Dalenberg et al. (2012) argued that convincing evidence (a) supports the longstanding trauma model (TM), which posits that early trauma plays a key role in the genesis of dissociation; and (b) refutes the fantasy model (FM), which posits that fantasy proneness, suggestibility, cognitive failures, and other variables foster dissociation. We review evidence bearing on Dalenberg et al.'s 8 predictions and find them largely wanting in empirical support. We contend that the authors repeat errors committed by many previous proponents of the TM, such as attributing a central etiological role to trauma in the absence of sufficient evidence. Specifically, Dalenberg et al. leap too quickly from correlational data to causal conclusions, do not adequately consider the lack of corroboration of abuse in many studies, and underestimate the relation between dissociation and false memories. Nevertheless, we identify points of agreement between the TM and FM regarding potential moderators and mediators of dissociative symptoms (e.g., family environment, biological vulnerabilities) and the hypothesis that dissociative identity disorder is a disorder of self-understanding. We acknowledge that trauma may play a causal role in dissociation but that this role is less central and specific than Dalenberg et al. contend. Finally, although a key assumption of the TM is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma-dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorders.Keywords: dissociation, dissociative disorder, dissociative identity disorder, trauma, sociocognitive modelThe notion that people dissociate to cope with trauma has its roots in the writings of Janet (1889/1973). This trauma model (TM) remains influential among some clinical scholars (e.g., Dalenberg et al., 2012), who contend that trauma is the key player in the genesis of dissociation. Nevertheless, as we discuss later, advocates of the TM have often neglected to articulate trauma's precise role in the cause of dissociation. Critics of the TM (e.g., Giesbrecht, Lynn, Lilienfeld, & Merckelbach, 2008, 2010Lynn, Lilienfeld, Merckelbach, Giesbrecht, & van der Kloet, 2012;Pope & Hudson, 1995) Correspondence concerning this article should be addressed to Steven Jay Lynn, Psychology Department, Binghamton University (SUNY), Binghamton, NY 13902. E-mail: stevenlynn100@gmail.com This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.Psychological Bulletin © 2014 American Psychological Association 2014 0033-2909/14/$12.00 DOI: 10.1037/a0035570 896 etiology of dissociation and dissociative disorders. 1 An early alternative to the TM, the sociocognitive model (SCM; Lili...

There is considerable interest in developing complementary and integrative approaches for ameliorating posttraumatic stress disorder (PTSD). Compassion meditation (CM) and loving-kindness meditation appear to offer benefits to individuals with PTSD, including symptom reduction. The present study was a pilot randomized controlled trial of CM for PTSD in veterans. The CM condition, an adaptation of Cognitively-Based Compassion Training (CBCT R ), consists of exercises to stabilize attention, develop present-moment awareness, and foster compassion. We compared CM to Veteran.calm (VC), which consists of psychoeducation about PTSD, rationale for relaxation, relaxation training, and sleep hygiene. Both conditions consist of 10 weekly 90-min group sessions with between-session practice assignments. A total of 28 veterans attended at least one session of the group intervention and completed pre-and posttreatment measures of PTSD severity and secondary outcomes as well as weekly measures of PTSD, depressive symptoms, and positive and negative emotions. Measures of treatment credibility, attendance, practice compliance, and satisfaction were administered to assess feasibility. A repeated measures analysis of variance revealed a more substantive reduction in PTSD symptoms in the CM condition than in the VC condition, between-group d = −0.85. Credibility, attendance, and satisfaction were similar across CM and VC conditions thus demonstrating the feasibility of CM and the appropriateness of VC as a comparison condition. The findings of this initial randomized pilot study provide rationale for future studies examining the efficacy and effectiveness of CM for veterans with PTSD.

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Elisabeth Barnes (a pseudonym) is quiet, retired, and 60 years of age; she lives alone in a small but comfortable A-frame home near Castleton, Vermont. Elisabeth is a deeply private person, is a good cook, and describes herself as an "arts-and-craftsy" person. One evening, on a small road she drove as a short-cut to her home, she recalls noticing a bright light in the sky. At first she thought it was a meteorite. When the light looked like a "dime on its side," Elisabeth felt very tired, pulled off the road, and fell asleep. She awoke some time later and, after she arrived at her home and watched her favorite television program, she realized she had experienced two hours of "missing time" she could not account for. She also complained of coughing and a strange itching feeling all over her body. About a week later, Elisabeth saw a television program about an elderly woman who was abducted by aliens. The woman was hypnotized by government agents to recall the experience. Ms. Barnes immediately identified with the woman in the program who experienced a puzzling episode of "missing time" in conjunction with her abduction. Her curiosity piqued, Ms. Barnes spoke with several of her friends and followed their suggestion to contact a lay-hypnotist in her community. The hypnotist immediately agreed to use hypnosis to help Elisabeth recover memories of what she surmised was her possible abduction by aliens.

Objective The aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain. Design Longitudinal. Setting Veterans Affairs San Diego Healthcare System. Subjects A total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83). Methods Linear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up. Results Participants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels. Conclusions PTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.

Ms. Jessica White (a pseudonym) is a quiet, retired lady of 60 years who lives alone in her small home near Lake Placid, New York. One morning she experienced a horrifying nightmare in which she felt a "creature" with cold hands and large eyes pressing down on her with a suffocating and paralyzing force. She tried to move, but her body did not respond; in fact, she had the strange sense that her consciousness was out of her body, watching her rendered helpless. She tried to scream, but words would not escape her mouth. She heard humming and strange noises and experienced an eerie sense that other creatures were nearby, watching in a cold, detached way. The feeling that she was somehow violated, surely emotionally, possibly physically, lingered throughout the day and returned in what she called "flashbacks" during the week.The only stories to which Jessica could relate her bizarre experience were accounts she had read about people abducted by aliens. Perhaps that

We confirmed that OEF/OIF/OND veterans seeking PTSD treatment experience PTSD-related problems in romantic relationships, low-relationship satisfaction, and relationship satisfaction was positively associated with perceived communication and problem-solving skills. A minority of veterans were interested in involving significant others in their PTSD treatment; however, in the present study, veterans were not given information about the various ways that a romantic partner might be involved in treatment, and they were not presented with specific conjoint therapies (e.g., Cognitive-Behavioral Conjoint Therapy for PTSD, Strategic Approach Therapy). For veterans with PTSD, relationship distress, and communication difficulties, conjoint psychotherapies may offer a way of increasing engagement in PTSD treatment by parsimoniously addressing multiple treatment targets at once (PTSD symptoms, relationship distress, communication problems) and providing veteran-centered care.

Background Pregnant veterans are a subpopulation known to be at elevated risk of developing mental health symptoms, such as depression and suicidal ideation. Inflammation has been associated with depression, specifically during the perinatal period. Critical changes in estradiol, cortisol, and inflammatory cytokines are necessary for the progression of a healthy pregnancy, which are then rapidly altered in the postpartum period. We explored changes in estradiol, cortisol, and pro-inflammatory cytokines relative to depressive symptoms and suicidal thoughts across pregnancy and postpartum in this pilot and feasibility study. Methods We measured estradiol, cortisol, and the inflammatory cytokines IL-1β, IL-6, IL-8, IFN-γ, and TNF-α in 18 pregnant veterans and analyzed the data using descriptive statistics, dependent t-tests, and correlation analyses. We assessed depression severity with the Edinburgh Postnatal Depression Scale and suicidality with the Columbia-Suicide Severity Rating Scale. Thirteen of the women repeated assessments in the early postpartum period at an average of 6.7 weeks after birth. Results As anticipated, estradiol ( t (12) ​= ​12.47, p ​< ​.001) and cortisol ( t (12) ​= ​9.43, p ​< ​.001) significantly decreased from pregnancy to postpartum. There were no differences in the means of gestational and postpartum IL-1β, IL-6, TNF-α, or IFN-γ, but IL-8 was significantly increased from pregnancy to postpartum ( t (12) ​= ​−4.60, p ​= ​.001). Estradiol during pregnancy was positively correlated with IL-6 levels both during pregnancy ( r p ​= ​.656, p ​= ​.008) and postpartum ( r ​= ​0.648, p ​= ​.023). Elevated IL-1β was associated with suicidal thoughts during pregnancy ( r ​= ​0.529, p ​= ​.029). Although not statistically significant, depressive symptom severity trended towards a positive association with larger increases in IL-1β ( r ​= ​0.535, p ​= ​.09) and TNF-α ( r ​= ​0.501, p ​= ​.08) from pregnancy to postpartum. Conclusion This preliminary study suggests the feasibility of our approach for exploring a complex interplay between hormonal and pro-inflammatory changes from pregnancy to postpartum, and their relationship with depressive symptoms. Given our small sample and the relatively exploratory nature of our analyses, additional investigation focusing on hormonal and inflammatory changes and their potential associations with perinatal mental health is necessary to confirm and extend our preliminary findings and examine additional potential cova...