EMDR临床指引

作者:张劲松 隋双戈 2015-05-25


眼动脱敏再加工(Eye Movement Desensitization and Reprocessing,EMDR)治疗于八十年代由美国心理学家Francine Shapiro博士发明并迅速发展起来。EMDR可激活大脑的信息加工系统,增强正性资源,快速消解与创伤事件有关的心理障碍。至今已有20多项随机对照研究肯定了EMDR对心理创伤的独特疗效,被美国、英国、荷兰、德国等多国精神病学会推荐用于治疗心理创伤,并于2013年被世界卫生组织(WHO)推荐。


世界卫生组织(2013年)《特别与应激相关的状态管理指南,日内瓦,WHO》仅推荐TF-CBT和EMDR治疗儿童、青少年和成人的PTSD。“与聚焦创伤的CBT一样,EMDR旨在降低与创伤事件有关的主观痛苦和加强适应性认知;与聚焦创伤的CBT不同的是,EMDR不涉及:(1)详细描述事件,(2)直接挑战信念,(3)延长暴露,或(4)做家庭作业” (WHO,2013)。


早在本世纪初,多个国家的政府部门或专业协会的研究报告就呈现EMDR对于创伤治疗的效果。例如2002年,以色列国家精神卫生署发布的《医院和社区中恐怖事件受害者的评估和专业化干预指南》中就在对对恐怖事件受害者进行治疗中推荐了EMDR(Bleich, et al.,2002)。2004年,美国精神科协会《急性应激障碍和创伤后应激障碍患者治疗的实践指南》中推荐EMDR做为对创伤有效的治疗之一(APA, 2004)。


此外,从2003年起,法国(INSERM, 2004)、北爱尔兰(CREST, 2003)、荷兰(Dutch National Steering Committee Guidelines Mental Health Care, 2003)、英国(National Collaborating Centre for Mental Health, 2005)等欧洲国家先后推荐或指定EMDR和CBT(后来认为是FT-CBT,聚焦创伤的CBT)为PTSD的治疗选择。2010年,美国国防部和退伍军人事务部《创伤后应激障碍实践指南》中将EMDR放在PTSD最有效治疗方法中(A类)。A类治疗是指强烈推荐临床医生给合适的患者提供此干预方法。有好的证据证明该种干预方法可以对预后有重要的改善作用,并对减轻伤害有潜在的益处(VA & DoD, 2010)。


【参考文献】


Guidelines for the management of conditions that are specifically related to stress (2013). Geneva, WHO.


Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002). A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel.


American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.


CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.


Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guideline Anxiety Disorders. Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.

INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research, Paris, France.


National Collaborating Centre for Mental Health (2005). Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care. London: National Institute for Clinical

Excellence.


Department of Veterans Affairs & Department of Defense (2010). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense.


(来源:张劲松, 隋双戈. EMDR(眼动脱敏再加工)研究进展. 深圳市首届心理应激干预大会论文集.深圳:深圳市应激干预服务中心,2015:21-24)

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