Re: Exposure & common factors

I agree that when Exposure therapy works it integrates somatosensory experience, affect and cognition.

However, when there are signifcant dissociative symptoms this no longer works that well. Incidentally, this has been recognized by Foa.

The more severely traumatized clients check out from their somatosensory and affective experience, and while they can often still recount their traumatic material cognitively, the therapeutic effect does not occur.

This does not only occur with Exposure but also with EMDR. However, in my experience less so.

There is also a theoretical concern I have about the use of Exposure in populations that have significant dissociative symptoms. There is evidence that the Exposure treatment effect is mediated by endogenous opiates. There is also evidence that dissociative symptoms are mediated by endogenous opiates. If you have a population that already has an excessive release of endogenous opiates, it is not surprising that we run into difficulties treating them.

Dissociative symptoms can be blocked in part by administering an opioid antagonist. If an opioid antagonist is administered during Exposure, the treatment effect appears to decrease. Based on preliminary findings this does not seem to be the case for EMDR.

Replies:

Re: Comments for Ulrich, by Cahill, 02/07/03 Re: Dissociation and emotion, by Fred H., 02/08/03 Re: Dissociation and emotion, by Cahill, 02/08/03 Re: Dissociation and emotion, by Fred H., 02/09/03 Re: Comments for Ulrich, by Ulrich Lanius, Ph.D., 02/10/03 2 cents worth, by Sandra Paulsen Inobe, PhD, 02/10/03 Exposure therapy and Borderline Personality Disorder, by Cahill, 02/11/03 Re:Exposure therapy and Borderline Personality Disorder, by Ulrich Lanius, Ph.D., 02/12/03 Re:Exposure therapy and Borderline Personality Disorder, by Cahill, 02/12/03 One more thing for Ulrich, by Cahill, 02/12/03

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