jueves, 21 de febrero de 2019

Psychological Intervention Strategies for Dissociative Amnesia

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By Chloe Bennett, B.Sc.Reviewed by Jennifer Logan, MD, MPH

Dissociative amnesia is a psychological disorder characterized by retrospective memory gaps which include the inability to recall personal information which might be related to a stressful or traumatic event. The symptoms can also be comorbid with a range of other disorders including those experienced in obsessive-compulsive disorder and personality disorders.

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Dissociative amnesia is a type of dissociative disorder characterized by the mental separation an individual may experience from a specific aspect of their self. This amnesia typically occurs following a traumatic or stressful life event. It has been argued that the dissociation enables the individual to cope with the event. Those with the disorder may experience some of the following symptoms.

Inability to recall vital information about one’s self which may be stressful or traumatic in nature
Memory issues experienced are not associated with other psychological disorders such as posttraumatic stress disorder, dementia, or Alzheimer’s
The symptoms significantly impact the individual’s ability to manage their daily life

Those with dissociative amnesia may forget a particular event, who they are, or their personal history. Furthermore, they may or may not be aware that they have issues with memory recall; they may, however, show symptoms of being confused.

How is Dissociative Amnesia Treated?

Treatments for dissociative amnesia aim to relieve symptoms, recover any lost memories, and deal with any issues surrounding the event that led to the development of the disorder. It is important to note that there is no single recommended treatment option, however, psychotherapy may be of benefit.

Psychotherapy

Psychotherapy is often the first line of treatment due to few reported side effects compared to drug treatments. Psychotherapy has been used to treat those with several types of dissociative amnesic disorders, including dissociative amnesia with dissociative fugue.

A particular case experienced by a male patient is characteristic of dissociative fugue, a subtype of dissociative amnesia characterized by purposeful or bewildered wandering associated with amnesia. To address memory recall problems following a traumatic event, this patient attended psychotherapy sessions. The therapists used suggestive techniques and persuasion as well as established a sense of security. The use of supportive psychotherapy and empathic validation initially allowed the patient to ‘feel good about feeling like a brand new person,’ which allowed him to avoid thinking about the traumatic event. After several sessions over 12 weeks, he began remembering the once unrecallable memories. Many argue that successful psychotherapy needs to involve gentle suggestion, cueing, and reteaching.

Drug-Assisted Interviews

Most treatment options used for dissociative amnesia aim to increase memory retrieval; however, in some cases this is not possible. If these approaches are ineffective, drug-assisted interviews can be performed using a drug such as a benzodiazepine. The use of the drugs can help to further facilitate memory recall and integration of dissociative incidents. The drugs are typically administered using an intravenous drip to help the patient feel relaxed and sleepy. Patients are then asked a series of questions which range from ordinary questions to those specifically related to the experienced memory loss.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is often used to treat a range of psychological conditions including dissociative amnesia. CBT aims to help address negative thinking and behavior associated with the traumatic or stressful event. It is hoped that this will allow the individual to deal with any issues surrounding the event that caused the dissociative amnesia.

Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) aims to teach patients coping skills to regulate emotions that could be linked to the stressful or traumatic event that triggered the dissociative amnesia. DBT also teaches the individual mindfulness techniques such as mediation, which can be used to manage their symptoms.

Eye Movement Desensitization and Reprocessing

Used to alleviate the distress associated with stressful or traumatic memories, eye movement desensitization and reprocessing (EMDR) uses a combination of CBT techniques and the relearning of thought patterns. This is achieved through the use of exercises focusing on visual stimulation to access the adverse memories and replace potential negative beliefs with positive ones.

Although, there is no single best recommended treatment option, the discussed psychological techniques have been used to good effect to help patients experiencing dissociative amnesia.