A Brief Summarize of Conversion Disorder Treatments

Review A brief summarize of conversion disorder treatments Altungy Labrador, P. Universidad Complutense de Madrid Little is known among the majority Nowadays, there are different of therapists about the Conversion approaches for disorder treatment, Disorder, and even less about the depending on the theoretical model used existent treatments. The idea of this for the intervention. Traditionally in our article is to explain the main treatments discipline, therapist used to select just that have been used so far in the clinical one theoretical approach and only their psychology, and the strengths and treatments, in a kind of “fight” against weaknesses of each one. The number of other psychological models that could studies in this field is not as exhaustive explain the disorder from other points of as it should be, considering the view. prevalence of this disorder in the However, nowadays most of population. Although since Janet’s time therapists acknowledge that a holistic there have not been remarkable point of view of the disorders is so developments in the field, in the last much useful than a restrictive one. This decades, cognitive-behavioural therapy, new (and unthinkable some decades along with pharmacological therapy, ago) view of the psychology, as a have been used in conversion disorder holistic discipline in which a disorder treatment with high effectiveness. can be explained from different models, Neuropsychological studies have is what currently we can find in offered new explanations for the conversion disorder treatment. So, disorder, due to neuroimage use. although we present the treatments Considering the information available classified under the model which about the disorder in the last ten years, “created” them, never forget that in conversion disorder can be considered present psychology, therapies from as an extreme stress response, so new different approaches are used together. treatments should consider this characteristic in order to improve the a) Psychodynamic treatments information known so far. 1 Psychoanalytic treatments were the The main idea for these therapists first in being used. Considering mental was that, through intensive dialogue, disorders as mainly caused by disorder could be solved. Therapist repression, therapists tried to work should be direct patient’s undercover those repressed emotions in thoughts, in order to help him to bring the patient, in order to allow them to stressful feeling to conscious. express their emotions in a healthy way. One of the techniques used by these The main tool used by them was, as is therapists was hypnosis. For its widely known, the psychoanalytic complexity and importance in dialogue, in which the therapist tried to conversion disorder treatment, it seems bring the repressed thoughts from the proper dedicate a specific part for its mind’s unconscious to the conscious. explanation. This way from the unconscious to the conscious part of the mind is not an II. Hypnosis easy job, so the use of complementary techniques to the dialogue seems Despite other times considered as strongly necessary. It is in this context one of the most effective treatments, in in which we include the two techniques the recent decades this psychological that, in our opinion, represent the most tool has been discredited, since the important ones along with the dialogue cognitive-behavioural establishment as per se. the paradigmatic one in psychology. Although not completely disappeared, I. Psychoanalytic therapy its use has been reduced mainly to psychodynamic therapists and some Rooted in Freud’s theories, psychiatrists (quite unknown among psychoanalytic therapy has been widely psychologists that most of psychiatrists used along last century and, of course, have a psychodynamic orientation). But for treating conversion disorder this general tendency it seems to be patients. Given that the first different in conversion disorder “psychological” definitions of the treatment. May it be due to the still disorder were made by psychoanalytic scarce knowledge about the disorder, therapists, it is clear why the main hypnosis is still considered as a useful conversion disorder therapies follow treatment for these patients. But if we this psychological model. talk about hypnosis, first it is necessary 2 talking about suggestion/self- dissociative symptomatology” (Roelofs suggestion. et al., 2002). Conversion disorder It was Janet who coined the term patients were compared with a control autohypnosis (Janet, 1907), which is a group. The results (table 8) showed that synonym for the nowadays more used conversion disorder patients were more concept self-suggestion. He purposed susceptible to hypnotic suggestions than that, in conversion disorder, patient control patients. As well, it was would autohypnotize himself in order to observed that the more susceptible a relief himself from the strong stress he patient was to hypnotic suggestion, the felt (Roelofs et al., 2002). This more symptoms he displayed. But, autohypnosis was the reason why, despite of these results, Roelofs et al. consequently, patient displayed (2002) purpose hypnotic suggestion somatoform symptoms (patient would susceptibility as a risk factor for have hypnotized himself some areas of developing conversion seizures, but not his brain, and the “hypnosis” of these a determinant factor. Even more, they areas would cause therefore the found that conversion patients were not symptomatology). only more susceptible to hypnotic So, having that in mind, it seems suggestions, but to nonhypnotic quite obvious which would be the suggestions (indirect suggestions) as disorder treatment: hypnotize the patient well. So, in the light of these results, again in order to allow the therapist to hypnotic suggestion cannot be unmake the patient self-hypnosis, bring considered as a determinant factor but his repressed stress out and, as result, as a risk factor. Despite of it, Roelofs et allow him to express it properly. al. (2002) study shows a strong support Some studies have been done in the for hypnosis therapy in conversion past decades, in order to find support for disorder patients. these previous assumptions (Goldstein et al., 2000). Roelofs et al. made a b) Cognitive-Behavioural treatments research under two main assumptions. The first one was that “patients with Despite conversion disorder is a well conversion disorder are highly known disorder since Egyptians time, it susceptible to hypnosis” The second is astonishing the lack of research in the assumption was that “hypnotic treatments field. Apart from the susceptibility is related to the 3 psychodynamic treatments mentioned patients’ shows, as it was explained before, which have been studied previously. So, what therapists have nowadays, are a bunch of treatments Table 8. Roelofs hypnosis study used for PNES in general, but almost no Control Conversion one of them specifically tested in patients patients (n=50) (n=50) conversion disorder patients. Anyway, a Measure M SD M SD Effect brief explanation of these treatments size SHSS-C* 3.9 2.6 5.6 3.1 0.6 from the cognitive-behavioural SDQ-20* 23.0 3.8 30.5 8.5 1.2 DES 9.1 7.9 11.7 11.0 0.3 approach is given. DIS-Q 1.8 0.5 1.8 0.7 0.0 Deeply rooted in learning theories, *Taken from Roelofs et al. (2002). SHSS-C: Stanford Hypnotic Susceptibility behavioural postulates have also Scale: Form C. integrated cognitive assumptions to SDQ-20: Somatoform Dissociation their model, with the result of the Questionnaire. paradigmatic psychological model DES: Dissociative Experiences Scale. nowadays. Because of that, treatments DIS-Q: Dissociation Questionnaire. will show traces from the very specifically for conversion disorder, traditional learning postulates, to the there are only other few examples of most recently cognitive psychological treatments specifically developed or assumptions. studied for conversion disorder. Which As the name indicates, cognitive- we can find for its treatment from a behavioural treatments will be cognitive-behavioural approach, are integrated by two different but therapies for Psychogenic Nonepileptic simultaneous techniques: the Seizures (PNES), among which we can behavioural and the cognitive. But, as classify conversion disorder. PNES are the name is, the intervention process is a group of mental seizures characterized integrated as well. For that, we talk for showing several different like- about Cognitive-Behavioural Therapy neurological seizures, which, indeed, (CBT). are not caused by neurological disorders This therapy is focused in two but psychological ones. The term processes: the primary and secondary “nonepileptical” is used because a high gain that the patient gets due to his percentage of the symptomatology is disorder. As it has been explained, almost identical to which epileptic patient gets two main benefits from his disorder: self-relief (primary gain) and 4 social attention (secondary gain). There -Phase B: make the patient is a specific intervention for each one. conscious of the irrational automatic As the primary gain is an internal thoughts that happen between the cognitive process, the most suitable stressful event and the anxiety state. therapy would be cognitive -Phase C: make the patient restructuring, as purposed by Ellis or conscious of his feelings and his Beck (we will explain their therapies anxious state, which come from later). For the secondary gain, a those automatic thoughts. behavioural approach seems more -Phase D: argue irrational thoughts suitable, due to the social

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