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Evidence-Based Clinical Practice and the Two Studies

According to the American Psychological Association (2000), the posttraumatic stress disorder gets caused when an individual gets exposed to either an event that happens too traumatic or a reaction involving intense fear, no sign of help or out of a horrible experience. Further, the Association continued and argued that the posttraumatic may arise out of the persistence of specific symptoms which develops in an individual for more than one month (Friesen-Storms, Moser, Loo, Beurskens, & Bours, 2015). In the essay paper, I would briefly compare two articles for their conclusion on the efficacy of two the Post-Traumatic Stress Disorder treatments and give an individual view on the defensible conclusion. One of the articles got authored by Ironson, Freund, Strauss and Williams (2002) and another article got authored by Taylor et al. (2003).

Usually, the Evidence-based clinical practice involves the application of the treatments that have got proven to work and offer reliable results. Focusing on the article authored by Ironson, Freund, Strauss and Williams (2002), the Eye Movement Desensitization and Reprocessing (EMDR) proved as a more efficient treatment for the PTSD than the treatment offered by the exposure therapy. The study by these authors argued that both the EMDR and the exposure therapy were dealing with similar symptoms. The EMDR had a rapid effect on the patients, unlike the exposure therapy (Ironson, Freund, Strauss, & Williams, 2002). Furthermore, most of the participants in the EMDR condition met the criterion significant for clinical practice as opposed to those subjected to the exposure therapy.  The dropout rate for EDMR patients was lower than that for exposure therapy, and the subjective units of the distress (SUDs) were low unlike in the exposure therapy.

On the contrary, the study put forward by Taylor et al. (2003) argued that the Exposure therapy was quite more efficient in the treatment of the PTSD than the EMDR. Though Taylor et al. (2003) put it that both the exposure therapy and the EMDR presented quite similar improvements in the numbing and the hyperarousal, they argued that the exposure therapy offered greater improvements in the avoidance and the re-experiencing. Besides, Taylor et al. (2003) further brought a claim forward that more of the participants in the exposure fulfilled the criteria for the clinically significant improvement. Based on the clinical evidence presented for the two treatments, the conclusion by Ironson, Freund, Strauss and Williams (2002) got more credible than the study by Taylor et al. (2003).

Ironson et al.'s Study: Favoring EMDR

The EMDR gets viewed as a complicated treatment procedure which incorporates various interventions, which includes the imaginal exposure, the free association, and the other techniques. However, the primary intervention needs that the participant or patient recalls the traumatic memories as he/she simultaneously attends to some a kind of the external oscillatory stimulation (van den Berg, et al., 2015). The stimulation gets typically induced in the process of treatment by the therapist who happens to move the finger from one side to another in the front of the area of view of the patient. Such simulations would prompt the eye movements until the distress get reduced.

In the pilot study Ironson, Freund, Strauss, Williams contrasted and compared the efficacy of the exposure therapy and the EDMR through the analysis of data for about 22 patients who had sought medication in the university-based clinic. The patients who had to visit the university clinic were mostly the victims of rape and other criminal activities in which they got trauma induced in them out of fear, horror, and helplessness (Horesh, Qian, Freedman, & Shaley, 2016). All the patients were exposed more than one active treatment session that got done after the preparatory sessions were complete. In the end, the results for both the treatment methods showed a significant reduction in the posttraumatic stress disorder and the symptoms of depression that got maintained for a few months period patient-centred care.

The community study revealed that the fruitful treatment for the PTSD was faster through EDMR than exposure therapy. In seven patients, out of the ten patients subjected to the EDMR showed a seventy percent reduction in PTSD clinical manifestations after the three total active sessions conducted as opposed to two patients out of the twelve patients who got subjected to exposure therapy (Shapiro, 2014). Furthermore, most of the patients had appeared to have a high toleration for EDMR as shown by the insignificant number of the dropout rate in contrary to the larger number of the patients’ dropout rate upon subjection to the exposure therapy. The study statistically showed that out of the ten patients who got subjected to EDMR, none dropped out of the active sessions unlike in exposure therapy where three patients out of the ten dropped out of the active sessions (Baldwin, et al., 2014). However, in both cases for all the patients who were persistent with the entire session exercise attained an improvement through the reduced score values for the PTSD.

Taylor et al.'s Study: Favoring Exposure Therapy

Similarly, during the initial session for the EDMR, the ratings for the Subjective Units of Units of Distress (SUDs) reduced significantly unlike in the exposure therapy where minute changes occurred. Further in the final session showed that the ratings for the SUDs seemed considerably lower for the EDMR than for the exposure therapy. In accordance to Wolpe (1990), the SUDs involve the single-item of the self-report measure for the degree of disturbance that a victim experienced in the process of thinking regarding a particularly traumatic event (McGuire, Lee, & Drummond, 2014). Normally the scores for the SUDs ranges from the neutral value, 0, to the highest possible disturbance level, 100. During the treatment sessions, the victims who were participating in the exercise were asked to give a rating of their SUDs at different times all through the entire treatment. The data as mentioned earlier got analyzed from the participants recorded SUDs scores for both the beginning and the end of the first active session.

Moreover, the SUDs may get impacted by how severe the initial symptoms are, in the analysis of the interaction between the EDMR and the exposure therapy testing showed a significantly different degree of variation (de Kleine, Smits, Hendriks, Becker, & van Minnen, 2015). In the case of the EDMR, the scores decreased significantly as opposed to the scores of the exposure therapy. Under the initial symptoms controlled conditions, the post-session testing for the SUDs scores showed a higher value significantly for the exposure therapy unlike for the EDMR lower value.

Focusing on the treatment comparisons, it got realized that though both the two treatment methods offered an equally effective reduction of the PTSD symptoms, there existed essential differences that prompted for further investigations (Badour, et al., 2017). The EDMR produced approximately 70% reduction of the PTSD clinical manifestations upon conducting the three consecutive treatment sessions. In this case, seven out of the ten EDMR completers received a satisfactory improvement and active development unlike two out of the nine patients subjected to the exposure therapy.

In conclusion, following the clinical research conducted by the Ironson, Freund, Strauss, and Williams (2002) gave a more credible treatment which is the EDMR. The EDMR got defensible due to the various reasons and evidence-based practices. For instance, the patients who got subjected to EDMR were more tolerant for the entire session without drop out compared to those who got subjected to exposure therapy. The EDMR patients received a considered rate of reduced PSTD symptoms and improvement unlike for those subjected to the exposure therapy. The EDMR treatment is faster than the exposure therapy. Additionally, on the end of the initial active session, the distress levels for SUDs measured were quite lower with the EDMR than the exposure therapy. In the process, the SUDs scores decreased more with the EDMR than the exposure therapy.

References

Badour, C. L., Flanagan, J. C., Gros, D. F., Killeen, T., Pericot-Valverde, I., Korte, K. J., ... & Back, S. E. (2017). Habituation of distress and craving during treatment as predictors of change in PTSD symptoms and substance use severity. Journal of consulting and clinical psychology, 85(3), 274.

Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., ... & Malizia, A. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439.

de Kleine, R. A., Smits, J. A., Hendriks, G. J., Becker, E. S., & van Minnen, A. (2015). Extinction learning as a moderator of d-cycloserine efficacy for enhancing exposure therapy in posttraumatic stress disorder. Journal of anxiety disorders, 34, 63-67.

Friesen?Storms, J. H., Moser, A., Loo, S., Beurskens, A. J., & Bours, G. J. (2015). Systematic implementation of evidence?based practice in a clinical nursing setting: A participatory action research project. Journal of clinical nursing, 24(1-2), 57-68.

Horesh, D., Qian, M., Freedman, S., & Shalev, A. (2016). Differential effect of exposure?based therapy and cognitive therapy on post?traumatic stress disorder symptom clusters: A randomized controlled trial. Psychology and Psychotherapy: Theory, Research and Practice.

Ironson, G., Freund, B., Strauss, J. L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58(1), 113-128.

McGuire, T. M., Lee, C. W., & Drummond, P. D. (2014). Potential of eye movement desensitization and reprocessing therapy in the treatment of post-traumatic stress disorder. Psychology research and behavior management, 7, 273-283.

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.

Taylor, S., Thordarson, D.S., Maxfield, L., Fedoroff, I.C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71(2), 330-338.

van den Berg, D. P., de Bont, P. A., van der Vleugel, B. M., de Roos, C., de Jongh, A., Van Minnen, A., & van der Gaag, M. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. Jama Psychiatry, 72(3), 259-267.

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