共感で繋がるSNS
人気
みのみの🍼👒🐊
Integration of Dissociative Disorders
4. Connecting Self-States (1) Stepwise Treatment
How can we connect separated self-states? Dissociation is a coping strategy for survival, separating frightening and overwhelming experiences from the self. Therefore, the process of reconnecting self-states accompanied by separated emotions, memories, and thoughts
must be conducted with caution. If trauma is accessed abruptly before the client is ready, there is a risk that past traumatic experiences may intrude and lead to re-traumatization. To address this risk,
a method known as graded exposure therapy is used to safely initiate treatment. Graded exposure therapy is widely supported by experts in dissociative disorders and is outlined in the treatment guidelines of the International Society for the Study of Trauma and Dissociation (ISST-D). It consists of three main stages: the first stage is “establishing safety,” the second stage is “recalling traumatic memories,”
and the third stage is “reintegration into daily life.” Howell (2011)
provides detailed descriptions of the key considerations for each stage, which are summarized below. The most important task in the first stage is establishing trust. In the case of clients with dissociative disorders, it is necessary to build a trusting relationship not only with the client in front of you but also with the multiple dissociated states of self. Howell (2011) describes this approach using the concepts of “coconsciousness” and “coparticipation.”
Coconsciousness refers to the shared awareness of the same mental, emotional, and perceptual states by two or more alter egos, which is essential for further harmony and collaboration within the internal system. Coparticipation means that multiple alter egos participate in the same activity simultaneously, which is also necessary for further harmony and collaboration within the internal system. Coconsciousness refers to two or more alter egos simultaneously sharing the same mind, emotions, and perceptions, which is necessary for greater harmony and collaboration within the internal system.
Coparticipation involves not just one person but multiple subjects participating in therapy, and by encouraging various personality parts to participate together, therapy can make significant progress. The methods for interacting with dissociative personality parts are: ① promoting shared consciousness and coparticipation, ② strengthening empathy among the parts, and ③ increasing information about the entire system. Here, attempting to force contact using hypnosis or similar methods is not advisable. Doing so could threaten self-states that are not yet ready to emerge. The therapist's impatience or desire may sometimes be perceived as a threat by the client, so it is essential to maintain honest and careful engagement in the initial first stage.
In the second stage, the therapist addresses the client's traumatic memories. Various hypnosis techniques are proposed to protect the client from the overwhelming emotions that arise when accessing terrifying memories (Putnam, 1989; Klu, 1993). Here, it is important to prevent the risk of re-traumatization and to ensure that dissociated memories are gradually recognized by the client.
In this process, as the therapist engages in dialogue with the dissociated self-states and as the dissociated self-states interact with one another, memories and emotions related to the trauma become evident and are shared.
In the third stage, reintegration into daily life occurs. By this stage, many dissociative symptoms have subsided, and the frequency of trauma recall has decreased, so the therapist supports the client in adapting to society. There is also the possibility that past traumatic memories may be recalled due to stimuli in daily life, so it may be necessary to return to the second stage and work on it again. In this way, the staged treatment is not linear but a process that moves back and forth according to the client's condition.
Translated with DeepL.com (free version)
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ヒロ🦻【えんの木】
① 心理学的な視点…ストレス脆弱性は，パーソナリティ特性やストレス対処方略によって規定され，単一の特性によって決定されず複数の心理特性によって形成されるため各個人のプロフィールが重要
② 生物学的な方法論…一つひとつは効果の小さな多数の感受性遺伝子が環境要因と複雑な様式で相互作用することによってストレス脆弱性が形成されると想定される。ゲノムと環境の相互作用の全体像は遺伝子発現のプロファイルにスナップショットとして現れる。また，ストレス脆弱性は，健常者からうつ病患者へと連続的に分布していると推定する
２．うつ病の患者数と原因と考えられるもの
・患者数：WHOによると2億８千万人、国内では159.3（R3年度）…コロナ明けて少し減少した。
うつ病の原因と考えられているもの
・ストレス…発症や増悪の主要な誘因と考えられている
・ストレスへの脆弱性
HPA系および免疫炎症系の異常と考えられているが知見は一致しておらず，病因・病態の解明には至っていない。
理由は
① 異種性を伴う疾患であること
② コルチゾールインターロイキン-6 などのHPA系・免疫炎症系の主要分子には概日リズムが存在すること
③ HPA系・免疫炎症系のほかにも多くのシテム・分子が関与している可能性があること
３．うつ病の異種性（特異性）
例）米国精神医学会による「精神疾患の診断・統計マニュアル第5版（Diagnostic and Statistical Manual of Mental Disorders，5th Edition： DSM-5）」
・「抑うつ障害群」の大分類に複数の下位診断がある。
【下位診断の例】
・メランコリー型うつ病…気分反応性がなくずっとうつうつとしている,不眠,コルチゾールが高くグルココルチコイドレセプターの感受性が低い（ストレス耐性低下,炎症増加,免疫異常,代謝異常になりやすい）
・非定型うつ病（一時的に気分が上がる）…気分反応性が有る,過眠,コルチゾールが正常＝低く,グルココルチコイドレセプターの感受性が高まる(ストレスに過敏,免疫抑制,筋肉分解の促進,血糖値上昇になりやすい)
→ 同じうつでも、症状がちがう亜型分類であり、ストレスに関連した生物学的特徴の異同がある。
【参考文献】
堀弘明（2022）うつ病の発症におけるストレスの役割,日本生物学的精神医学会誌 33巻4号
【ベストコメント】
ヘナはホルモンバランスを整える効果も期待できるため、自律神経の乱れを改善する可能性があります…だそうです
注）うつ病とは無関係です。
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