medical practitioners, licensed counselors, and psychiatric mental health nurse practitioners (PMHNPs) can efficiently conduct PTSD interventions. Some of the ways nurses can intervene at the bedside at local hospitals include cognitive therapy, exposure therapy that helps patients reduce flashbacks and nightmares, and psychopharmacology. This entails the use of anti-anxiety drugs and antidepressant drugs. Additional training can help expand skills and career opportunities for active nurses to prepare to carry out nursing interventions for PTSD. EMDR is still recommended in the future due to its effectiveness in treating conditions that have been unsuccessful before.
Cognitive therapy is a medication that assists patients to identify and alter hypothetically destructive thinking patterns such as fear and trauma. Cognitive therapy is centered on teaching patients on assessing and changing disturbing thoughts that occur after trauma. As the patients change thoughts, the emotions also change. Most of the time, trauma alters thinking patterns. These negative thinking patterns are the underlying reasons for the sustenance and prevalence of PTSD (Center, 2018). Through the application of cognitive therapy, the nurse can help a patient acquire skills that could assist them to control their thoughts. The role of the nurse is to create a connection between mannerisms and thinking patterns. More so, cognitive therapy aims to better a patient's functionality through altering the thinking patterns. It is one of the most effective treatment because it assumes that betterment in one domain leads to the improvement of another one. For instance, accepting positive thoughts leads to proper behavior.
Apart from cognitive therapy, exposure therapy is used to assists PTSD patients minimize recurrences and hallucinations. Through exposure therapy, the patient is exposed to situations that previously triggered PTSD circumstances and reminiscences until a point where the patient can comfortably cope with the situations. Exposures might be actual or even fictional. Virtual reality technological devices could be used to bring about exposure therapy. Subsequently, eye motions and recovery are combined with exposure therapy. The nurse normally observes eye motions to assist patients process shocking recollections and at the same time control the outcomes. Eye motion desensitizations and reprocessing (EMDR) are used to capture hurtful feelings, recollections, and other types of stress that the patient might have experienced in the past. In the end, the nurse has to process these experiences in a constructive way that relieves the patient from PTSD symptoms (Center, 2018). Most of the time, after PTSD, the patients might find it hard to regain their normal routine after suffering from PTSD. At this point, the patient might develop a negative perception of the entire world. These thoughts can prevent a patient from fully recovering and continuing with normal life. this intervention teaches the patient new methods for handling disturbing thoughts and ways of developing more positive thoughts towards the world and immediate surroundings. For the most part, the nurse normally encourages close family members to come and engage the patient more productively. For instance, the family might form new routines for the family members. Also, the patient’s family members are meant to shape the immediate surrounding of the patient and affirmatively help to bring meaning back to the life of the patient. Some of the chances of bringing into place the effectively needs proper training and observation.
The first phase entails assessing patient intial history and designing the medication. During this phase the therapist can take 1-2 sessions. From the patient’s history, the therapist can create or design a medication plan. The second phase is centered on preparation. Normally, it would take 1-4 sittings depending on the severity of the condition. the third phase is dominated with assessment of the patient’s details as the therapist is forced to separately evaluate fact in a manageable and standardized manner (Menon, & Jayan, 2010). The forth phase is about desensitization where the therapist assesss the patient’s destructive emotions and thoughts through SUD ratings hence the patient’s reaction are captured in detail. additionally, the fifth phase is known as installation. The aim of the installation pahse is to increase the impact positive thoughts have on the patient. the sixth phase is the body scan which occurs after ascertaining that the patient only thinks positive thoughts. Phase 7 is the closure section. Closure ensures that the client has improved in each and every aspect after undergoing the therapy. The eighth phase is the reevaluation phase and it directs the therapist through medication plans required to handle the patient’s main challenges. The significance of EMDR is based on conditioning ideologies hence the negative thoughts are replaced with positive thoughts. Therefore, the procedure is reliable and effective
The nurse has to offer social support to the patient and their close relatives. It is mutual for individuals suffering from PTSD to isolate themselves from relatives and close friends (Center, 2018). This is because the patients might not want to burden their relatives with their issues. even though it is vital to respect others, the nurse has to step in and ensure that the connection between the patient and the rest of his or her relatives and close friends. It is vital to note that the nurse should not pressure a PTSD patient into doing things that he or she does not want to do. This way, the PTD patient will learn to express his experiences in a laid back manner that would be beneficial for his wellbeing and other things and intuitiveness.
Summary
Post-traumatic stress disorder is a prevalent and debilitating psychiatric condition that may develop following life-threatening events. One of the most promising therapies is eye movement desensitization and reprocessing. This study considered EMDR particularly in the veteran population, which is at increased risk for PTSD. It demonstrated that EMDR produces significantly improved symptoms in veterans suffering PTSD, even those whose symptoms have been refractory to other forms of therapy and psychopharmacology. The statistically significant benefits also proved to be maintained after long-term follow-up. EMDR is a treatment modality that requires minimal resources, is cost-effective, and can be performed at the bedside. Nurses in the clinical psychiatric practice must be aware of PTSD and the benefits of EMDR. Many of the components of the 8 phases of EMDR could easily be incorporated into nursing care. If more nurses were trained in EMDR, it might revolutionize the field of clinical psychiatry. It is evident that EMDR is an effective method, with an increase in mental health cases primarily caused by the pandemic, the number of cases may continue to rise. Nursing courses and curriculum should be designed to incorporate a course or a unit to train EMDR to all students to deal with the rising menace.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–80. ISBN 978-0-89042-555-8.
Hurley, E.C. (2018). Effective treatment of veterans with PTSD: Comparison between intensive daily and weekly EMDR approaches. Frontiers in psychology, 9, 1458.
National Center for PTSD (2018). PTSD Basics. U.S. Department of Veterans Affairs. Retrieved from https://www.ptsd.va.gov/understand/what/ptsd_basics.asp
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress. 2 (2): 199–223.
Center, S. (2018). Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches. Retrieved 11 February 2021, from https://www.frontiersin.org/articles/10.3389/fpsyg.2018.01458/full.
Menon, S. B., & Jayan, C. (2010). Eye movement desensitization and reprocessing: A conceptual framework. Indian journal of psychological medicine, 32(2), 136-140.
