Challenging Beliefs about the Psychotherapy of Post-Traumatic Stress Disorder (PTSD)

Clinical guidelines for treating post-traumatic stress disorder (PTSD) have recommended using cognitive-behavioural therapy (CBT) only. This is not surprising given that almost all randomized clinical trials were conducted by CBT researchers examining the efficacy of CBT. The two types of standardized CBT -- trauma-focused and non-trauma-focused – were both found to be equally efficacious for treating PTSD. However, their observed efficacy is limited -- only partial PTSD remission in only 50% of informed and selected volunteers. Beyond a limited efficacy, claims of high efficacy are often made for trauma-focused CBT, although these modalities were repeatedly found to be associated with attrition and iatrogenic effects. Whenever dynamic and supportive therapies were included in controlled clinical trials, these therapeutic modalities were provided in non-representative ways. Furthermore, any differential findings between therapies disappeared at follow-up, invaliding any conclusion about the superiority of CBT. Only one randomized clinical trial had compared the efficacy of dynamic therapy vs. CBT for treating PTSD, but no differential efficacy was found (Brom et al., 1989). Taken together, these findings suggest that there is a pro- CBT bias in funding, research, and guidelines in the field of PTSD. This pro-CBT bias needs to be acknowledged and corrected. In the meantime, clinicians need to rely on their own judgment, using integrative approaches for treating PTSD in a flexible manner.

Importance of Employee Motivation in Workplace

Introduction: Why do organization engage with an employee at work? Why do organization want the employees to work towards a common goal? The answer to these questions lies in motivation. Motivation is the key feature that drive employees to work hard and to devote more time. It is also known as the same force that encourages organizations to engage with their employees to attain a common organizational and employee goal. Employee engagement is a new construct to businesses, management, and human resources to adopt in an organizational setting. This report was based on the current organization that employed with - WSM– focused on the results of the previous Engagement Survey. The objective of the survey was to identify the employees’ workplace engagement through motivational theory and a necessary to promote their drive towards job satisfaction. Purpose: This study explored the relationship between job dissatisfaction and employee engagement in organizational settings. The study had been divided into two parts: The first part was to analyze the job satisfaction/dissatisfaction between two departments which had turnover issues in the previous year (the following departments has been identified based on the turnover issue from the previous year): Report 1: WSM Finance, Report 2: WSM Vessel Accounting The second part was to compare with another department which is Report 3: WSM Global Procurement Services - known for their high motivational level and the turnover rate was extremely low. The intention was to analyze what factors they have used to identify organizational issues within their department. The analysis was to identify the cause of job dissatisfaction and lack of motivation by assessing the work stressors through the WSM Engagement Survey results. Conclusion: The study had found concerns in the area of Working Conditions which was derived from the lack of motivation. Both intrinsic and extrinsic motivation has a strong positive impact on employee engagement. Based on the results, excellent Leadership was required to maintain the motivation level and stronger employee engagement.

The Effectiveness of Cognitive Behavioral Therapy for People with Depression Following Stroke: A Systematic Review and Meta-Analysis

Post-stroke depression (PSD) is a common psychiatric manifestation of stroke, which has a devastating impact on survivors’ quality of life with an increasing burden on caregivers and the public medical system. Even so, no meta-analysis on specific psychotherapeutic treatment has been conducted. How effective is cognitive behavioral therapy (CBT) in reducing depressive symptoms in randomized-controlled trials (RCTs) targeting community-dwelling stroke survivors with PSD? Through systematic procedures of screening and data extraction, four RCTs were synthesized for meta-analysis (N= 270) on effect size estimates. Overall, CBT groups showed significant improvement in depression compared with controls. Methodological quality, intensity of CBT, and duration of post-treatment follow-up proved critical to treatment effects. Despite the potential threat of external validity, this paper had reviewed their content comprehensively with the implication of facilitating public understanding, research, and service development of PSD using CBT. To fill the knowledge gap, standardized protocol and further subgroup analyses are necessary.

Chronic Pain and Etiology of Psychological Disturbances

Objective: The aim of this study was to review the impact of a possible association between self- efficacy, symptom severity, pain intensity, depression, anxiety and catastrophizing on health- related quality of life among chronic pain patients. Background: A large number of people experience and live with various types of physiological-oriented chronic pain (CP) diseases. Lives of individuals who suffer from CP may alter in various ways. Particularly, in terms of health-related quality of life after diagnosis. Even though, there has been significant increase in chronic pain research, this area of research continues to offer patients significant health repercussions. Findings: This research has discovered that, there still, is an urgent need for improvements in regard to treatment and quality of chronic pain management care. A range of literatures assessed several aspects in which CP alters the patients’ lives, as well as its potential repercussions in the workplace, on the dynamic of patients’ families, and their social environments. Methods: An exploratory review of literature alongside the implementation of a small exemplary pilot study that was solely undertaken to help further validate the results that were acquired via review of literature. The data presented in the pilot study were drawn from purposive sampling and structured survey questionnaires. Participants of the pilot study: Thirty adults (>18 years) diagnosed and currently living with various kinds of chronic physical non-cancer pain.

Multicultural Stress Management

Stress is a specific response by the body to a stimulus which tends to disturb the normal physiological equilibrium. Stress management skill can be culturally different due to the different parenting styles that is more popular in a culture. Diet is also related to stress as the mind and body are interrelated. Some evidences shown that staple diet had given rise to Parkinson or Alzheimer. Thus, nutrition and psychotherapy need to go together for effective stress management. Much evidence has supported the use of Ketogenic diet to manage stress. Psychotherapy, particularly schema therapy could manage stress through focusing on creating disassociation between our own vulnerability and our internalized critical voice. US recently focused on balancing imbalanced neurotransmitters in reducing stress symptoms. Lab tests can help detect the levels of our neurotransmitters and identify any imbalance of individual neurotransmitters contributing to stress related disorders, which are now available in Malaysia.

Integrating Focusing and Differentiation: A Therapeutic Path for Couples in Intimate Relationships

Continuing the workshop I've given in the WPC Paris (2017), this article elaborates my discussion of the way I interlace Focusing with Differentiation Based Couples Therapy (Megged, 2017) under the systemic view, in order to facilitate processes of change and healing in working with intimate couples. This article presents the theory and rationale of integrating Differentiation (Bowen, 1978; Schnarch, 2009; Megged, 2017) and Focusing (Gendlin, 1981) approaches, and its therapeutic potential in couple's therapy. It is written from the point of view of a practicing professional in order to illustrate the experiential nature and dynamics of the suggested therapeutic path. Differentiation is a key to mutuality. It offers a solution to the central struggle of any long term intimate relationship: balancing two basic life forces - the drive for individuality and the drive for togetherness (Schnarch, 2009). Focusing is a body-oriented process of self-awareness and emotional healing, in which one learns to pay attention to the body and the ‘Felt Sense’, in order to unfold the implicit, keep it in motion at the precise pace it needs for carrying the next step forward (Gendlin, 1996). Combining Focusing and Differentiation perspectives can cultivate the kind of relationship where a conflict can be constructively and successfully held in the inner world of each partner, while taking into consideration the others' well-being. This creates the possibility for two people to build a mutual emotional field, open to changes, permeable and resilient.

Heart to Heart: The Associative Pathway to Therapeutic Growth

Language is constitutive of who we are as people. Play between infant and carer has a strong influence on how language is acquired and the way it becomes generative of self. It is the communicative exchanges of life that create one’s sense of self and significance. When individuals enter into “free play” in therapy, they embark upon an associative pathway where distinct associations, emerging from what has been considered the “id”, form the basis of an emergent self, probably mediated by right-hemispherically determined communication. A case vignette illustrates a transition involving a moment of emotional connection, followed by a realization, at a later point in therapy, with discussion of both patient and therapist perceptions of these moments and an illustration of underlying physiology. The importance of right-hemispheric regulation in the psychotherapeutic setting calls for a revision of Freudian notions of primary and secondary process. The affective basis of associational life needs to be seen in a normative, integrative way rather than as an unruly process to be overcome by a rational ego.

Starting Over After Environmental Trauma

In August 2016, Baton Rouge, Louisiana, was inundated by 31 inches of rain during a 48-hour period. Entire communities were flooded. Many homes had six feet of water. People were awakened in the middle of the night with water rising around them. Once things began to settle, the emotional damage became apparent. Nemeth and Whittington 2012, outlined the following six stages of recovery from environmental trauma: 1) Shock, 2) Survival Mode, 3) Assessment of Basic Needs, 4) Awareness of Loss, 5) Susceptibility to Spin and Fraud, and 6) Resolution. Many flood victims, who presented for health care, were reporting the following symptoms: constant worry, irritability, tension, headaches, restlessness, sleep disturbance, sadness, and fatigue. These symptoms were anniversary reactions. Most likely, these individuals had been flooded in March 2016 and/or during Hurricane Katrina in 2005, not just in August 2016. People were still emotionally numb four months afterwards. As thinking in the shadow of feelings is often very hard to do, the need for psychotherapeutic intervention was apparent. People who attended these Emotional Resiliency workshops were given an opportunity to be heard, to share their feelings, and to learn effective coping mechanisms. The real strength of the workshops was, however, the opportunity for bonding. People who felt very alone came together and found strength in their common purpose. Psychological coping skills were enhanced and a deeper sense of spiritual awareness occurred. Creative drawings, relaxation exercises, and expressions of thankfulness allowed people to express their feelings and to move forward.

A Blend of Western and African Psychotherapy

Pritz (2002) defined psychotherapy as a systematic application of defined methods in the treatment of psychic suffering and psychosomatic complaints as well as life crises of various origins. Madu (2015), also defined psychotherapy as a process that enables people to express their feelings in a protected environment, to a person trained to listen with understanding and compassion. In the African context, psychotherapy is a culture-based treatment, which starts with the recognition that culture is highly relevant to people’s everyday behaviour (Grills, 2006). It includes social context, history, ethnicity and other issues that the client deems relevant. African Psychotherapy is therefore a holistic approach that encompasses the cultural, social, spiritual, psychological, and economic aspects of life. An estimate of 80% of Africans, seek traditional therapy and hence, the existence of both Western and African Psychotherapy, has posed a state of dilemma among the modern African psychotherapists as well as among the clients. The central argument of this paper is to look at how the Western and African Psychotherapies influence one another for the benefit of the black African. This paper is a systematic literature review on psychotherapeutic processes of African traditional and religious faith healers, the current western focused psychotherapy practices in Africa. The authors also used their own knowledge on the Africa Psychotherapy from both the Digo and the Kamba communities in writing this paper. The researchers hereby recommend a blended psychotherapy form, where the western, the traditional African, and the religious psychotherapeutic values are blended for the benefit of modern African clients.