Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial

Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD

“…However, the magnitude of this effect was very small, which led the authors to conclude that exposure therapy is indeed effective in dissociative symptoms. These findings are consistent with the results of a secondary analysis of a treatment study of narrative exposure therapy (NET) and treatment as usual among severely traumatized asylum seekers and refugees, which showed that DS did not substantially moderate the treatment outcomes (Halvorsen, Stenmark, Neuner, & Nordahl, 2014). A recent study replicated these findings by generalizing the results to individuals with a severe psychiatric condition and performing a secondary analysis of a randomized clinical trial comparing prolonged exposure with EMDR therapy among PTSD patients with psychosis (van den Berg et al, 2015; van Minnen et al, 2016).…”

“…Although further research about the specific role that physical activity plays in our treatment programme is needed, it should be noted that the results are consistent with a number of recent studies that did not incorporate any physical activity within their treatment. For example, those with women undergoing Cognitive Processing Therapy (CPT; Resick et al, 2012), female veterans and active duty service members undergoing Prolonged Exposure (PE; Wolf et al, 2016), individuals suffering from psychosis of schizophrenia who were treated with PE or EMDR Therapy (van Minnen et al, 2016) and asylum seekers and refugees who received NET (Halvorsen et al, 2014). The latter study demonstrated that 50% of the patients with severe derealization, and 50% showing severe depersonalization at pre-treatment, achieved clinically significant change in their CAPS total scores following treatment (Halvorsen et al, 2014).…”

“…For example, those with women undergoing Cognitive Processing Therapy (CPT; Resick et al, 2012), female veterans and active duty service members undergoing Prolonged Exposure (PE; Wolf et al, 2016), individuals suffering from psychosis of schizophrenia who were treated with PE or EMDR Therapy (van Minnen et al, 2016) and asylum seekers and refugees who received NET (Halvorsen et al, 2014). The latter study demonstrated that 50% of the patients with severe derealization, and 50% showing severe depersonalization at pre-treatment, achieved clinically significant change in their CAPS total scores following treatment (Halvorsen et al, 2014). Interestingly, our results mimicked the findings of van Minnen et al (2016) who also found that individuals with DS reported significantly greater PTSD symptom severity at the beginning, while this difference remained constant throughout treatment.…”

“…Secondly, the sample was dichotomized into either fulfilling DSM-5 criteria of a dissociative subtype or not, whereas no separate measures pertaining to dissociative features were included in the current study. Although derealization and depersonalization were indexed using the same items from CAPS as used in most previous research (Armour, Karstoft, & Richardson, 2014; Halvorsen et al, 2014; Wolf et al, 2012, 2016), the inclusion of a more elaborate measure of dissociative phenomena, such as the Multiscale Dissociation Inventory (Briere, 2002), would allow for a more in-depth analysis of gradations and alterations in dissociative symptoms. Thirdly, it could be considered a methodological weakness to not include an analysis on the follow-up data.…”

Exploring Outcome Predictors in UK Veterans Treated for PTSD

“…The role of dissociation is intriguing and is supported by theoretical assumptions about there being a dissociative subtype of PTSD (Wolf, Lunney, Miller, Resick, Friedman, & Schnurr, 2012;Wolf, 2013;Lanius, Brand, Vermetten, Frewen, & Spiegel, 2012). However, this finding contrasts with recent research, not restricted to military samples, that appears to suggest that dissociation does not predict treatment outcomes (Halvorsen, Stenmark, Neuner, & Nordahl, 2014;Cloitre, Petkova, Wang, & Lu, 2012;Hagenaars, van Minnen, & Hoogduin, 2010). Whilst differences exist between the findings of these studies, it appears that higher levels of co-morbid mental health difficulties predict worse treatment outcomes for symptoms of PTSD in veterans.…”