Dissociative Disorder Not Otherwise Specified (DDNOS), Dissociative Identity Disorder, PTSD and Trauma-related Symptoms
Conditions
Keywords
childhood trauma, inpatient, outpatient, dissociation, selfcompassion, emotion regulation
Brief summary
The purpose of the pilot is to examine the usefulness of the psychoeducational program, Finding Solid Ground, for patients with dissociative disorders in a naturalistc observational study, involving a 3-months inpatient treatment followed by patients continuation with the program in their local outpatient settings, by examining outcome of main trauma-related symptoms and adaptive coping. In addition, performing focus-group interviews with the patient groups at discharge and at follow-up, to gain information on their subjective experiences from participating in the program. The patients' therapists in the outpatient settings are invited to give written feedback on their experiences from working with FSG.
Detailed description
Adult survivors of childhood trauma have complex and diverse symptoms profiles. A subgroup develop a complex dissociative disorder. Modum Bad has for years offered a 3-months inpatient treatment program for this patient group. Patients leave the hospital after this treatment period and continue with treatment in their local outpatient settings. They come back for a 5-days follow-up 9 months after discharge from the residential setting. The aim of the pilot study is to examine changes in posttraumatic and dissociative symptoms and adaptive coping in this patient-group within the described naturalistic context, following patients' participation in Finding Solid Ground (FSG). FSG is developed by dr Bethany Brand, dr. Hygge Schielke, and dr Ruth Lanius (2022), and designed for this patient-group. It has 30 topics. Patients start up with FSG and complete 8 topics in the inpatient setting, and are offered to continue with the remaining topics during the outpatient period in collaboration with local treatment providers. 32 patients were recruited. Two of them were not included: one did not want to participate, and the other patient had a different focus in her treatment than FSG. Patients were assigned from referrals to the residential Department for Trauma treatment, Modum Bad, in Norway. As part of the usual clinical practice they were referred to our treatment group if they had a complex dissociative disorder in need of stabilization. The inpatient treatment lasts for 11 weeks and combines group- and individual therapies with different treatment modalities, all within the framework of FSG. Patients came back for a 5-days follow-up stay, 9 months after discharge from the inpatient treatment.
Interventions
BEHAVIORALPsychotherapy
Patients are admitted in groups of eight. During the 3-months inpatient treatment period, the program include a daily group session, and 3 weekly individual sessions with individual therapists and milieu-therapists, with focus on FSG-interventions from a trauma- and dissociation-informed perspective. FSG follows the international guidelines (ISSTD, 2011) for treatment of dissociative disorders from the International Society for the Study of Trauma and Dissociation. It uses different treatment modalities, such as live psychoeducation, psychoeducational videos, written and practical exercises, equine facilitated therapy, reflection and discussion groups. They have parallel individual therapy with therapist (psychiatrist or psychologist) and milie-therapists, and participate in physical activity and ward meetings together with other patients in the unit. All therapists are trained in trauma- and dissociation therory and treatment, as well as the FSG model.
Sponsors
Modum Bad
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* The study include adults (minimum age of 18 years) with a complex dissociative disorder related to childhood trauma. All patients had received outpatient therapy with insufficient effect. Patients were diagnosed with at DSM-IV dissociative disorder, transformed to the ICD-10 dissociative disorders.
Exclusion criteria
* Ongoing psychosis, severe ongoing drug addiction, very disturbed group functioning, ongoing severe life crisis, mental disability, severe unsafe behavior (suicidality, self-harm).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progress in Treatment Questionnaire (PITQ-p) | at respectively: baseline (T1); 3 months (T2); and 1-year follow-up (T3) | Asesses adaptive capacities. It has 32 items scored on an 11-point scale ranging from 0% to 100%. Scores are averaged. Higher scores indicate higher capacitiy for adaptive coping. |
| PTSD Checklist for DSM-5 (PCL-5) | assessmentsat respectively: baseline (T1); 3 months (T2); and 1-year follow-up (T3) | Posttraumaticstress disorder checklist for DSM-5, scale and subscales. Sum scores range from 20-80, with higher scores indicating greater PTSD symptoms severity |
| Difficulties in emotion regulation scale (DERS) | assessments at respectively: baseline (T1); 3 months (T2); and 1-year follow-up (T3) | Difficulties in emotion regulation scale, scale and subscales. It has 36 items ranging from 1 to 5. Scores are averaged. Higher scores indicate higher level of difficulties in emotion regulation. |
| Self-compassion Scale - Short Form (SCS-SF) | assessments at respectively: baseline (T1); 3 months (T2); and 1-year follow-up (T3) | Self-compassion scale short form (SCS-SF) has 12 items ranging from 1 to 5. Scores are averaged. Total average socres are calculated after reverse scoring of relevant items, with higher scores indicating higher level of self-compassion. |
| Dissociative Experiences Scale (DES-II) | assessments at respectively: baseline (T1); 3 months (T2); and 1-year follow-up (T3) | Dissociative experiences scale - version II has 28 items ranging from 0% to 100%. Scores are averaged. Higher scores indicate higher levels of dissociation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hedonic deficits and interference scale (HDIS) | Assessment at respectively: 1) baseline (T1); 2) 3-months (T2); and 3) 1-year follow-up. | Includes three subscales; 1) Positive emotionality (PE); 2) Hedonic deficits (HD); 3) Negative affective interference (NAI). All subscales are scored on a scale of 1 to 10. The scores are averaged. PE has 5 items, a higher score indicates higher levels of PE; HD has 5 items, a higher score indicates higher levels of HD; NAI has 11 items, a higher score indicates higher levels of negative affective interference. |
Countries
Norway
Contacts
STUDY_DIRECTORPeter Sele, PhD candidate
Modum Bad, Research Institute, Vikersund, Buskerud, Norway
Outcome results
None listed