An Evidenced-Based Nursing presented to the

Institute of Health Sciences and Nursing

Far Eastern University-Manila

In Partial Fulfillment of the Requirements for the course:

NCM 117- CARE OF CLIENTS WITH MALADAPTIVE
PATTERNS OF BEHAVIOR

Deypalan, Judiel
Dimapilis, Aaron Miguel
Dio, Yanneka
Domingo, Lucky Leu
Enriquez, Hillary

Dr. Alma T. Taragua

Lecturer
February 2023
 I. Clinical Question: Is Psychotherapy a better approach than psychopharmacological and
somatic treatment in treating Dissociative Amnesia?

II. Citation:
Mangiulli, M., Jelicic, M., Patihis, L., & Otgaar, H. (2021). Believing in dissociative
amnesia relates to claiming it: a survey of people’s experiences and beliefs about
dissociative amnesia.
https://www.tandfonline.com/doi/full/10.1080/09658211.2021.1987475

Staniloiu, A.,& Markowitsch H.J. (2018). Dissociative Amnesia – A Challenge to Therapy

. International Journal of Psychotherapy Practice and Research - 1(2):34-47.
https://doi.org/10.14302/issn.2574-612X.ijpr-18-2246

III. Study Characteristics

Patient Intervention Comparison Outcome

The study surveyed a Psychotherapeutic Psychopharmacologi Increased chance of

sample from the intervention through cal and somatic retrieving the
general population cognitive-behavioral therapies through the memories of the
(N = 1017), revealing therapy, use of patients with
that about a tenth (n = psychodynamic antidepressants or dissociative amnesia
102) claimed to have therapy, and selective serotonin through
experienced hypnosis. reuptake inhibitors psychotherapeutic
dissociative amnesia. such as barbiturates intervention.
or benzodiazepines.

Based on the result of the study by Staniloiu & Markowitsch (2018), the psychotherapeutic
intervention has shown a more favorable outcome rather than only using psychopharmacologic
intervention because most psychotherapeutic approaches follow a specified – more holistic –
scheme that starts with an attempt to stabilize the personality which seems to be important, as it is
indeed an established observation that patients with dissociative amnesia frequently have a more
fragile, insecure personality with low self-esteem. Furthermore, the use of psychopharmacological
and somatic treatments such as electroconvulsive therapy (ECT) has been successful in previous
trials however, in another case, ECT treatment precipitated an episode of persistent anterograde
dissociative amnesia which led the researchers to rely more on psychotherapeutic interventions
rather than psychopharmacological and somatic treatments. On the other hand, based on the study
about the psychotherapeutic intervention of Ivan Mangiulli et al.,(2021,) the result showed that
the majority (63.7%, n = 65/102) of people who reported having dissociative amnesia claimed to
have recovered their memories or specifically 58.5% (n = 38/65) recovered their memories by
talking to their family, friends, 30.8% (n = 20/65) spontaneously, 7.7% (n = 5/65) via
psychotherapy, and 3.1% (n = 2/65) due to sensory cues.
Does the study focus on the significant problem in clinical practice?

Yes, and as stated in some of the citations in the study. Despite the use of some
pharmacological treatments, some authors posited that skillful psychotherapeutic interventions
might assist in the recovery from dissociative amnesia or with the combination of psychotherapy
and psychopharmacological therapies (Staniloiu & Markowitsch, 2018).

IV. Methodology/Design

a. Methodology

In psychiatry and clinical psychology, dissociative amnesia is controversial.

This study surveyed a general population sample (N=1017) and discovered that
approximately one-tenth (102) of those who responded to the survey declared to
have experienced it. These claims concerned traumatic autobiographical
experiences, whereas other claims concerned memory loss for non-traumatic or
non-stressful experiences. An important finding was that many individuals had this
belief, which was higher than the sample average. Furthermore, many participants
indicated that they had at least once stated to have feigned cognitive problems in
their lives, as well as that they had experienced a certain kind of implicit memory
when attempting to recall events for which they lied.

b. Design

The survey of the study which was conducted in the English language, was
created with Qualtrics and distributed to participants via an internet link.
Participants completed the survey, which consisted of three major parts (a) self-
reports of amnesia, (b) acquired knowledge about memory loss, and dissociative
amnesia beliefs, and (c) reported feigned amnesia, after providing informed consent
and demographic information. Moreover, data information was gathered through
the concerning memory loss experience of the participants. The respondents'
responses were based on a 5-point Likert scale ranging from "strongly disagree"
(=1) to "strongly agree" (= 5). Thus, all respondents were thanked and debriefed
prior to their participation in the survey.

c. Setting

In the research paper, the setting of the place where the research was
conducted was not mentioned in the study. However, the research is an
experimental study done through a survey using Qualtrics. Hence, Qualtrics failed
to record the respondent’s MTurk location information. As a result, even though
the majority of MTurk users are from the United States and India (Caseu et al.,
2017; Paolacci et al., 2010), researchers cannot fully attribute the findings to a
specific population. Moreover, the survey was approved by the Ethics Review
Committee Psychology and Neuroscience of Maastricht University.
 d. Data sources

Prior to conducting the analysis of the study, the researchers categorized the
participants according to the causes of their reported amnesia based on their
responses. Researchers specifically categorized emotional shock or traumatic
events, stressful events, and physical causes (such as head damage) under the term
"organic." Additionally, where respondents offered over than a single response
comprising both organic and dissociative variables, they classed it underneath the
label "mix of both". However, take into consideration that they slightly departed
from the pre-registration, which means that they primarily examined frequency data
related to reports of pretended memory loss and dissociative amnesia claims.

e. Has the original study been replicated

The study is original research that was conducted by Mangiulli, I., Jelicic,
M., Patihis, L., and Otgaar, H. (2021), wherein original scientific results of the
study were correct that according to the findings of the study, claiming dissociative
amnesia is interchangeable with believing in dissociative amnesia.

f. What were the risks of the nursing actions/interventions test in the study?

The prevalence of the study about dissociative amnesia in the general

population must be mitigated by the reality that the self-reported memory
impairments can sometimes not be precise, and respondents may have trouble
attempting to estimate the length of time of their memory loss retrospectively.
However, it was stated in the study that they do not know whether the respondents
received treatment as a result of the nature of their memory deficit, or if they had
previously undergone therapy for other psychological problems prior to allegedly
retrieving the memories. Thus, it cannot be fully inferred a possible correlation
between the occurrence of emotional shocks or traumatic experiences and the onset
of amnesia in the respondents.

V. Results of the Study

The results of the study of Mangiulli, et al. (2021) consist of 3 parts. For the first
part of the study, under the category of Self-reports of amnesia, it was revealed that 40.8%
or 415 out of 1017 participants had experienced at least one episode of amnesia, and out of
those figures, it was suggested that men had a higher incidence of amnesia. In addition, the
study showed that 44.1% or 45 out of 102 patients who suffered from dissociative amnesia
experienced retrograde and anterograde memory issues. Furthermore, the results showed
that the majority of the participants who had dissociative amnesia experienced memory
loss for 2-6 days. Moreover, the investigation has shown that 63.7% of those with
dissociative amnesia recovered their memories, and the top contributing factor as to how
 they recovered their memories was through talking to their family and friends, followed by
spontaneity, psychotherapy, and last via sensory cues.

The second part of the study Acquired knowledge about memory loss, and
dissociative amnesia beliefs discussed how the participants learned about memory loss or
amnesia and their belief about it. The investigation revealed that 33.3% of the people who
have suffered from dissociative amnesia mostly learned about memory loss in their
school/university, 24.5% through the internet, 12.7% through movies, 11.8% via reading
newspapers/magazines, 1% by reading through novels/short stories, and 16.7% learned
about it with the use of two or more sources. Additionally, 65.1% of the participants believe
that people can develop amnesia if they experienced traumatic events during childhood and
62.3% concur that people with dissociative amnesia have their memories unconsciously
blocked for years before recovering them.

The third part of the investigation focused on the Reported feigned amnesia, and it
was found that 16.9% of the total participants confessed that they had feigned memory loss
(faking memory impairment) at least once in their life. Furthermore, 91.3% of the total
participants who admittedly committed feigned memory loss reports that they experienced
partial memory loss, whereas the remaining, had complete amnesia. In addition, 36% of
the participants committed feigning amnesia for a day, 23.8% for less than a day, and the
remaining figures feigned their memory loss for more than one day. Lastly, it was revealed
that 54.1% of the participants who admitted to feigning amnesia experienced memory
impairments after pretending that they have amnesia.

VI. Author’s Conclusions/Recommendations

a. What contribution to the client’s health status does the nursing action/intervention
make?

In the study of Mangiulli, et al. (2021), talking to a friend or family member

is one of the most important steps in recovering the memories of those with
dissociative amnesia. Additionally, psychotherapy is also another important
approach that could aid in the recovery of memory even though the study revealed
that only 7.7% or 5/65 participants claimed that this intervention has been useful
for them.

b. What overall contribution to nursing knowledge does the study make?

The overall contribution of the study to nursing knowledge is that the

investigation highlighted the importance of talking to a friend or family as a way to
recover one’s memory. So, as nurses, we must encourage the patient to converse
with their family/friends because this could be a helpful approach that could aid
them to recover their memories. Furthermore, it is also important that we suggest
to the patients undergo psychotherapy because this intervention might help in
stimulating the brain to recover the lost memories of the patient.
VII. Applicability

a. Does the study provide enough answer to your critical question in terms of type of
patients, interventions, and outcome?

Yes, according to the results of the study, the majority of 102 respondents
with dissociative amnesia, 65 of them, were able to recover their memories through
the three types of psychotherapeutic intervention such as (1) conventional therapy,
(2) hypnosis, or (3) Eye Movement Desensitization and Reprocessing (EMDR) that
are commonly used for stabilization of the individual's personality due to having
symptoms of becoming fragile, insecure, and having low self-esteem (Mangiulli, et
al. 2021). In addition, based on the study of Mangiulli (2021), several patients with
both organic and dissociative amnesia have successfully regained their purported
dissociative memories by simply having a conversation with relatives or friends.
Psychotherapeutic interventions focus primarily on therapeutic discussion for
enhancing their confidence and self-management while psychopharmacological
and somatic therapy approaches were not recommended and used rarely due to the
potential side effects of respiratory complications (Staniloiu & Markowitsch,
2018).

b. Is it feasible to carry out the nursing action in the real world?

Yes, according to the research of Staniloiu and Markowitsch (2018),

dissociative amnesia is caused by traumatic or stressful events, depending on the
type of amnesia: both retrograde and anterograde memory problems (44.1%
n=45/102), purely retrograde impairment (40.2% n=41/102), or anterograde
memory problems "continuous dissociative amnesia" (15.7% n=16/102).
Dissociative amnesia is said to be common due to traumatic experiences such as
(1) assault, (2) sexual abuse, (3) war combat, (4) or sudden death of the family
(Staniloiu and Markowitsch 2018). Psychotherapy intervention is widely utilized
to encourage individuals to speak with their therapists in order to assist them cope
with their situations through the use of therapeutic communication. In a modern
approach, psychotherapeutic intervention with patients who have dissociative
amnesia does not focus on reinstating their retrograde/anterograde memories, but
rather helps the patient recover by boosting their confidence, express their feelings,
and teaching them self-management for their future well-being (Staniloiu &
Markowitsch 2018). Instead of encouraging the patient to recall his/her miseries,
the study indicates that it is preferable to teach him how to build a bright future for
himself and incorporate future perspectives into his/her everyday life.
VIII. Reviewer’s Conclusion/Commentary

Dissociative amnesia is a serious condition in which an individual suddenly

forgets certain things, experiences, and who they are due to “traumatic
experiences." Thus, in the stage of dissociative amnesia, talking with family and
friends can recall purported memories (Mangiulli, et al. 2021). Psychotherapeutic
intervention is more effective and widely used than psychopharmacologic
intervention since it stabilizes the patient's personality with the assistance of the
therapist. Moreover, individuals with dissociative amnesia are frequently fragile,
insecure, and have low self-esteem; therefore, either (1) conventional therapy, (2)
hypnosis, or (3) Eye Movement Desensitization and Reprocessing (EMDR) can
help to recall their memories. At first, psychopharmacologic intervention and
somatic treatments such as electroconvulsive therapy (ECT) were successful to
treat amnesias, but after a few cases, ECT caused an episode of persistent
anterograde dissociative amnesia and also has side effects that causes respiratory
problems in the patient (Staniloiu and Markowitsch 2018). As a result,
pharmacologic intervention and somatic treatments were rarely used.

IX. Evaluating Nursing Care Practices

a. Safety

The competence of nurses to guarantee patient safety depends on their

vigilant nature. There are very few reliable statistics on the number of persons who
were able to recall their past. While looking at how people regained their memories,
psychotherapist therapies aided the safety of the patients in a minority of the cases,
precisely in 7.7-11% percent of subjects who reported having both biological
memory loss and dissociative amnesia, or this latter problem alone. The process of
restoring participants' ostensibly dissociated memories may entail
psychotherapeutic orientations (for example, attachment-based therapy). To restore
participants' purportedly dissociated memories, psychotherapeutic orientations
(such as attachment-based therapy) may be used.

b. Competence of the care provider

The patient needs it’s possible that purportedly dissociated participant

memories will be restored using psychotherapeutic philosophies (such as
attachment-based treatment). The intervention was carried out using hypnotic
techniques and psychotherapy intervention, and the researchers made sure that the
participants learned about both organic and dissociative memory loss.
c. Acceptability

To assist people with dissociated amnesia regain their memories,

conversing with family or friends was acknowledged as a specific treatment.
 Contrarily, in this study researchers classified the organic and dissociative factors,
as a "combination of both" with standard care has given a positive result and
primarily analyzed frequencies and improved the well-being of those patients who
have dissociative amnesia claims as well as reports of feigned memory loss.

d. Effectiveness

Whereas the study demonstrates the efficacy of various pharmaceutical

therapies, several authors suggested that recovery from dissociative amnesia might
be aided by good psychosocial sessions. Concerning those individuals, the
interventions range from "soft suggestion" to hypnotic methods. Before supposedly
retrieving memories, researchers may have already demonstrated the effectiveness
of various forms of therapy for psychological problems.

e. Appropriateness

This research confirms what is acceptable in response to both organic and

dissociative elements, and it classified them under the heading "combination of
both" in order to provide the right care and therapies for patients who have
dissociative amnesia. Researchers in this study also looked into the best ways for
the patients' appropriate safety and recovery (such as talking to family and/or
friends, discussing the memory during psychotherapy, or acting spontaneously,
using visual, verbal, or other sensory clues).

f. Efficiency

The psychotherapeutic and hypnotic techniques (specifically the talking to

family and/or friends therapy) intervention is efficient because it can be used as the
most effective treatment for people suffering from dissociative amnesia. It can help
the patients be guided through a process to induce a trance-like state that helps them
focus their minds, respond more readily to suggestions, and become deeply relaxed.
All of the participants can improve their self through the interventions.