Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

Hoeboer, Chris M.; Kleine, Rianne A. de; Molendijk, Marc L.; Schoorl, Maartje; Oprel, Danielle; Mouthaan, Joanne; Does, A.J.W. van der; Minnen, Agnes van

doi:10.1192/bjo.2020.30

Cited by 43 publications

(36 citation statements)

References 48 publications

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“…These findings are in line with studies on psychological dissociative symptoms (see [ 7 ]), in that dissociative symptoms do not seem to have a significant impact on the decrease in PTSD symptoms when trauma-focused therapy is administered without treating dissociative symptoms first. To our knowledge, this is the first study that extends these meta-analytic findings to somatoform dissociation.…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, other studies found that dissociative symptoms did not predict trauma-focused treatment efficacy [ 5 , 6 ]. A recent meta-analysis showed that dissociation had no significant effect on treatment outcome, and that the impact of dissociation was about zero [ 7 ]. Additionally, some studies found that direct trauma-focused therapy actually led to a decrease in dissociative symptoms, e.g., [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD

Zoet¹,

Jongh

Minnen

2021

JCM

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For patients with complex or other severe forms of PTSD, particularly in cases with dissociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post-treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD

Zoet¹,

Jongh

Minnen

2021

JCM

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“…The participants in this study were gender-matched and shown to be a homogeneous group with no significant differences in pathology and trauma experiences between the age groups, with the exception of the dissociative subtype of PTSD, which was less prevalent in older adults, yet a similar outcome was also found in a previous study [ 45 ]. However, a recent meta-analysis found no evidence that dissociation symptoms moderate the effectiveness of psychotherapy for PTSD [ 46 ]. Another strength of the study was the use of common PTSD assessments and manualized, empirically-based treatment protocols with secured treatment fidelity, by supervision.…”

Section: Discussionmentioning

confidence: 99%

Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults

Gielkens

Jongh

Sobczak

et al. 2021

JCM

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Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60–78 years) and 62 younger PTSD patients (19–58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).

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“…These findings are in line with some other NET studies and other TFT studies. 17,56,58 Also, a meta-analysis on the effect of dissociation suggests that pre-treatment dissociation does not determine trauma-focused psychotherapy outcomes in PTSD. 58 SMI symptoms were assessed with generic measures to allow for comparisons across diagnostic groups.…”

Section: Main Findingsmentioning

confidence: 99%

“…17,56,58 Also, a meta-analysis on the effect of dissociation suggests that pre-treatment dissociation does not determine trauma-focused psychotherapy outcomes in PTSD. 58 SMI symptoms were assessed with generic measures to allow for comparisons across diagnostic groups. 59 The coherence of the SMI outcomes was low: a slight improvement in SMI was seen based on HoNOS, there were no significant changes in perceived care needs (CAN) and quality of life (MANSA) based on self-reporting, and care providers concluded that global functioning (GAF) was significantly increased.…”

Section: Main Findingsmentioning

confidence: 99%

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder

et al. 2020

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Background Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. Aims We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. Method The study had a single-group, pre-test–post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months’ follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. Results The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (−6.0 difference, 95%CI −10.0 to −2.0), and decreased further to 24.5 at T2 (−13.4 difference, 95%CI −17.4 to −9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. Conclusions NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.

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Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis

Cited by 43 publications

References 48 publications

Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD

Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD

Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults

Treating patients with severe mental illness with narrative exposure therapy for comorbid post-traumatic stress disorder

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