RESUMEN
OBJECTIVES: Posttraumatic stress disorder (PTSD) after exposure to multiple (childhood) trauma's is strongly associated with accelerated aging and high psychiatric and somatic comorbidity, influencing frailty and Quality of Life (QoL) in older adults. Eye Movement Desensitization therapy (EMDR) addresses psychological and physiologic symptoms stemming from adverse life events and therefore could influence frailty and QoL in older adults. METHODS: We conducted a multi-center feasibility study (two psychiatric hospitals) in Dutch older outpatients (N = 24; ≥60 years) with PTSD. Participants received weekly EMDR-treatment during the course of the trial (3 months to a maximum of 9 months). Frailty (Groninger Frailty Indicator) and QoL (EuroQol 5D-3L), were assessed pre- and posttreatment. RESULTS: A linear mixed-model approach showed significant reduction of frailty (F(1,23) = 9.019, p = .006) and improvement of QoL (F(1,23) = 13.787, p = .001). For both frailty and QoL, there was no significant influence of Clinician-Administered PTSD Scale (CAPS-5) pre-treatment score, therapy duration, and neither an interaction effect of therapy duration x CAPS-5 pre-treatment score. CONCLUSIONS: EMDR with older adults with PTSD showed a significant reduction of frailty and improvement of QoL. Randomized controlled studies are needed to more precisely study the impact of trauma-focused treatment in older adults on frailty and QoL and the implications this might have for lessening disease burden. CLINICAL IMPLICATIONS: Screening for PTSD in older frail adults is important to treat PTSD as a possible way to reduce frailty and improve QoL.
RESUMEN
Repeated and compulsive-like checking reduces confidence in memory for the last check. Obsessive-compulsive (OC) patients are not only uncertain about memory, but may also be uncertain about perception, while this perceptual uncertainty may be associated with prolonged visual fixation on the object of uncertainty. It was reported earlier that, among healthy participants, prolonged staring at light bulbs or gas rings induces OC-like uncertainty about perception and feelings of dissociation [van den Hout, M. A., Engelhard, I. M., de Boer, C., du Bois, A., & Dek, E. (2008). Perseverative and compulsive-like staring causes uncertainty about perception. Behaviour Research and Therapy, 46, 1300-1304]. In that study, staring continued for 10min. For patients, however, staring intervals seem to be considerably shorter. To test the clinical credibility of the paradigm as a model of the maintenance of OC perceptual uncertainty, we investigated whether the effects of staring materialize long before 10min. Five groups of 16 undergraduates participated: one group did not stare at a gas stove while the others stared for 7.5, 15, 30 or 300s. In the absence of staring, no pre-to-post increase in dissociation/uncertainty was reported, but after staring it was. The larger part of the observed dissociation/uncertainty after 5min had occurred within 30s, and around 50% of this maximal increase was reported between 7.5 and 15s. Thus, even relatively short intervals of staring induce uncertainty about perception and dissociative experiences. Perseverative looking at objects may be a counter-productive OC strategy, which increases uncertainty about perception and may serve to maintain the disorder.