EMDR介入PTSD治療歷程與效果之個案研究

謝馨儀

指導教授 ： 鄔佩麗

國立臺灣師範大學/教育學院/教育心理與輔導學系/碩士(2011年)

摘要

EMDR是一項緣起於西方國家的新興治療方法，目前已有許多研究證實其對創傷之療效，然而臺灣地區缺乏相關研究，故本研究試圖應用EMDR於國內之臨床心理治療實務、進行一個探索性的個案研究，藉此瞭解PTSD案主在參與EMDR治療過程中的經驗，以及評估PTSD案主在接受EMDR介入過程及治療前後的差異，企盼國內應用EMDR的起點自此開啟。 　　本研究之PTSD案主在接受美國總會認可之EMDR治療師參與治療，於結案後，由研究者邀請成為研究參與者。研究者於EMDR治療結案後四個月及六個月，與研究參與者及其太太進行訪談、並進行觀察，並在徵得研究者參與者同意之情況下，蒐集治療過程中的相關紀錄以及案主自我觀察紀錄。研究者將PTSD案主於接受EMDR介入前後之歷程撰寫成為一治療案例，並且將有關資料進行整合與分析，歸結出 PTSD 案主在參與 EMDR 治療過程中的經驗，以及 PTSD 案主在接受EMDR 介入過程及治療前後的差異，並進一步討論PTSD案主使用精神用藥之影響。 　　本研究之整理與發現如下： 一、本案例之PTSD案主與太太共同參與前後為期四個月、共計19次的療程，期間透過EMDR處理了三項創傷事件，案主的身心狀況獲得大部分的舒緩，因此結束EMDR療程，在後續的追蹤亦發現案主的身心適應狀況相當穩定，並無嚴重的復發情形。 二、本案例之PTSD案主在參與EMDR治療過程中的認知想法轉換為正向、情緒感受則消除了負向情緒；案主在EMDR治療過程中的生理感受較不敏銳，但在治療結束時皆能進入放鬆之狀態。 三、經歷嚴重發病及EMDR治療之後，本案例之PTSD案主大多數的症狀已經解除，在身心警覺度和生活功能方面，相較於發病前的程度是有差別的；然而在面對生活中的壓力源時，案主能夠運用EMDR治療過程學習到的新技巧進行自我安撫以恢復身心狀態的平衡。 四、本案例顯示出EMDR的介入以及精神藥物造成PTSD案主的身心症狀改善情況是二者相輔相成造成的效果； EMDR治療師與案主所建立的信任關係開啟了案主穩定接受身心合併治療之契機。 　　針對上述研究結果，研究者進行以下討論：(1) 案主「發病」後的生理症狀及求助管道，反應出國人的壓力反應及求助行為；(2) 本案例之EMDR介入過程，協助案主正視與處理創傷議題，且介入過程符合創傷療癒之原則與策略；(3) EMDR之介入，有效協助臺灣地區案主解除情緒和生理症狀，並造成認知上的轉換，顯示EMDR具跨文化之效用，且案主之改善情況符合國際創傷性壓力研究學會治療指導手冊所提醒治療目標新興之關注面向；(4) EMDR合併藥物治療，打破案主生心理的惡性循環；(5) EMDR介入與案主自陳之進步情形，療效呈現一致上升的現象。 　　研究者針對研究結果及相關討論，建立一則以EMDR介入治療PTSD之邏輯模型，並進一步提出有關實務及研究上的建議，以供後續參考。

關鍵字

眼動減敏與歷程更新治療 ； 創傷後壓力疾患

並列摘要

Regarded as one newer therapy originated from Western countries, Eye Movement Desensitization and Reprocessing (EMDR) has been proven efficient by numerous researches. However, due to the fact that there is not much related research in Taiwan, this study aims at a psychological therapy practice applying EMDR in Taiwan for the future exploration. Via a client’s positive result from the therapy and the comparison before and after the intervention of EMDR to the Post Traumatic Stress Disorder (PTSD) therapy, it is anticipated that EMDR will be practiced more in the psychotherapeutic field and thus dispersed in Taiwan.
The researcher invited the interviewee for this study after the closure of his therapy with an EMDR therapist certified in the USA. The researcher interviewed the interviewee and his wife after the closure of the therapy had passed four months and six months respectively. With the interviewee’s permission, all related records to the process and the interviewee’s self-observation are collected as the reference material for this study. The case description developed by the researcher contains the process before and after the intervention of the EMDR therapy. The research has also collaborated pertinent materials to analyze the interviewee’s experience during the process of therapy and to distinguish all differences before and after the intervention of the EMDR therapy, as well as to discuss the effects caused by psychiatric medication to the interviewee.
The procedure and the findings of this study are listed as follow:
1. The interviewee and his wife had totally been through a four month therapy with nineteen sections, in which three traumas the interviewee had experienced were targeted by the EMDR therapy. During the therapy, the interviewee stably adjusted and benefited a lot. In the follow-up tracking, the interviewee was found to have adapted and recovered well afterward.
2. Also during the therapy, the interviewee’s cognition turned positive along with the ease of the negative motions. The interviewee was insensitive but could usually relax himself when the section came to an end.
3. After the interviewee went through the severe morbidity and underwent the intervention of the EMDR therapy, most of the interviewee’s symptoms were eased even though the aspects of physical arousal and daily functions differed from those before the morbidity. However, when facing the source of pressure, the interviewee could adopt new skills learned from the EMDR therapy to comfort and balance himself both mentally and physically.
4. The case study has revealed that that the interviewee’s improvement is an effect mutually caused by the intervention of EMDR and the psychiatric medication; the key to the success of this case should be attributed to the trust established between the EMDR therapist and the interviewee that serves as a critical turning point for the interviewee to accept the combined treatment from psychological and pharmaceutical therapies.
Based on the result mentioned above, the researcher has proposed the following discussions:
1. The interviewee’s physical condition and consultation channel reflect the Taiwanese people’s reactions to pressure and help-seeking behaviors.
2. The intervention of EMDR helps the interviewee face and deal with the trauma, and the process of the intervention meets the principles and strategies of the trauma remedy.
3. The intervention of EMDR not only effectively helps the clients in Taiwan ease emotional and physical symptoms, but also significantly leads to the clients’ cognitive transformation. This explains that EMDR contains cross-cultural effects. In addition, the improvements seen on the interviewee meet the treatment goal and the new issues mentioned in Practice Guidelines for the International Society for Traumatic Stress Studies.
4. The combination of the interventions of EMDR and medication breaks the vicious stress cycle between the interviewee’s body and mind.
5. The interventions of EMDR and the self claims by the interviewee have shown the consistent positive effect.
Based on the study result and pertinent discussions, the researcher has established a logic model for the intervention of EMDR to the PTSD therapy and proposed further academic and clinical suggestions for future study.

並列關鍵字

EMDR ； PTSD

參考文獻

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