Group treatment for complex dissociative disorders: a randomized clinical trial

Harald Bækkelund, Pål Ulvenes, Suzette Boon-Langelaan, Espen Ajo Arnevik, Harald Bækkelund, Pål Ulvenes, Suzette Boon-Langelaan, Espen Ajo Arnevik

Abstract

Background: Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment.

Methods: Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties.

Results: Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period.

Conclusion: In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning.

Trial registration: Clinical Trials ( NCT02450617 ).

Keywords: Dissociative disorders; Group psychotherapy; Psychological trauma; Psychotherapy outcome research; Randomized clinical trial.

Conflict of interest statement

SB is the first author of the treatment manual of the study and receives royalty from W. W. Norton & Company. She also received consultation fees for trainings in the use of the manual and treatment of dissociative disorders.

The other authors have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow-diagram of a randomized controlled trial of group treatment for complex dissociative disorders
Fig. 2
Fig. 2
Illustration of study design combining a randomized trial with a delayed treatment control group and multiple time series with switching replication
Fig. 3
Fig. 3
Global Assessment of Functioning across a randomized trial with delayed treatment control

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