Treatment of Posttraumatic Embitterment Disorder with Cognitive Behaviour Therapy Based on Wisdom Psychology and Hedonia Strategies

Abstract

Background: Posttraumatic embitterment disorder (PTED) is a reaction to unjust or humiliating life events, including embitterment and impairment of mood, somatoform complaints, reduction in drive, withdrawal from social contacts, and even suicide and murder suicide. Patients have been shown to be nonresponders to many treatments. This paper gives an outline of cognitive behaviour therapy based on wisdom psychology and reports first data on treatment effects. Method: In a first pilot study on psychotherapy for PTED, a cohort of 25 PTED inpatients was treated with routine multidimensional cognitive behaviour therapy. A second consecutive cohort of 28 patients was treated with PTED-specific cognitive behaviour therapy, which is based on wisdom psychology (wisdom psychotherapy) and another 29 patients with cognitive behaviour therapy based on wisdom psychology together with additional hedonia strategies (wisdom and hedonia psychotherapy). Treatment integrity was measured with special modules of the Behaviour Therapy Competency Checklist. The outcomes were measured in all 3 groups with the SCL-90 and a global clinical rating of patients and therapists on treatment outcome. Results: There were significant and clinically meaningful reductions in the SCL score after wisdom therapy, as compared to routine treatment. In clinical ratings by therapists and patients, both specific treatments were judged as more effective than treatment as usual. Additional hedonia strategies did not lead to better treatment effects. Conclusions: The results of this pilot study suggest that wisdom psychology offers an approach to treat PTED and justify further randomized controlled outcome studies.

Suicidal and Aggressive Ideation Associated with Feelings of Embitterment

“…From a psychoanalytic perspective, Alexander [18] characterized embitterment as a self-reinforcing “masochistic adaptation response,” which gives a sense of control through self-destruction. Similar to anxiety, embitterment can occur as a normal emotion, in the context of other mental disorders [19], or as separate problem in the form of posttraumatic embitterment disorder (PTED; ICD-10 F 43.8) [12-14, 18-23], a reaction to the violation of basic beliefs, with a transition from full health to severe and persisting mental impairment from one minute to the next (trauma) [24]. The prevalence rate of reactive embitterment with a clinically relevant intensity varies between 2 and –3% [14].…”

Frequency of Perceived Poststress Symptoms in Inpatients, Outpatients and Healthy Controls: The Role of Perceived Exhaustion and Stress

“…While allostasis refers to the normal biological process of adaptation to stress, allostatic overload, as defined by Fava et al [3], refers to the price the body pays for being forced to adapt to prolonged, heightened, or adverse psychosocial or physical situations [4,5]. This can be physical but also purely psychological stress, as is known from learned helplessness or embitterment reactions [5,6,7,8]. Allostatic overload may therefore not only cause symptoms under stress but also promote a poststress symptomatology: ‘A state of allostatic load entails some clinical manifestations that can be observed in daily practice.…”

The polarities of psychological well being and their response to treatment

“…This has led to a growing number of investigations on positive emotions (Fredrikson, & Joiner, 2002), subjective wellbeing (Diener, 2000;Diener Suh, Lucas, & Smith, 1999), human strengths (Peterson & Seligman, 2004) and other positive personality characteristics such as compassion, hope, and altruism (Park, Peterson, & Seligman, 2004). These are as specific ingredients in "positive interventions" (Magayar-Moe, 2009;Rashid, 2009;Seligman, Steen, Park, & Peterson, 2005;Sin & Lyubomirsky, 2009) such as the positive psychotherapy (Seligman, Rashid, Parks, 2006); wisdom psychotherapy (Linden, Baumann, Lieberei, Lorenz, & Rotter, 2011); gratitude interventions (Wood, Maltby, Gillett, Linley, & Joseph, 2008); positive coaching (Biswas-Diener, 2009;2010); strengths based approaches (Biswas-Diener, Kashdan, & Minhas, 2011;Govindji, & Linley, 2007;Linley & Burns, 2010); hope therapy (Geraghty, Wood, & Hyland, 2010;Snyder et al, 2000); and forgiveness therapy (Lamb, 2005).…”