The objective of this pilot is to establish if CVS has any effect on patients with this psychogenic disorder in self-related cognition after psychotrauma and forced migration, and if so, to describe this effect in comparison with the effect CVS has…
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Source
Brief title
Condition
- Psychiatric disorders NEC
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
In the CVS experiments so far anosognosia and asomagnosia were assessed using 4
point rating scales. The proposal is to apply a similar scale for the
assessment of the level of self alienation induced by confrontation with a
mirror.
1. the patient recognises his/her reflection without discrepancy
2. the patient reports a discrepancy between the perceived reflection and
his/her self-image but has no doubt it is correct
3. the patient reports doubt as to whether the perceived reflection really
belongs to his/her self
4. the patient reports that someone else is gazing back from the mirror
A similar scale can be applied if trauma related memories are induced.
1. the patient reports no reminiscences
2. the patient reports induction of trauma related memories, but does not
locate them in the mirror
3. the patient reports induction of trauma related memories, locates them in
the mirror but identifies them as mere imagery
4. the patient reports that persons inside the mirror intend to inflict harm
like in the past
The reaction of the patient is rated by the nurse who applies the intervention.
As the aim of this pilot is to assess a so far unknown effect, a qualitative
assessment of the experiences of the participants in general following the
intervention will also be part of the protocol. After each confrontation the
patient will also be asked about his/her experiences in general in an open
interview for a more qualitative description of the effect. This part of the
assessment will be done by the author, and will, if the patient consents, also
be recorded on videotape. This will ensure the transparency of the procedure by
making it available to assessment later by independent assessors, as the
interviews themselves are for logistic reasons not done by an independent
assessor.
Secondary outcome
The fact that the CVS effect is assessed following exposure to a mirror, makes
assessment by several independent and blinded assessors, assessing the exact
same material also possible. This would be helpful especially in a pilot in
which the main purpose is to establish whether there is any effect at all, like
this study.
For this the one-way screen of the clinic, acting as a mirror could be used.
The one-way screen will be partly shaded to appear like a common size bathroom
mirror, to prevent undue fear possibly caused by a larger reflecting surface.
The confrontation with the mirror could be videotaped from the other side of
the one-way screen with a camera. The results can then be shown in random order
to independent mental health professionals; the assessors will be simply asked
to guess which of the confrontations was baseline, which one followed the
control intervention and which the experimental intervention.
Apart from this the author will ask the assessors in an open interview to
describe their observations in a qualitative way as well.
Background summary
The Eye Movement Desensitisation Reprocessing (EMDR) technique is at present
one of the most effective tools in the treatment of psycho trauma. What makes
EMDR that effective is as yet unknown. It is thought that bilateral sensory
stimulation induces an orienting response in the brain which activates
structures involved in episodic memory processing. More specifically, the self
image of the patient encoded in episodic memory seems to be processed allowing
self related cognitions biased by the trauma to change into more positive ones.
However, the technique also entails prolonged exposure to the traumatic memory,
which precludes its use for patients lacking in either psychological or social
stability.
Unfortunately this makes EMDR unsuitable for many traumatized asylum seekers,
who tend to live in insecure social circumstances and often suffer from
co-morbid psychiatric pathology. Yet both psycho trauma and forced migration
are likely to affect the self image of these patients in a profoundly negative
way. In fact, some patients admitted to a psychiatric clinic specialised in the
treatment of asylum seekers were observed to cover the mirrors in their
bedrooms out of fear of looking at themselves. When asked about it, a majority
of patients indicates that they experience a significant discrepancy between
their self image and their mirror image.
Study objective
The objective of this pilot is to establish if CVS has any effect on patients
with this psychogenic disorder in self-related cognition after psychotrauma and
forced migration, and if so, to describe this effect in comparison with the
effect CVS has on patients with a neurogenic disorder in self-related
cognition.
Study design
The study is intervention-based and blinded, controlled and randomised.
The intervention and the control intervention will follow the baseline mirror
confrontation in random order. Assessment of the effect will also be done in
random order.
The patients will be only blinded as to which of the interventions is the
control. They will however be fully informed on the technical aspects of the
CVS intervention, including the assessment by videotape. The nurse applying the
vestibular stimulation will be blinded likewise; he or she will be both
familiar with the patients however and with possible adverse effects of the
intervention like temporary dizziness in order to be able to assist the
patients during the intervention and the confrontation. The assessors of the
effect of the intervention will also be blinded; when the video material is
shown to them, they will not be informed whether they are observing the effect
of the intervention, the control or the base line condition.
Intervention
The intervention will consist out of the irrigation of the external canal of
the contra lateral (left) ear with room temperature tap water, using a common
plastic Luer lock syringe (without needle attached). To check whether the
intervention was applied correctly, the nurse applying the intervention will
check the presence of a nystagmus (saccadic eye movements) which should
normally follow stimulation. Following this the patient will be asked to
observe his/her face in a mirror. This confrontation does not need to last
longer than a few seconds; the emotional alienation which the patients
experience occurs instantly upon looking in the mirror, and so, presumably,
would any change.
If the command of Dutch or English is not sufficient in the patients, a
professional translator will be asked to provide life translation, as is
standard procedure in the clinic.
The intervention will be preceded by baseline mirror confrontation without
prior intervention. Vestibular stimulation of the ipsi lateral (right) ear in
the same study object will serve as control intervention.
Study burden and risks
The patients need to:
1. visit the physician to have their eardrums checked and, if necessary, excess
earwax removed;
2. do a baseline confrontation with a mirror assisted by a nurse, lasting a few
seconds, followed by an open interview by the research psychiatrist lasting
about 15 minutes;
3. do the CVS procedure, lasting about 5 minutes, followed a mirror
confrontation and an open interview
4. repeat the CVS procedure for the contralateral ear, followed by a mirror
confrontation and an open interview
Although the aim of the study is to contribute to the development of
therapeutic reprocessing without confrontation with traumatic memory,
confrontation with a mirror is still unavoidable for the purpose of this study.
Confrontation with a mirror typically induces fear in the study objects; they
should therefore be sufficiently stabilised, and preferably still admitted in
order to monitor them sufficiently after the experiment.
In some cases CVS may induce vertigo that may last a few minutes and that may
be accompanied by nausea.
During the otoscopy by the phycisian the external earcanal can be damaged, and
in extreme cases the eardrum may be even perforated.
Wolfheze 2
6874 BE Wolfheze
Nederland
Wolfheze 2
6874 BE Wolfheze
Nederland
Listed location countries
Age
Inclusion criteria
Sampling
The patients should be recruited from sufficiently stabilised inpatients from a psychiatric clinic for asylum seekers and refugees; in addition they should suffer from a psychogenic disorder in mirror self-recognition. The intervention should initially only be applied to patients with minor degrees of fear for mirrors and intact reality testing. If no adverse effects are observed, more severely affected patients could be included later.
Exclusion criteria
Exclusion criteria
Although the aim of the study is to contribute to the development of therapeutic reprocessing without confrontation with traumatic memory, confrontation with a mirror is still unavoidable for the purpose of this study. Confrontation with a mirror typically induces fear in the study objects; they should therefore be sufficiently stabilised, and preferably still admitted in order to monitor them sufficiently after the experiment.
Patients with organic brain anomalies or injuries are excluded.
Prior to the intervention every patient will be otoscopically assessed by a physician to check if the eardrums are intact (perforation of the eardrum is an exclusion criterium) and to clear away excess earwax if necessary.
The physician will also establish the lateralisation of hand function in the patient (left- or righthandedness); left-handed patients are not excluded, but in their case the intervention is likely to be the control and vice versa.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL12853.097.06 |