The role of trauma and dissociation in cognitive-behavioral psychotherapy outcome and maintenance for panic disorder with agoraphobia

Michelson, Larry; June, Kimberly; Vives, Allan; Testa, S. Marc; Marchione, Norman

doi:10.1016/s0005-7967(98)00073-4

Cited by 87 publications

(82 citation statements)

References 79 publications

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“…11 It is plausible that dissociative features such as disturbed consciousness or memory hamper learning and thereby impede the effectiveness of therapies that rely on learning (e.g., cognitive restructuring and exposure). 12,13 Recently, both clinical 13 and experimental research involving patients with BPD yielded empirical support for this hypothesis that links dissoci ation to psychotherapy response. Ebner-Priemer and colleagues 14 conducted a differential aversive Pavlovian delay conditioning procedure in patients with BPD to investigate the impact of acute dissociative states on emotional learning processes.…”

Section: Introductionmentioning

confidence: 99%

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

109

113

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Background: Stress-induced dissociative states involving analgesia are a common feature of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Our aim was to investigate the psychologic, somatosensory (pain sensitivity) and neural correlates of dissociative states in patients with these disorders. Methods: We included 15 women with BPD who were not taking medication; 10 of these women had comorbid PTSD. While undergoing functional magnetic resonance imaging at 1.5 Tesla, participants were exposed to a script describing a personalized dissociation-inducing situation and a personalized script describing a neutral situation. We assessed dissociative psychopathology and pain sensitivity. Results: Dissociative psychopathology scores were significantly higher and pain sensitivity was lower after the dissociation-inducing script was read compared with the neutral script. The blood oxygen level-dependent (BOLD) signal was significantly increased in the left inferior frontal gyrus (Brodmann area [BA] 9) during the presentation of the dissociationinducing script. Regression analyses revealed positive correlations between BOLD signal and dissociative psychopathology in the left superior frontal gyrus (BA 6) and negative correlations in the right middle (BA 21) and inferior temporal gyrus (BA 20). In the subgroup of participants with comorbid PTSD, we also found increased activity in the left cingulate gyrus (BA 32) during script-driven imagery-induced dissociation, a positive correlation between dissociation scores and activity in the right and left insula (BA 13) and a negative correlation in the right parahippocampal gyrus (BA 35). Limitations: The main limitation of this pilot study is the absence of a control group. Therefore, the results may also reflect the neural correlates of non-BPD/PTSD specific dissociative states or the neural correlates of emotionally stressful or "loaded" memories. Another limitation is the uncorrected statistical level of the functional magnetic resonance imaging results. Conclusion: Our results showed that the script-driven imagery method is capable of inducing dissociative states in participants with BPD with and without comorbid PTSD. These states were characterized by reduced pain sensitivity and a fronto limbic activation pattern, which resembles the findings in participants with PTSD while in dissociative states.

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Section: Introductionmentioning

confidence: 99%

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Ludäscher

Valerius

Stiglmayr

et al. 2010

jpn

109

113

View full text Add to dashboard Cite

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“…In the comorbidity group, scores obtained at admission and at discharge showed significant differences except for 9th (agitation), 11th (somatic anxiety), 15th (hypochondriasis), 16th (weight loss) and 17th (insight about the condition) items. Dissociative psychopathology seems to be an important predictor for poor treatment response and high relapse rates, at least in patients with panic and obsessive-compulsive disorders (40,41). A concurrent dissociative disorder more generally predicted higher psychiatric comorbidity, including somatization disorder, dysthymic disorder, major depression, borderline personality disorder, self-destructive behavior, suicide attempts, and childhood trauma (48).…”

Section: Discussionmentioning

confidence: 99%

Yatarak Tedavi Gören Bipolar Bozukluk Hastalarında Dissosiyatif Bozukluk Eştanısı Olan ve Olmayan Hasta Gruplarının Karşılaştırılması

Bakım

Baran

Güleken³

et al. 2016

Aile Hekimliği Ve Palyatif Bakım

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Introduction: This study aims to compare sociodemographic characteristics of the patients with bipolar disorder (BD) with and without comorbid dissociative disorder (DD) and to investigate the eventual effect of the comorbidity on the treatment. Methods:We enrolled a total of 149 patients diagnosed with BD and treated as inpatients consecutively in Şişli Etfal Hospital, Psychiatry Clinic between 2010 and 2011. For the patients who were diagnosed with DD using SCID-D and with BD using SCID-I, sociodemographic characteristics, YMRS, HAM-D, BPRS, DES scores and duration and number of hospital stays were evaluated. Results: 23 patients (15.4%) had dissociative disorder not otherwise specified (DD-NOS), 4 patients (2.6%) had dissociative identity disorder (DID) and 1 patient (0.6%) had dissociative amnesia. BD patients with comorbid DD were found to be predominantly female (p=0.015) and younger (p=0.002) and to have significantly higher DES scores than BD patients without DD (p<0.001). The total score of DES was correlated with duration hospital stay (p=0.001, Spearman r=0.336) in the total sample. Total HAM-D score at the time of admission was significantly higher in the comorbidity group (p=0.027), and suicide item was found to be significantly higher both at admission and at discharge (p<0.001 and p=0.035). Among BPRS scores at admission, hallucinatory behavior item was found to be higher in the comorbidity group (p=0.019). Among YMRS scores both at admission and at discharge, velocity and amount of speech item (p=0.027) and insight item at admission (p=0.006) was found to be significantly higher in the pure bipolar group (p=0.018). Conclusion:In patients with BD, DD comorbidity should be investigated. The BD patients with DD comorbidity tend to be female and younger, and show higher depression scores, leading to a prolonged hospital stay. In the presence of dissociation comorbidity, attempts and number of suicides and hallucinatory behaviors seem to be increased.

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“…Esses dados sugerem uma relação entre o tratamento bem-sucedido do TEPT e a redução dos sintomas de dissociação, apesar de o protocolo não ter tido como foco o tratamento dos sintomas dissociativos. Tal resultado se contrapõe a estudos em que a TCC não foi efi caz para a redução dos sintomas dissociativos presentes em outros transtornos 25,26 .…”

Section: Discussionunclassified

Marcadores neurobiológicos e psicométricos da eficácia da terapia cognitivo-comportamental no transtorno de estresse pós-traumático associado a sintomas dissociativos: relato de caso

Lages

Norte

Pedrozo

et al. 2011

Rev. psiquiatr. Rio Gd. Sul

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Marcadores neurobiológicos e psicométricos da efi cácia da terapia cognitivo-comportamental no transtorno de estresse pós-traumático associado a sintomas dissociativos: relato de caso ResumoIntrodução: O transtorno de estresse pós-traumático (TEPT) tem sido associado à desregulação de diversos parâmetros psicofi siológicos e pode apresentar comorbidade com diversas psicopatologias, inclusive a dissociação, podendo difi cultar o tratamento. O objetivo do presente trabalho foi investigar os efeitos da terapia cognitivo-comportamental em um paciente com TEPT e sintomas dissociativos com base em medidas psicofi siológicas e psicométricas em diferentes momentos do tratamento. Descrição do caso: O paciente é um homem de 38 anos, com diagnósticos de TEPT e transtorno depressivo maior recorrente com sintomas dissociativos e resistência ao tratamento farmacológico. O tratamento psicoterápico teve duração de 4 meses, sendo composto por uma sessão semanal de terapia e três sessões semanais de coterapia. Os parâmetros fi siológicos (frequência cardíaca, tônus vagal, balanço simpático e cortisol) e psicométricos (afeto negativo e positivo, resiliência e sintomas de estresse pós-traumático, depressão, ansiedade e dissociação) foram medidos antes, durante (uma vez ao mês) e após o tratamento. Comentários: Os resultados mostraram diminuição do balanço simpático e aumento do tônus vagal, da frequência cardíaca e dos níveis de cortisol ao longo do tratamento. O tratamento também promoveu redução no afeto negativo e nos sintomas de estresse pós-traumático, depressão, ansiedade e dissociação, além de um aumento nos escores de resiliência, apoio social e afeto positivo. Esses resultados sugerem que a terapia cognitivocomportamental é um tratamento efi caz para o TEPT com sintomas dissociativos. Além disso, parece promover a normalização das alterações fi siológicas do sistema nervoso autônomo e neuroendócrino relacionadas ao TEPT. Descritores: Transtornos de estresse pós-traumáticos, psicofi siologia, transtornos dissociativos, psicometria. AbstractIntroduction: Post-traumatic stress disorder (PTSD) has been associated with dysregulation of many psychophysiological parameters and may present comorbidity with different psychopathologies, including dissociation, potentially affecting treatment outcome. The aim of this study was to evaluate the effects of cognitive behavioral therapy in a patient with PTSD and dissociative symptoms based on psychophysiological and psychometric measures at different time points throughout the course of treatment. Case description: Our patient is a 38-year old man diagnosed with PTSD, major depression, and dissociative symptoms, resistant to pharmacotherapy. Psychological treatment lasted for 4 months and consisted of one weekly therapy session and three weekly coaching sessions. Physiological (heart rate, vagal tone, sympathovagal balance, and cortisol) and psychometric measures (negative and positive affect, resilience, and post-traumatic stress, depression, anxiety, and dissociative symptoms) were ob...

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The role of trauma and dissociation in cognitive-behavioral psychotherapy outcome and maintenance for panic disorder with agoraphobia

Cited by 87 publications

References 79 publications

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Pain sensitivity and neural processing during dissociative states in patients with borderline personality disorder with and without comorbid posttraumatic stress disorder: a pilot study

Yatarak Tedavi Gören Bipolar Bozukluk Hastalarında Dissosiyatif Bozukluk Eştanısı Olan ve Olmayan Hasta Gruplarının Karşılaştırılması

Marcadores neurobiológicos e psicométricos da eficácia da terapia cognitivo-comportamental no transtorno de estresse pós-traumático associado a sintomas dissociativos: relato de caso

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