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Transcript
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.