Leon A. Hyer

Eye Movement Desensitization and Reprocessing (EMDR) as Treatment for Post‐Traumatic Stress Disorder (PTSD)

Eye Movement Desensitization and Reprocessing is a new and controversial cognitive–behavioural treatment technique that combines cognitive processing and exposure methodology to treat conditioned emotional responding and other trauma-related symptoms. EMDR is controversial in part due to initial excessive claims by its originator, Francine Shapiro, and also because of what many believe to be Shapiros proprietary emphasis in controlling who may use the technique with patients. In this paper our aim is to take an objective look at the process and effectiveness of this technique. The purpose here is to (1) offer a brief objective review of the outcome literature to date on EMDR; (2) present a short summary of results of an ‘early look’ at an ongoing controlled study of this method that we are presently conducting; (3) speculate on the merits of this approach based on both scientific and clinical experience with EMDR and (4) offer a brief description of the evolved process of EMDR along with a commentary on that process.

NEO-PI profiles in PTSD as a function of trauma level

One hundred Vietnam veterans with combat-related PTSD were administered the NEO Personality Inventory (NEO-PI) and the Combat Exposure Scale and were sorted into three groups based on trauma exposure level. Results indicate no significant differences among the personality profiles of the three trauma-exposed groups. A normative NEO-PI profile for persons diagnosed with combat-related PTSD is presented, characterized by an extremely high Neuroticism score (T > 75) and an extremely low Agreeableness score (T < 25).

Negative parenting behavior, combat exposure, and PTSD symptom severity : test of a person-event interaction model

The “personal characteristics” and “extreme event” hypotheses have been proposed as alternative explanations for the development of posttraumatic stress disorder (PTSD) among combat veterans. The person-event interaction model attempts to integrate both perspectives by hypothesizing that premilitary individual vulnerability characteristics play a greater role in influencing risk of PTSD or PTSD symptom severity at lower than at higher levels of exposure to traumatic combat stressors. Focusing on a sample of 57 Vietnam veterans undergoing inpatient treatment for diagnosed PTSD, we assessed this model by examining interactions between negative parenting behaviors in childhood (e.g.-test), inconsistent love) and degree of combat exposure in predicting PTSD symptom severity. Hierarchical regression analyses supported the model, indicating that the fathers negative parenting behaviors were more predictive of PTSD symptom severity at relatively lower levels of combat exposure. Implications of the findings for further research on multivariate, interactional models of PTSD etiology among Vietnam combat veterans are discussed.

Relationship between the Millon Clinical Multiaxial Inventory and the Millon-II : value of scales for aggressive and self-defeating personalities in posttraumatic stress disorder

This study addressed two issues, the interrelationship between the Millon Clinical Multiaxial Inventory (MCMI) and the Millon II (MCMI-II) and the value of the new personality scales, Aggressive and Self-defeating, in a sample with diagnoses of combat-related Posttraumatic Stress Disorder. 100 confirmed cases of combat-related Posttraumatic Stress Disorder were given a battery of measures including both Millon inventories and the Minnesota Multiphasic Personality Inventory (basic scales and selected subscales). They were rated on discharge status during a structured treatment program. Basic treatment and background information were also obtained. Analysis showed scores on the MCMI-II scales were higher but generally reflective of MCMI scales and that the Self-defeating personality style tends to be reflective of greater psychopathology, suicidal problems, treatment/disposition difficulties, overreporting of symptoms, and intensity of problems. Discussion encouraged the use of the MCMI-II with special emphasis given to the Self-defeating style in this group with Posttraumatic Stress Disorder.

Comparison among Four Measures of Depression in Younger and Older Alcoholics

Two hypotheses were tested: (1) The Geriatric Depression Scale (GDS) would be less affected by age in an older alcoholic group than in a younger one. (2) In comparison with other depression scales—Beck Depression Inventory, Depression Scale of MMPI, and Dysthymic Scale of Millon Clinical Multiaxial Inventory—the Geriatric Depression Scale would be the one least affected by age in the older group. To test these hypotheses two groups were formed, containing 36 and 37 subjects, whose mean ages were 32.50 and 53.98 yr. All subjects were administered the four depression scales and tests of cognitive function. The results confirmed the first hypothesis as r was .32 between age and the Geriatric Depression Scale for the younger group and .03 for the older group. The second hypothesis was not confirmed. All four depression scales correlated nonsignificantly with age in the older group. The use of the depression scales for all ages was supported and discussed.

Interaction of Age and Opioid Dependence on Length of Hospital Stay for Spine Surgery Patients

Clinical information suggests that opioid dependence is a major contributor to poor outcomes involving health status and to increased length of stay in hospital settings. Before spine surgery, 150 patients who were using an opioid medication for pain relief were interviewed using the six World Health Organization (WHO) guidelines for the diagnosis of opioid dependence. Three groups were defined: opioid-dependent, nonopioid-dependent, and a subclinical group. Results revealed an average of 20% of patients (N = 30) who met the WHO criteria for the diagnosis of opioid dependence. There were significant positive correlations between age and number of positive WHO criteria, length of stay, and time under surgery. Length of stay was significantly higher for the older age group (> 55 yr.). ANCOVA analysis using two opioid dependence groups (+ and -) and age group as independent variables affecting length of stay, after controlling for type of surgery, pain intensity, and number of previous spine surgeries, revealed that effects of opioid dependence status and age were significant but their interaction was not. Age did add length of stay independently of opioid dependence status; older adults remain in the hospital longer for various reasons probably associated with comorbidities.

Self-Critical Depressive Experience in Posttraumatic Stress Disorder

Consistent with prior research, 73 hospitalized male Vietnam veterans with combat-related Posttraumatic Stress Disorder (PTSD) reported high scores on Self-criticism as measured by the Depressive Experiences Questionnaire. Self-criticism scores predicted greater severity of PTSD (Mississippi scale) after controlling for symptomatic depression (MMPI-D scale), suggesting that the nature of depression in Posttraumatic Stress Disorder differs from that in major depressive disorder.