An attempt is underway to lead symptoms and pain of unknown cause to pleasure by mental treatment

by Gerd Altmann

Even if a doctor is consulted at a hospital because of pain or discomfort in the body, "cause is unknown", and in cases such as how many hospitals go round, if "mental factor" is the cause There seems to be one. For such unknown symptoms, Canadian doctors are working on the spirit to alleviate symptoms.

Their pain is real - and for patients with mystery illnesses, help is coming from an unexpected source - The Globe and Mail

At Halifax , the capital of eastern Canada and Nova Scotia, Dr. Alan Abbas , a psychiatrist, is doing very innovative treatment. The therapy is called Intensive Short-Term Dynamic Psychotherapy (thorough / short-term dynamic psychotherapy / ISTDP), a specialized trained therapist will discuss with patients who complain of symptoms carefully.

What appears in the video explaining ISTDP treatment is "Patient who was dragged with a cane walking without using a cane after a while talking with Mr. Abbas". It also shows how a patient who was unable to issue a word for a month speaks in his own words when it takes only 90 minutes after receiving dialogue treatment. Mr. Abbas said "About the cases from the surroundings it looks like fraud and fraud, but this is not a miracle, but a scientific treatment."

Mr. Abbas and others are trying to treat patients who suffer from long-term symptoms where the highest premiums in medical systems are used. About 50% of patients with family physicians and 15% of patients with specialists are complaining of general symptoms such as migraine, back pain, abdominal pain, but that medical cause can not be specified. Patients complaining of these unexplained symptoms are told that "cause unknown" each time they are repeatedly examined at the hospital, in the worst case, they may hurt their work and daily living with long-term obstacles Yes.

Some people view that they are complaints of unexplained symptoms, "they are scammers who complain about symptoms that are not actually occurring", but Mr. Abbas says that their pain is genuine. And I think that the cause of these symptoms and the reason for deterioration are psychological.

Mr. Abbas heard the lecture of Mr. Abibu Davanro, a pioneer of ISTDP, in the autumn of 1990, he was learning at McGill University . "I was shocked by the fact that it might be possible to treat patients in a one and two hour interview," Abbas says. Mr. Abbas convinced that this field is very important and he told Mr. Davanro and he did research on ISTDP for ten years.

This treatment is based on the idea that "a physical symptom, which is a manifestation of oppressed negative emotions, can be relieved by recalling or releasing emotions that triggered the symptoms" . In ISTDP, a conversation is conducted to deal with anger and guilt feelings of a patient, the therapist records the state of the session in a video, sometimes reviews the video with a colleague or the patient himself and looks back on the session .

As the name "Intensive", ISTDP will do very intense dialogue. It is not a type of conversation that never cares close to the patient naturally, the therapist does not sit slowly in the chair while the patient talks, always making a dialogue by asking questions or making challenging remarks. Mr. Abbas calls this dialogue "severe coaching" and "actively frustrating process", and sometimes "Do you ever want to murder your mother and want to kill you?" "How did you want to kill? ? "" What do you think about what you thought of wanting to kill your mother? "

In the case where Mr. Abbas treated ISTDP, it is said that 95% of cases are actually carved about the childhood experience in the heart, and when it is an adult it develops as various symptoms such as headaches and stomach pain Thing. Causes that cause causes such as abuse and abandonment of childcare, parents' deaths and divorce are various, but both have a harmful effect on their hearts. In addition, there are cases where stress in recent years such as spouses hiding cheating ones may cause reasons, and in some cases it is caused by events that are not necessarily negative, such as promotion and life turning point.

At Mr. Abbas' medical clinic, I firstly visit the patient once and see whether ISTDP treatment is effective or not. Normally, patients reaching ISTDP are visited by many hospitals, and medical reasons for symptoms are rarely found, but in rare cases the causes such as pneumonia and gallstones have been overlooked That's right. In such a case, I recommend another examination institution to the patient, and I will correct the trajectory in the direction to treat the medical cause.

When treatment with ISTDP starts, it will persistently repeat interactive sessions by Mr. Abbas and other therapists. There seems to be a case in which 60 sessions have been repeated in some people who have serious symptoms, but on average 7 treatment sessions will be continued.

As a metaphor, Mr. Abbas says "I am waiting for a patient to open the door." Mr. Abbas expects the patient to show a fear of feeling fear and guilt by asking questions about the patient's family and the past painful incident and shaking a story. Although the patient himself often tries to deny obsession with past events or dark emotions, many patients alleviate the symptoms by touching or talking to the cause which places a heavy burden on their own spirit is.

Computer scientist computerist scientist Matthew Isnar who had been treated ISTDP 2 years ago by Mr. Abbas said he was suffering from symptoms similar to Tourette's disorder and was taking six medicines. It was Mr. Isnner who frequently sniffs and makes the face cramp, but with a total of 20 sessions with Mr. Abbas, the symptoms go well and now I am stopped taking medication and returning to normal life.

Also, a woman named Mr. Kim Hoes was accidentally exposed to a large amount of chemical substances at the workplace. It was said that it was hypersensitive to chemical substances and specific environments due to it, and it was in a state where it was not leaving home. However, after 45 sessions with Mr. Abbas, he was able to freely go outside and now he seems to be a spokeswoman for ISTDP treatment and visiting various places by train. "I thought that I will have this disorder throughout my life until ISTDP treatment," Mr. Hawes said.

While some people highly appreciate ISTDP, there are also people who have a critical view on ISTDP. Psychologist Alan Carberling says, "ISTDP is creating a stressful and strange situation for patients," and states that attempts to create changes in the patient's mind too soon are dangerous. ISTDP is very aggressive and treats based on short-term sessions, so it is easy to be viewed as a dangerous person from long-term, patient-led psychoanalysts.

In addition, Mr. Abbas himself acknowledges concern that it is "offensive" against ISTDP. Indeed, Mr. Abbas who saw a video in which Mr. Davanro won the ISTDP in 1990 seems to have felt "Mr. Davanro is attacking the patient." In ISTDP, it is recommended that a therapist actively push a delicate part of a patient, so it may seem that they criticize or suffer from the patient from the side.

Mr. Abbas also acknowledges that ISTDP, like many other treatments, is not universal. Not everyone who complains of unfamiliar symptoms of medical causes receives ISTDP and is not going to improve. Of course, many patients do not improve their symptoms. "Although psychological causes alone can not explain the symptoms of all patients, ISTDP is certainly sometimes more effective than pill treatment," Abbas said.

by Nathan Cowley

Already in Nova Scotia, extensive pilot projects are underway on ISTDP, Mr. Abbas said that by treating ISTDP patients who have visited hospitals many times over and over again, the medical costs to be borne by the government are It says it can save money. According to the results of the survey released in 2015, if ISTDP treatment is given to patients who are repeatedly consulted with unknown symptoms, medical expenses expended from medical insurance can be reduced, and the patient has returned to society It also has merits.

Dr. Samuel Campbell, who works for the QEII Health Science Center , a medical facility in Nova Scotia state, recommends interviews with psychiatrists for patients who are considered to be effective treatment by ISTDP for several years. Mr. Campbell explains the effect of stress on physical condition for patients who may have symptoms due to psychological factors and recommends ISTDP treatment by introducing the method of psychiatric examination And that. Actually Campbell feels that his work is being streamlined by introducing Mr. Abbas and other ISTDP therapists.

On the other hand, there are many patients who feel disgusted with being told that "Your pain may be due to mental reasons", Mr. Campbell carefully and patiently affects the body by the spirit Despite the fact, there are not a few patients who are angry with Mr. Campbell when still recommending interviews with psychiatrists. "A patient who recommended me to interview with a psychiatrist says that I am cynical about writing sarcastic on the Internet," Campbell said.

At the moment the ISTDP pilot project is doing well, the state project, which was originally planned for 3 years, was extended to 4 years, and I was able to hire an additional ISTDP treatment staff. There are plans to adopt more ISTDP therapists in the future and plan to improve access to ISTDP from family physicians and specialists throughout the state. Mr. Abbas saves at least 5 million dollars (about 560 million yen) by improving the route of ISTDP treatment though it is expected to cost 1.8 million dollars (about 200 million yen) annually to implement the program I calculate it when it is done.


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