Psychosensory therapy

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Psychosensory therapy is a form of therapeutic treatment that uses sensory stimuli (i.e., touch, sight, sound, taste, smell) to affect psychological and emotional health. [1] In addition, psychosensory therapy is a group of therapeutic techniques that involves applying sensory inputs to treat various behaviors, mood, thoughts, symptoms, and pain. [2]  Psychosensory therapy has its roots in traditional Chinese medicine in addition to energy psychology. [3] [4] Some important figures in psychosensory therapy include chiropractor George Goodheart, psychiatrist John Diamond, clinical psychologist Roger Callahan, and Ronald Ruden. [4] [2]

Contents

Some of the common techniques used in psychosensory therapy include havening techniques, [5] emotional freedom techniques, [6] Callahan technique–thought field therapy (Callahan, 1985), and eye–movement desensitization and reprocessing.

These techniques in addition to others, according to both American Psychiatric Association (2016) and Stapleton and colleagues, [6] are effective for treating Generalized Anxiety Disorder, Depression, and Post Traumatic Stress Disorder.

Background and influences

The origin of psychosensory therapy is rooted in applied kinesiology, traditional Chinese medicine, and the field of energy psychology. [4] [7] The term was first used by Ruden, [2] which he described as altering feelings, thoughts, and behaviors through utilizing sensory input. Ruden [2] argues that psychosensory therapy should be thought of as a third pillar to treatment, in addition to psychotherapy and psychopharmacology. Regarding traditional Chinese medicine, acupuncture was used as a way to cure disease through different energy meridians in our body. [8] According to Chang, [8] the idea with TCM is that health is harmony, and disease is a lack of harmony, and one way of achieving harmony is through interaction of rhythms. Beginning in the field of Applied Kinesiology, where chiropractor George Goodheart (in the 1960s and 1970s) began exploring clinical observations through muscle testing (i.e., technique where tester monitors subtle changes in muscle tone as an indicator of sickness and health within the body). [4] Goodheart also developed the technique “tapping” which he found helped his patients feel relief from trauma and stress, and is currently used today. [4] According to Mollon, around the same time, John Diamond, a psychiatrist, joined Goodheart's team and began exploring the implications to psychological disorders and emotional conditions. [4] What the team found was that when an individual thinks of something upsetting or lies, the muscle test will be slightly weaker. [4] The team also found that by stimulating specific acupuncture meridians and asking the individual to say certain emotional affirmations, that would result in an ameliorated weakened muscle test and the individual would experience relief from the distress that just occurred. [4] Therefore, Diamond found connections between acupuncture meridians, words, and emotions, and thus found a way of rapidly ameliorating the distress.

Roger Callahan, a clinical psychologist, extended Diamond's work after a client he had been working with, was responding only marginally to cognitive and behavioral forms of treatment for a longstanding phobia of water. [4] According to Mollon, [4] one day in 1979, Callahan performed a muscle test (as Goodheart and Diamond did) and found his client to have a problem in her stomach meridian, so he asked her to tap on the other side of the meridian (her second toe or under the eye), and within a few seconds his client reported the anxiety in her stomach was gone and she ran to the swimming pool with her phobia never returning. Dr. Callahan went on to explore this event further, and with minimal success at the beginning, he eventually discovered that individuals require multiple points to be tapped in a specific sequence, and that varied between individuals. [4] Callahan developed this procedure further and eventually, through trial and error, refined a muscle testing procedure that enabled the tapping sequence to be found, which worked rapidly at relieving distress for his clients. [4] Callahan initially only applied this technique with phobias and anxieties, as his first book was titled “The Five Minute Phobia Cure” but was later found to be helpful with other emotional problems and with PTSD. [4]

Callahan also discovered, through an individual's muscle response, an indication of individual's resistance to recovery. [4] For example, a normal muscle response when an individual says, "I want to get over this issue" is strong, and when an individual says, "I don't want to get over this issue" the normal muscle response is weak. [4] However, some individual's muscles would respond to "I don't want to get over this issue" as strong, and as Callahan suggests, these individuals would not benefit from the tapping method in addition to other treatments. [4] According to Mollon, Callahan called this "a reversal" and claimed it would completely block treatment. Callahan speculated that these reversals would contain hidden motivations and conflicts that result from the body's energy system, and they can be rapidly reduced by Callahan's methods. [4] Callahan called these methods thought field therapy (TFT) because an individual's thought does not only occur in the mind, but also in an energy field within the body that can be accessed through acupuncture and other similar methods. [4] TFT was not based on a theory but more on observations based on the techniques he used. [4] Callahan was mostly the only clinician during the 1980s to use these techniques, but in the 1990s others have started to promote these techniques. [4]

Energy psychology is a form of therapeutic techniques aimed at using our senses (e.g., touch) in combination with psychological exposure and cognitive techniques. [3] The idea is thought to in part be sparked by quantum theory, in that, energy and matter are from the same reality, therefore, all psychological problems involve a dysregulated or imbalanced energy system. [3] These techniques are derived from non-Western systems for spiritual development and healing. [9] Energy psychology is also thought of as "acupuncture without needles" for treating psychological disorders. [9] Energy psychology has roots in applied kinesiology, traditional Chinese medicine, and clinical psychology. [7] For example, TFT involves utilizing imagery and/or thoughts, feelings, and acupuncture as a way of improving symptoms. [7] TFT involves techniques performed while the individual is thinking about his/her problem. [7] These techniques involve activating specific acupuncture points, which then alleviate negative emotions that are associated with the psychological problems. [7]

Elements

Psychosensory therapy can be defined as a form of therapeutic treatment that uses sensory input (i.e. touch, sight, sound, taste, smell) to alter our thoughts, mood, and behavior. [10] The sensory input is often used therapeutically to evoke an extrasensory response—a response not bound to the limits of human senses (beyond the five senses). Sensory input can alter the brain. For instance, one may feel joy when listening to music, hunger when passing a restaurant, and comfort and warmth when massaged.

Touch

Touch therapy is older than recorded time, dating back to 1800 BC. [11] The mechanism of touch is based on mechanoreceptors embedded in the skin. These mechanoreceptors monitor pressure, heat, perception of pain, and texture. [10] Touch is a form of nonverbal communication that can have an extrasensory effect. The use of touch has been long associated with healing. [12] For instance, acupuncture needling, an ancient practice in traditional Chinese medicine (TCM) and a touch therapeutic technique, deals with the insertion of needles into the skin in order to affect one's mood and perception of pain. [13] Reiki, a Japanese touch technique, deals with movement of hands on the body and is often used for stress reduction. [10] Massage therapy involves kneading different parts of the body with some pressure. [11] This form of touch therapy breaks down tissue tensions, and restores normal lengths to the tendons, thus reducing stress. [10] Massage has been shown to decrease cortisol levels, and cause a rise in dopamine and serotonin. [10]

Sight

Symmetry and order may produce a calming effect to one's sight. The construction of symmetry can produce a sense of balance, harmony and perfect proportion. [14] Symmetry is usually perceived to be more attractive than asymmetry. For instance, a beautiful symmetrical face can be comforting and pleasing to look toward. [14] Lack of order can evoke confusion. Extensive research has demonstrated that the lack of sunlight can produce disorders such as depression, substance abuse, and suicidal ideation and intent. [14]

Sound

The Ancient Greeks considered music and sound to penetrate the depths of the soul. [10] Various aspects of music can affect one's emotional state. For instance, the speed, rhythm, and melody are some aspects of music that can affect the human mind and emotions. [10] Early forms of music such as communal chanting was often used in religious settings in order to evoke a feeling of safety and unity within the community. Some researchers consensually agree that music's soothing effect is due to inhibiting other sensory input (taste, sight, etc.), from affecting the senses. [10] Different forms of music can affect one's mood. For instance, seasonal music may make one feel more cheerful, while martial music can make one feel more combative and quarrelsome. [15]

Taste

Taste can have a sensory impact other than curbing hunger. Sugar is a mind-altering substance that can trigger a serotonin-release and produce a craving for sweet things such as comfort foods. [10] Comfort foods typically have a high-carbohydrate and sugar content. The extrasensory effect of food can cause it to feel like a drug and comforting, which may lead to health concerns such as obesity. [10] These comfort foods may be associated with positive, good feelings such as comfort, home, and safety.

Smell

Smell is a chemical sense that involves odoriferous molecules as the primary source of information. Smell is the fastest route to the brain's limbic system which governs emotion. [16] Smell impulses are faster than other sensory stimuli such as visual and auditory processing, and thus has a powerful effect on one's emotional state. [16] Aromatherapy, is a smell technique that uses essential oils, extracted from plants for the treatment of physical and emotional health. [17] The essential oils can be ingested or inhaled, or applied topically. [18] Research has shown aromatherapy to produce modest to significant effects. In one study, researchers studied various scents (lavender, lemon, rose) for anti-stress. Results indicated that lemon scents were the best anti-stress aromas for stress situations. [10]

Interventions

According to Ruden [2] there are multiple psychosensory therapy techniques, including havening techniques, emotional freedom techniques (EFT), Callahan technique–thought field therapy (CT-TFT) and eye movement desensitizing and reprocessing (EMDR). Ruden [2] claimed that some psychosensory therapy techniques need continuing maintenance, while others can facilitate permanent change. However, of these psychosensory therapy techniques, only EMDR for posttraumatic stress disorder (PTSD) is recognized as a psychological treatment for the Society of Clinical Psychology Division 12 of the American Psychological Association. [19]

Havening techniques

Havening therapy refers to Ruden's approach to treating suffering related to trauma. [5] This technique utilizes sensory inputs, including physical touching between the therapist and patient, to create a safe space for de-encoding traumatic memories. [5] In practice a practitioner might lightly tap and stroke a subject who hums and practices eye movements, in the hope this might alleviate pain. [20]

According to Ruden, touch facilitates an increase in calming chemicals like serotonin, which deactivates specific receptors in the memory bank. Consequently, successful havening can result in permanent change as amygdala-activated emotional responses to the traumatic memory are removed. [10] However, havening has been criticized for a lacking empirical support, and that significantly more research on havening is needed before the practice can be considered evidence based. [5]

Emotional freedom techniques

Emotional freedom techniques (EFT) utilizes various psychological treatments, like exposure techniques and cognitive techniques in tandem with stimulation of acupuncture points. [6] In place of needles, EFT patients tap acupuncture points on the upper body and face. [6] Reviews of EFT literature suggest that EFT only has moderate empirical support from primarily small or moderate randomized controlled trials. [21] One report of two major reviews of the supportive evidence for EFT gathered over 30 years showed support for EFT to be methodologically weak. [3]

Callahan technique–thought field therapy

Callahan technique–Thought field therapy (CT-TFT) was introduced by Roger Callahan in his book Five Minute Phobia Cure (Callahan, 1985). Like EFT, CT-TFT utilizes manual stimulation of acupuncture points, utilizing the stimulation while simultaneously focusing on the objects of fear or anxiety. [3] As with havening techniques and EFT, the empirical basis for CT-TFT is a contested issue, as critics state CT-TFT support is methodically weak. [3]

Eye movement desensitizing and reprocessing

Eye movement desensitization and reprocessing (EMDR) combines traumatic memory processing with eye movement. EMDR hypothesizes that bilateral eye movements information processing and integration, promoting fuller processing of traumatic memories. Unlike havening techniques, EFT, and CT-TFT, EMDR is recognized by the Society of Clinical Psychology Division 12 of the American Psychological Association as psychological treatment for PTSD with strong, albeit controversial research support. [19] Some evidence shows that EMDR is comparably effective to exposure therapies for trauma, suggesting that exposure represents the critical element, and the eye movement component is superfluous. [19]

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

<span class="mw-page-title-main">Emotional Freedom Techniques</span> Form of pseudoscientific counseling intervention

Emotional Freedom Techniques (EFT) is a technique that stimulates acupressure points by pressuring, tapping or rubbing while focusing on situations that represent personal fear or trauma. EFT draws on various theories of alternative medicine – including acupuncture, neuro-linguistic programming, energy medicine, and Thought Field Therapy (TFT). EFT also combines elements of exposure therapy, cognitive behavioral therapy and somatic stimulation. It is best known through Gary Craig's EFT Handbook, published in the late 1990s, and related books and workshops by a variety of teachers. EFT and similar techniques are often discussed under the umbrella term "energy psychology."

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder, but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Emotional reasoning is a cognitive process by which an individual concludes that their emotional reaction proves something is true, despite contrary empirical evidence. Emotional reasoning creates an 'emotional truth', which may be in direct conflict with the inverse 'perceptional truth'. It can create feelings of anxiety, fear, and apprehension in existing stressful situations, and as such, is often associated with or triggered by panic disorder or anxiety disorder. For example, even though a spouse has shown only devotion, a person using emotional reasoning might conclude, "I know my spouse is being unfaithful because I feel jealous."

A relaxation technique is any method, process, procedure, or activity that helps a person to relax; attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Relaxation techniques are often employed as one element of a wider stress management program and can decrease muscle tension, lower blood pressure, and slow heart and breath rates, among other health benefits.

Flooding, sometimes referred to as in vivo exposure therapy, is a form of behavior therapy and desensitization—or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it is used to treat phobia and anxiety disorders including post-traumatic stress disorder. It works by exposing the patient to their painful memories, with the goal of reintegrating their repressed emotions with their current awareness. Flooding was invented by psychologist Thomas Stampfl in 1967. It is still used in behavior therapy today.

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

<span class="mw-page-title-main">Thought Field Therapy</span> Fringe psychological treatment recognized as a pseudoscience.

Thought Field Therapy (TFT) is a fringe psychological treatment developed by American psychologist Roger Callahan. Its proponents say that it can heal a variety of mental and physical ailments through specialized "tapping" with the fingers at meridian points on the upper body and hands. The theory behind TFT is a mixture of concepts "derived from a variety of sources. Foremost among these is the ancient Chinese philosophy of chi, which is thought to be the 'life force' that flows throughout the body". Callahan also bases his theory upon applied kinesiology and physics. There is no scientific evidence that TFT is effective, and the American Psychological Association has stated that it "lacks a scientific basis" and consists of pseudoscience.

Energy is a concept in some psychological theories or models of a postulated unconscious mental functioning on a level between biology and consciousness.

Francine Shapiro was an American psychologist and educator who originated and developed eye movement desensitization and reprocessing (EMDR), a form of psychotherapy for resolving the symptoms of traumatic and other disturbing life experiences.

Somatic psychology or, more precisely, "somatic clinical psychotherapy" is a form of psychotherapy that focuses on somatic experience, including therapeutic and holistic approaches to the body. It seeks to explore and heal mental and physical injury and trauma through body awareness and movement. Wilhelm Reich was first to try to develop a clear psychodynamic approach that included the body.

Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.

The management of traumatic memories is important when treating mental health disorders such as post traumatic stress disorder. Traumatic memories can cause life problems even to individuals who do not meet the diagnostic criteria for a mental health disorder. They result from traumatic experiences, including natural disasters such as earthquakes and tsunamis; violent events such as kidnapping, terrorist attacks, war, domestic abuse and rape. Traumatic memories are naturally stressful in nature and emotionally overwhelm people's existing coping mechanisms.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Emotional abandonment is a subjective emotional state in which people feel undesired, left behind, insecure, or discarded. People experiencing emotional abandonment may feel at a loss. They may feel like they have been cut off from a crucial source of sustenance or feel withdrawn, either suddenly or through a process of erosion. Emotional abandonment can manifest through loss or separation from a loved one.

<span class="mw-page-title-main">Dual representation theory</span>

Dual representation theory (DRT) is a psychological theory of post-traumatic stress disorder (PTSD) developed by Chris Brewin, Tim Dalgleish, and Stephen Joseph in 1996. This theory proposes that certain symptoms of PTSD - such as nightmares, flashbacks, and emotional disturbance - may be attributed to memory processes that occur after exposure to a traumatic event. DRT proposes the existence of two separate memory systems that run in parallel during memory formation: the verbally accessible memory system (VAM) and situationally accessible memory system (SAM). The VAM system contains information that was consciously processed and thus can be voluntarily recalled or described. In contrast, the SAM system contains unconsciously processed sensory information that cannot be voluntarily recalled. This theory suggests that the VAM system is impaired during a traumatic event because conscious attention is narrowly drawn to threat-related information. Therefore, memory of the trauma is heavily focused on fear, which affects information processing. This gives rise to PTSD symptoms such as trauma-related cognitions, appraisals, and emotions. The SAM system captures vivid sensory information during the traumatic event, which is automatically recalled through exposure to trauma-related triggers. This system is thought to be responsible for the presence of flashbacks and nightmares in PTSD symptomatology.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

References

  1. ↑ Ruden, "Psychosensory Therapy A Brief Introduction"
  2. 1 2 3 4 5 6 Ruden, R. A. (2005). "A Neurological Basis for the Observed Peripheral Sensory Modulation of Emotional Responses". Traumatology. 11 (3): 145–158. doi:10.1177/153476560501100301.
  3. 1 2 3 4 5 6 Bakker, Gary M. (November 2013). "The current status of energy psychology: Extraordinary claims with less than ordinary evidence". Clinical Psychologist. 17 (3): 91–99. doi:10.1111/cp.12020.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Mollon, P (2007). "Thought Field Therapy and its Derivatives: Rapid Relief of Mental Health Problems Through Tapping on the Body". Primary Care and Community Psychiatry. 12 (3–4): 123–127.
  5. 1 2 3 4 Cousins, Wendy (2011). "Mesmer's ghost: A new approach to treating trauma conjures up shades of history". PsycCRITIQUES. 56 (25). doi:10.1037/a0023692.
  6. 1 2 3 4 Stapleton, P.; Bannatyne, A. J.; Urzi, K.; Porter, B.; Sheldon, T. (2016). "Food for thought: A randomized controlled trial of emotional freedom techniques and cognitive behavioral therapy in the treatment of food cravings" (PDF). Applied Psychology: Health and Well-Being. 8 (2): 232–257. doi:10.1111/aphw.12070. PMID   27140673.
  7. 1 2 3 4 5 Diepold, J. H., & Goldstein, D. M. (2008). Thought Field Therapy and QEEG Changes in the Treatment of Trauma: A Case Study. Traumatology, 1-9
  8. 1 2 Chang, S (2012). "The Meridian System and Mechanism of Acupuncture – A Comparative Review. Part 1: The Meridian System". Taiwanese Journal of Obstetrics and Gynecology. 51 (4): 506–514. doi: 10.1016/j.tjog.2012.09.004 . PMID   23276552.
  9. 1 2 Feinstein, D. (2008). Energy Psychology: A Review of the Preliminary Evidence. Psychotherapy: Theory, Research, Practice, Training. 45(2), 199-213
  10. 1 2 3 4 5 6 7 8 9 10 11 12 Ruden, R. A. (2011). When the past is always present. New York, NY: Taylor and Francis Group
  11. 1 2 Field, Tiffany M. (30 June 2016). "Touch Therapy Effects on Development". International Journal of Behavioral Development. 22 (4): 779–797. doi:10.1080/016502598384162. S2CID   145661602.
  12. ↑ Harrison, Carmel; Jones, Robert S.P.; Huws, Jaci C. (September 2012). ""We're people who don't touch": Exploring clinical psychologists' perspectives on their use of touch in therapy". Counselling Psychology Quarterly. 25 (3): 277–287. doi:10.1080/09515070.2012.671595. S2CID   145783250.
  13. ↑ Cabioglu, Mehmet Tugrul; Surucu, H. Selcuk (March 2009). "Acupuncture and Neurophysiology". Medical Acupuncture. 21 (1): 13–20. doi:10.1089/acu.2009.0638.
  14. 1 2 3 Fink, Bernhard; Penton-Voak, Ian (23 June 2016). "Evolutionary Psychology of Facial Attractiveness". Current Directions in Psychological Science. 11 (5): 154–158. doi:10.1111/1467-8721.00190. S2CID   10217832.
  15. ↑ Landis-Shack, Nora; Heinz, Adrienne J.; Bonn-Miller, Marcel O. (December 2017). "Music therapy for posttraumatic stress in adults: A theoretical review". Psychomusicology: Music, Mind and Brain. 27 (4): 334–342. doi:10.1037/pmu0000192. PMC   5744879 . PMID   29290641.
  16. 1 2 Miller, R. A. (1983). The magical and ritual use of herbs. Rochester, VT: Destiny Books
  17. ↑ Herz, Rachel S. (24 August 2009). "Aromatherapy Facts and Fictions: A Scientific Analysis of Olfactory Effects on Mood, Physiology and Behavior". International Journal of Neuroscience. 119 (2): 263–290. doi:10.1080/00207450802333953. PMID   19125379. S2CID   205422999.
  18. ↑ Butje, Andrea; Repede, Elizabeth; Shattell, Mona M. (1 October 2008). "Healing Scents" (PDF). Journal of Psychosocial Nursing and Mental Health Services. 46 (10): 46–52. doi:10.3928/02793695-20081001-12. PMID   18935936.
  19. 1 2 3 Division 12 American Psychological Association. (2016). Posttraumatic stress disorder psychological treatments. Retrieved from https://www.div12.org/psychological-treatments/disorders/post-traumatic-stress-disorder/
  20. ↑ Cizmic Z, Edusei E, Anoushiravani AA, Zuckerman J, Ruden R, Schwarzkopf R (November 2018). "The Effect of Psychosensory Therapy on Short-term Outcomes of Total Joint Arthroplasty: A Randomized Controlled Trial". Orthopedics (Randomized controlled trial). 41 (6): e848–e853. doi:10.3928/01477447-20181010-04. PMID   30321440.
  21. ↑ Metcalf, O.; Varker, T.; Forbes, D.; Phelps, A.; Dell; DiBattista, A.; O'Donnell, M. (2016). "Efficacy of emerging interventions for the treatment of posttraumatic stress disorder: A systematic review". Journal of Traumatic Stress. 29 (1): 88–92. doi:10.1002/jts.22070. PMID   26749196.
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