Deprem Travmasında EMDR'nin Etkinliğinin Araştırılması: Olgu Sunumu

EMDR ağırlıklı olarak ruhsal travma olgularında kullanılan bir müdahale tekniğidir. Bu araştırmada nitel araştırma yöntemlerinden olgu deseninden yararlanılmış olup; sunulan olguda depremden kaynaklı TSSB'de Göz Hareketleri ile Duyarsızlaştırma ve Yeniden İşleme (Eye Movement Desensitization & Reprocessing-EMDR) tekniğinin uygulanabilirliğini ortaya koyma amaçlanmıştır. Araştırma kapsamındaki sunulan olguda sekiz aşamalı EMDR protokolü uygulanmıştır. Danışanın travmatik belirtilerine ilişkin EMDR müdahalesinin etkililiğinin nicel olarak da incelenebilmesi ve müdahale öncesi ve müdahale sonrası travma sonrası stres belirleme puanları arasındaki farklılığın ortaya konulması amacıyla “Travma Sonrası Stres Belirleme Ölçeği”nden yararlanılmıştır. EMDR müdahalesi sonrasında sunulan olgudaki danışanda hem kaygı ve korku düzeylerinde azalma, hem de depreme yönelik işlevsel olmayan düşüncelerin ortadan kalktığı ve TSSB belirtilerinin büyük oranda azalma olduğu görülmüştür. Travma Sonrası Stres Belirleme Ölçeği puanlarına ilişkin “tekrarlayan düşünceler”, “fizyolojik uyarılma” ve “zihinsel kaçınma” alt ölçek puanlarında ön-test ve son-test arasında farklılıklar olduğu gözlenmiştir. Bu çalışmada sunulan olgudan hareketle, deprem gibi doğal afet yaşanılan travmanın neden olduğu TSSB olgularında EMDR’nin kısa ve etkili bir müdahale olabileceği söylenebilir.
Anahtar Kelimeler:

Deprem, TSSB, EMDR, Olgu Sunumu

Investigation of the Efficacy of EMDR in Earthquake Trauma: Case Report

EMDR is an intervention technique mainly used in psychological trauma cases. In this study, the case study of qualitative research methods has been used; the aim of this study is to determine the feasibility of Eye Movement Desensitization and Reprocessing (EMDR) technique in PTSD of the earthquake. Eight-stage EMDR intervention has been implemented in the presented case. In order to investigate the effectiveness of EMDR intervention quantitatively related to the traumatic symptoms of the client and to determine the difference between the pre-test and post-test scores, “Post-Traumatic Stress Symptoms Scale” has been used. In the presented case after the EMDR intervention, it has been observed that the client’s both the anxiety and fear levels have been decreased as well as the dysfunctional thoughts about the earthquake have been disappeared and the PTSD symptoms have been greatly reduced. According to Post-Traumatic Stress Symptoms Scale scores it has been observed that there are differences between the scores of subscales as “intrusive thoughts”, “physiological arousal” and “cognitive avoidance”. Based on the case presented in this study, it can be said that EMDR may be a short-term and effective intervention in PTSD cases caused by the trauma of natural disasters such as earthquakes.

Kaynakça

Adúriz, M. E., Bluthgen, C., & Knopfler, C. (2011). Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences. International Perspectives in Psychology, Research, Practice, Consultation, 1, 58-67. doi:10.1037/2157-3883.1.S.58

Afet ve Acil Durum Yönetim Başkanlığı, AFAD (2014). Müdahale, iyileştirme ve sosyoekonomik açıdan 2011 Van Depremi [Intervention, improvement and socioeconomic outlook on 2011 Van Earthquake]. Ankara: AFAD Yayınları.

Altındag, A., Ozen, S., & Sir, A. (2005). One-year follow-up study posttraumatic stress disorder among earthquake survivors in Turkey. Comprehensive Psychiatry, 46(5), 328-333. doi:10.1016/j.comppsych.2005.01.005

Amerikan Psikiyatri Birliği (2014). Ruhsal bozuklukların tanısal ve sayımsal elkitabı, beşinci baskı (DSM-5) [Diagnostic and statistical manual of mental disorders, (5th ed.) (DSM-5)] (E. Köroğlu, Trans.). Ankara: Hekimler Yayın Birliği. (Original work published 2013).

Bilal, M. S., Rana, M. H., Khan, S. U., & Quayyum, R. (2015). Efficacy of Eye movement desensitization and reprocessing beyond complex post traumatic stress disorder: A case study of EMDR in Pakistan. The Professional Medical Journal, 22(4), 514-521.

Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727-735.

Caldwell C. (2012). Sensation, movement and emotion: Explicit procedures for implicit memories. In S. C. Koch, T. Fuchs, M. Summa, & C. Müller (Eds.), Body memory, metaphor and movement (pp. 255-265). Amsterdam: John Benjamins.

Collie, K., Backos, A., Maichiodi, C., & Spiegel, D. (2006). Art Therapy for combat-related PTSD: recommendations for research and practice. Art Therapy: Journal of the American Art Therapy Association, 23(4), 157-164. doi:10.1080/07421656.2006.10129335

Guo, J., Wu, P., Tian, D., Wang, X., Zhang, W., Zhang, X., & Qu, Z. (2014). Post-traumatic stress disorder among adult survivors of the Wenchuan Earthquake in China: A repeated cross-sectional study. Journal of Anxiety Disorders, 28, 75-82. doi: 10.1016/j.janxdis.2013.12.001

Farooqui, M., Quadri, S. A., Suriya, S. S., Khan, M. A., Ovais, M., Sohail, Z., Shoaib, S., Tohid, H., & Hassan, M. (2017). Posttraumatic stress disorder: a serious post-earthquake complication. Trends in Psychiatry and Psychotherapy, 39(2), 135-143. doi:10.1590/2237-6089-2016-0029

Fernandez, I. (2007). EMDR as treatment of post-traumatic reactions: A field study on child victims of an earthquake. Educational & Child Psychology, 24(1), 65-72.

Fujiwara, T., Yagi, J., Homma, H., Mashiko, H., Nagao, K., & Okuyama, M. (2017). Symptoms of post-traumatic stress disorder among young children 2 years after the great East Japan Earthquake. Disaster Medicine and Public Health Preparedness, 11(2), 207-215. doi: 10.1017/dmp.2016.101

Gabrielli, J., Gill, M., Koester, L. S., & Borntrager, C. (2014). Pyschological perspectives on ‘acute on chronic’ trauma in children: Implications of the 2010 Earthquke in Haiti. Children & Society, 28(6), 438-450.

Greenwald, R. (2004). Eye Movement desensitization and reprocessing (EMDR) in child and adolescent psychotherapy. Northvale, NJ: Jason Aronson.

Gupta, D., Gupta, N., & Choudhary, T. (2014). Effectiveness of the EMDR therapy on specific phobia in young children. Delhi Psychiatry Journal, 17(2), 175-178.

Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure subjective stress. Psychosomatic Medicine, 41(3), 209-218.

Işık, Ö., Aydınoğlu, H. K., Koç, S., Gündoğdu, O., Korkmaz, G., & Ay, A. (2012). Afet yönetimi ve afet odaklı sağlık hizmetleri [Disaster management and disaster oriented health services]. Okmeydanı Tıp Dergisi, 28(2), 82-123. doi:10.5222/otd.supp2.2012.082

Jarero, I., Artigas, L., & Luber, M. (2011). The EMDR protocol for recent critical incidents: Application in a disaster mental health continuum of care context. Journal of EMDR Practice and Research, 5(3), 82-94. doi:10.1891/1933-3196.5.3.82

Jarero, I., Artigas, L., Uribe, S., & Miranda, A. (2014). EMDR therapy humanitarian trauma recovery interventions in Latin America and the Caribbean. Journal of EMDR Practice and Research, 8(4), 260-268. doi:10.1891/1933-3196.8.4.260

Javadian, R. (2007). Social work responses to earthquake disasters: A social work intervention in Bam, Iran. International Social Work, 50(3), 334-346. doi:10.1177/0020872807076047

Kavakçı, Ö. (2012). Ruhsal travma tedavisi için EMDR [EMDR for mental trauma treatment]. Ankara: HYB Yayıncılık.

Kimura, M., Ueda, M., Takeda, Y., Sugimoto, F., & Katayama, J. (2013). Aftermath of 3/11: Earthquakes and involuntary attentional orienting to sudden ambient sounds. Biological Psychology, 94(2), 419-425. doi:10.1016/j.biopsycho.2013.08.008

Konuk, E., Knipe, J., Eke, I., Yuksek, H., Yurtsever, A., & Ostep, S. (2006). The effects of eye movement desensitization and reprocessing (EMDR) therapy on posttraumatic stress disorder in survivors of the 1999 Marmara, Turkey, earthquake. International Journal of Stress Management, 13, 291-308. doi:10.1037/1072-5245.13.3. 291

Korn, D. L. (2009). EMDR and treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278. doi:10.1891/1933-3196.3.4.264

Maslovaric, G., Zaccagnino, M., Mezzaluna, C., Perilli, S., Trivellato, D., Longo, V., & Civilotti, C. (2017). The effectiveness of eye movement desensitization and reprocessing integrative group protocol with adolescent survivors of the central Italy earthquake. Frontiers in Psychology, 8, 1-8. doi:10.3389/fpsyg.2017.01826

Maxfield, L. (2008). EMDR treatment of recent events and community disasters. Journal of EMDR Practice and Research, 2(2), 74-78. doi:10.1891/1933-3196.2.2.74

Natha, F. & Daiches, A. (2014). The effectiveness of EMDR in reducing psychological distress in survivors of natural disasters: A review. Journal of EMDR Practice and Research, 8(3), 157-170. doi:10.1891/1933-3196.8.3.157

Pynoos, R. S., Goenjian, A., Tashjian, M., Karakashian, M., Manjikian, R., Manoukian, G., Steinberg, A. M., & Fairbanks, L. A. (1993). Post-traumatic stress reactions in children after the 1988 Armenian Earthquake. The British Journal of Psychiatry, 163(2), 239-247. doi:10.1192/bjp.163.2.239

Rosen, S. (2014). Cults: a natural disaster-looking at cult involvement through a trauma lens. International Journal of Cultic Studies, 5, 12-27.

Saltini, A., Rebecchi, D., Callerame, C., Fernandez, I., Bergonzini, E., & Starace, F. (2017). Early eye movement desensitisation and reprocessing (EMDR) intervention in a disaster mental health care context. Psychology, Health & Medicine, 25, 1-10. doi:10.1080/13548506.2017.1344255

Seggie, F. N., & Bayyurt, Y. (2017). Nitel araştırma yöntem, teknik, analiz ve yaklaşımları [Qualitative research methods, techniques, analysis and approaches]. Ankara: Anı Yayıncılık.

Shapiro, E. (2012). EMDR and early psychological intervention following trauma. European Review of Applied Psychology, 62(4), 241-251. doi:10.1016/j.erap.2012.09.003

Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199-223.

Shapiro, F. (2002). EMDR 12 years after its introduction: Past and future research. Journal of Clinical Psychology, 58(1), 1-22.

Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): information processing in the treatment of trauma. Journal of Clinical Psychology, 58(8), 933-946. doi:10.1002/jclp.10068

Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: Addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71-77. doi:10.7812/TPP/13-098

Stein, D., Rousseau, C., & Lacroix, L. (2004). Between innovation and tradition: The paradoxical relationship between eye movement desensitization and reprocessing and altered states of consciousness. Transcultural Psychiatry, 41(1), 5-30. doi:10.1177/1363461504041351

Sumer, N., Karanci, A. N., Berument, S. K., & Güneş, H. (2005). Personal resources, coping self‐efficacy, and quake exposure as predictors of psychological distress following the 1999 earthquake in Turkey. Journal of Traumatic Stress, 18(4), 331-342. doi:10.1002/jts.20032

Şahin, N. H., Batıgün, A. D., & Yılmaz, B. (2002). TC Milli Eğitim Bakanlığı ve Birleşmiş Milletler Çocuk Fonu (UNICEF) psikososyal okul projesi değerlendirme çalışması [Psychosocial School Project Effectiveness Research: Psychosocial Risk Factors and Post-Disaster Trauma]. Ankara: MEB/UNICEF Psikososyal Okul Projesi.

Şahin, N. H., Batıgün, A. D., & Yılmaz, B. (2009). Debriefing with teachers after the Marmara earthquake: an evaluation study. Disasters-The Journal of Disaster Studies, Policy and Management, 33(4), 747-761.

Tang, T.-C., Yang, P., Yen, C.-F., & Liu, T.-L. (2015). Eye movement desensitization and reprocessing for treating psychological disturbances in Taiwanese adolescents who experienced Typhoon Morakot. The Kaohsiung Journal of Medical Sciences, 31(7), 363-369. doi:10.1016/j.kjms.2015.04.013

Ten Hoor, N. M. (2013). Treating cognitive distortions with EMDR: A case study of a sex offender. International Journal of Forensic Mental Health, 12(2), 139-148. doi: 10.1080/14999013.2013.791350

Weathers, F. W., Litz, B. T., Herman, D. W., Huska, J. A., & Keane, T. M. (1993, October) The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Paper presented at the Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.

Webb, N. B. (2004). Mass trauma and violence. New York- London: The Guilford Press.

Wesson, M., & Gould, M. (2009). Intervening early with EMDR on military operations. Journal of EMDR Practice and Research, 3(2), 91-97. doi:10.1891/1933-3196.3.2.91

Wizansky, B. (2007). Resource connection in EMDR work with children. Journal of EMDR Practice and Research, 1(1), 57-63.

Yıldırım, A., & Şimşek, H. (2013). Sosyal bilimlerde nitel araştırma yöntemleri [Qualitative research methods in the social sciences]. Ankara: Seçkin Yayıncılık.