International Handbook of Clinical Hypnosis - E-Lib FK UWKS

152 INTERNATIONAL HANDBOOK OF CLINICAL HYPNOSIS
Acute Stress Disorder ASD) as a new diagnosis in the DSM-IV Spiegel &
Cardena, 1991; Liebowitz, Barlow et al., 1994). It is diagnosed when high levels of
dissociative, anxiety and other symptoms occur within one month of trauma, and
persist for at least 2 days, causing distress and dysfunction. Such individuals must
have experienced or witnessed physical trauma, and responded with intense fear,
helplessness, or horror. This `A' criterion of the DSM-IV requirements for ASD is
identical to that of PTSD. The individual must have at least three of the following
®ve dissociative symptoms: depersonalization, derealization, amnesia, numbing, or
stupor. In addition, the trauma victim must have one symptom from each of the
three classic PTSD categories: intrusion of traumatic memories, including nightmares
and ¯ashbacks; avoidance; and anxiety or hyperarousal. If the symptoms
persist beyond a month, the person receives another diagnosis based on symptom
patterns. Likely candidates are dissociative, anxiety or post-traumatic stress disorders.
TREATMENT
Three types of psychotherapy have been applied to PTSD: psychodynamic,
cognitive-behavioral CBT), and hypnotic-restructuring. In each of these approaches,
telling and retelling the story of the trauma is an essential element, albeit
with different methods and goals: clari®cation of unconscious themes and transference
distortions in psychodynamic treatment, correction of cognitive distortions in
CBT, and abreaction and the restructuring of traumatic memories with the help of
hypnosis.
Psychodynamic treatment is rooted in the exploration of unconscious implications
of traumatic loss, with the premise that the disorder is complicated by
unconscious implications of the trauma Horowitz, 1976; Horowitz, Wilner et al.,
1980). At the same time it can help to strengthen ego function by bringing
unconscious determinants of symptomatology into conscious awareness, thereby
rendering the symptoms less overwhelming and facilitating coping Marmar, Weiss
& Pynoos, 1995; Menninger & Wilkinson, 1988).
The helplessness imposed at the time of trauma is seen as generalizing to
encompass the self as helpless in other domains of life, a fate experienced as
deserved. Ironically, fantasies of omnipotence reinforce rather than contradict this
self-schema. Attempts to compensate for the lack of control imposed by traumatic
stress often lead to guilt-inducing fantasies of unrealistic control: the accident or
assault should have been foreseen and therefore avoided. Therefore it happened
because of a lapse of judgment or personality defect rather than the randomness of
life. Fantasized guilt at `causing' trauma is for some more bearable than enduring
the helplessness engendered by it.
Psychodynamic psychotherapy is aimed at unearthing and working through such
unconscious determinants of symptoms, through retellings of the story of the