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Katherine L Hilton, LPC Mississippi College Evidence Based Practice Evidence Based Practices (EBPs) (Chambless, 1998; Gertlehner, Hasenc, & Nissman, 2006) Applying EBP Starts with Effective Assessment (Byng, 2012; Caldwell, Bennett, & Mellis, 2012; Rice, 2013) Assessment Difficult with complex clinical presentations (Ellason, Ross, & Fuchs, 1996) Trauma (Lamagna & Gleiser, 2007; Sprang, Craig, & Clark, 2007) Something May be Missing… (International Society for the Study of Trauma and Dissociation [ISSTD], 2011) Dissociation a disruption in typically integrated mental functioning of experience, especially in regards to consciousness, memory, identity, or perception (APA, 2000, p. 519) 50%- 65% in a lifetime – (APA, 2013; Ross, Joshi, & Currie, 1990) “A normal process that is… used defensively by an individual to handle traumatic experiences”(Putnam, 1989, p. 9) Types of Dissociation Depersonalization & Derealization Identity Disruption DID “Unreality or Detachment” Not delusional Dissociative Amnesia Localized Selective Generalized (APA, 2013; Schauer & Elbert, 2010) Maladaptive Dissociation Dissociative Disorder Characteristic of a Trauma-Related Disorder Co-occurring Symptom Dissociative Disorders Depersonalization/ Derealization Disorder Dissociative Identity Disorder 50% - One Episode 2% - Lifetime prevalence 1.5% - Lifetime prevalence Dissociative Amnesia Disorder 1.8% in a given year (APA, 2013) Dissociation in Other Disorders Borderline Personality Disorder Dissociative experiences Disruption of identity Post-Traumatic Stress Disorder Flashbacks Specifier (APA, 2013) Co-Occurring Disorders Somatization Disorder/ Somatic Symptom Disorder (Brown, Schrag, & Trimble, 2005) OCD (Hollander & Benzaquen, 1997) Social Anxiety (Fontonelle et al., 2007) Panic Disorder (Pfaltz, Michael, Meyer, & Wilhelm, 2013) Bulimia Nervosa & Binge Eating (Hallings-Pott, Waller, Watson, & Scragg, 2005) Depression (Hagenaars, van Minnen, & Hoogduin, 2010) Schizophrenia (Braehler et al., 2013) Effect on Treatment “poses a serious obstacle to successful treatment” (Schauer & Elbert, 2010, p. 109) OCD & Dissociation - Rufer et. al (2006) 52 participants, CBT treatment Baseline DES scores positively correlated with… Earlier Termination Lack of Treatment Response OCD Symptoms Post-Treatment Effect on Treatment Borderline personality disorder (Kleindienst et al., 2011) 57 clients; 3 months of DBT Agoraphobia with panic (Michelson et al., 1998) 89 clients; CBT treatment Inpatient treatment for non-psychotic disorders (Spitzer et al., 2007) 133 clients; short-term CBT psychotherapy Statement of Problem The problem of this literature review is to identify and describe the effects of dissociation on treatment outcome. An additional concern is to identify specific disorders and their treatments that are the most impacted by dissociation. Significance Results could improve screening and assessment Recommendations for improving course of treatment and outcome for co-occurring disorders Research Questions 1. What effects does dissociation have on treatment outcomes? 2. Does dissociation negatively influence treatments for certain co-occurring disorders? 3. How could screening for dissociation improve treatment of co-occurring disorders? Method Systematic Literature Review Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement PRISMA Checklist PRISMA Flowchart Method 1980 – 2014 Databases: PscyhINFO PscyhARTICLES Sage Premier SocINDEX Wiley Online Library Reference Lists Specific Journals e.g. Journal of Trauma and Dissociation Dissociation Search Terms Treatment Co-occurring Disorders Dissociation Treatment Comorbidity Dissociative Outcome Co-occurring Disorders Dissociate Efficacy Post-traumatic Stress Disorder Depersonalization Effectiveness Borderline Personality Disorder Derealization Course of Treatment Obsessive-Compulsive Disorder Identity disruption Drop-Out Anxiety Disorder Premature Termination Panic Disorder Treatment Response Eating Disorder Post-Treatment Symptoms Bulimia Nervosa Depression Schizophrenia Inclusion Criteria Psychometric assessment(s) that have proven validity and reliability Subscales or items from other assessments (e.g., Briere, 1995) Structured Clinical Interview for DSM–IV Dissociative Disorders– Revised (SCID-D-R; Steinberg, 1994) Multidimensional Inventory of Dissociation (MID; Dell, 2006) Dissociative Experiences Scale (DES; Bernstein & Putnam, 1993) Dissociative Disorders Interview Schedule (DDIS; Ross et al., 1989) Exclusion Criteria Non-English Non-peer reviewed Focus of Treatment is a Dissociative Disorder Definition of Terms Dissociation - “a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, motor control, and behavior” (APA, 2013, p. 519) Dissociation - Not inherently pathological Definition of Terms Depersonalization –”the experience of unreality or detachment from one’s mind, self, or body”(APA, 2013, p. 291) Derealization – “the experience of unreality or detachment from ” (APA, 2013, p. 291) the environment Dissociative amnesia –the “inability to recall autobiographical information that is inconsistent with normal forgetting” (APA, 2013, p. 291) Definition of Terms Treatment - any number of interventions in the counseling and psychotherapy field Treatment Outcome changes made and/or maintained throughout treatment that can be reasonably attributed to the treatment Remainder of Study Chapter 2 1. Theories of development 2. Current views on how dissociation operates 3. Common cooccurring disorders 4. Available assessment procedures and treatments Chapter 3 Methodology Procedures Chapter 4 Literature Review Chapter 5 Implications References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Barlow, M. R., & Freyd, J. F. (2009). Adaptive dissociation: Information processing and response to betrayal. In P. F. Dell & J. A. O’Neil (Eds.). The Dissociative Disorders: DSM-V and Beyond (pp. 93-106). New York, NY: Routledge. Bernstein, E. M., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation, 6, 16–27. References Bonanno, G. A., Keltner, D., Holen, A., & Horowitz, M. J. (1995). When avoiding unpleasant emotions might not be such a bad thing: Verbal-autonomic response dissociation and midlife conjugal bereavement. Journal of Personality and Social Psychology, 69(5), 975-989. Braehler, C., Valiquette, L., Holowka, D., Malla, A. K., Joober, R., Ciampi, A., & ... King, S. (2013). Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls. Psychiatry Research, 210(1), 36-42. doi:10.1016/j.psychres.2013.05.033 Briere, J. (1995). Trauma Symptom Inventory (TSI) Professional Manual. Odessa, FL: Psychological Assessment Resources. Brown, R. J., Schrag, A., & Trimble, M. R. (2005). Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. American Journal of Psychiatry, 162, 899-905. References Byng, R. (2012). Care for common mental health problems: Applying evidence beyond RCTs. Family Practice, 29(1), 3-7. doi:10.1093/fampra/cmr132 Caldwell, P., Bennett, T., & Mellis, C. (2012). Easy guide to searching for evidence for the busy clinician. Journal Of Paediatrics And Child Health, 48(12), 1095-1100. doi:10.1111/j.1440-1754.2012.02503.x Chambless, D. L. & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18. Dell, P. F. (2006). The Multidimensional Inventory of Dissociation (MID): A comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation, 7(2), 77–106. References Dell, P. F. (2009). Understanding dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 709-825). New York, NY: Routledge. Ellason, J. W., Ross, A. C., & Fuchs, D. L. (1996). Lifetime axis I and axis II comorbidity and childhood trauma history in dissociative identity disorder. Psychiatry: Interpersonal and Biological Processes, 59, 255-266. Fontenelle, L. F., Domingues, A. M., Souza, W. F., Mendlowicz, M. V., de Menezes, G. B., Figueira, I. L., & Versiani, M. (2007). History of trauma and dissociative symptoms among patients with obsessive-compulsive disorder and social anxiety disorder. Psychiatric Quarterly, 78(3), 241250. doi:10.1007/s11126-007-9043-1 Freyd, J. J. (1994). Betrayal trauma: Traumatic amnesia as an adaptive response to childhood abuse. Ethics & Behavior, 4, 307–329. References Gertlehner, G., Hasenc, R. A., & Nissman, D. (2006). Criteria for distinguishing effectiveness from efficacy trials in systematic reviews. Rockville, MD: Agency for Healthcare Research and Quality. Hallings-Pott, C., Waller, G., Watson, D., & Scragg, P. (2005). State Dissociation in Bulimic Eating Disorders: An Experimental Study. International Journal Of Eating Disorders, 38(1), 37-41. doi:10.1002/eat.20146 Hagenaars, M. A., van Minnen, A., & Hoogduin, K. L. (2010). The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD. Behaviour Research and Therapy, 48(1), 19-27. doi:10.1016/j.brat.2009.09.001 References Hollander, E., & Benzaquen, S. (1997). The obsessive- compulsive spectrum disorders. International Review Of Psychiatry, 9(1), 99-110. doi:10.1080/09540269775628 International Society for the Study of Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, 3rd Revision. Journal of Trauma & Dissociation, 12(2), 115-187. Lamagna, J., & Gleiser, K. A. (2007). Building a secure internal attachment: An Ingra-relational approach to ego strengthening and emotional processing with chronically traumatized clients. Journal of Trauma and Dissociation, 8(1), 25-52. References Marmar, C. R., Weiss, D. S., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., Kulka, R. A., & Hough, R. L. (1994). Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans. American Journal of Psychiatry, 151, 902–907. National Institute of Mental Health. (2014a). Any disorder among adults. Retrieved from http://www.nimh.nih.gov/statistics/1ANYDIS_ADULT.sh tml National Institute of Mental Health. (2014b). Mental healthcare cost data for all Americans (2006). Retrieved from www.nimh.nih.gov/statistics/4COST_AM2006.shtml References National Institute of Mental Health. (2014c). Use of mental health services and treatment among adults. Retrieved from http://www.nimh.nih.gov/statistics/3use_mt_adult.shtml Pfaltz, M. C., Michael, T., Meyer, A. H., & Wilhelm, F. H. (2013). Reexperiencing symptoms, dissociation, and avoidance behaviors in daily life of patients with PTSD and patients with panic disorder with agoraphobia. Journal Of Traumatic Stress, 26(4), 443-450. doi:10.1002/jts.21822 Putnam, F. W. (1989). The diagnosis and treatment of multiple personality disorder. New York, NY: Guilford Press. References Rice, M. J. (2013). Evidence-based practice: A model for clinical application. Journal of the American Psychiatric Nurses Association, 19(4), 217-221. Rischel, C. W. (2007). Evidence based prevention practice in mental health: What is it and how do we get there? American Journal of Orthopsychiatry, 77(1), 153-164. Ross, C. A., Heber, S., Norton, G. R., Anderson, D., Anderson, G., & Barchet, P. (1989). The dissociative disorders interview schedule: A structured Interview. Dissociation, 11(3), 69-189. Ross, C. A., Joshi, S., Currie, R. (1990). Dissociative experiences in the general population. American Journal of Psychiatry, 147(11), 1547-1552. References Rufer, M., Held, D., Cremer, J., Fricke, S., Moritz, S., Peter, H., & Hand, I. (2006). Dissociation as a Predictor of Cognitive Behavior Therapy Outcome in Patients with Obsessive-Compulsive Disorder. Psychotherapy And Psychosomatics, 75(1), 40-46. doi:10.1159/000089225 Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress: Etiology and treatment. Journal of Psychology, 218(2), 109127. doi:10.1027/0044-3409/a000018’ Sprang, G., Carlton, C., & Clark, J. (2008). Factors impacting trauma treatment practice patterns: The convergence/divergence of science and practice. Anxiety Disorders, 22, 162-174. Steinberg, M. (1994b). Structured Clinical Interview for DSM-IV Dissociative Disorders–Revised (SCID-D-R) (2nd ed.). Washington, DC: American Psychiatric Press.