Academic journal article European Journal of Psychotraumatology

Six-Year Follow-Up of the Treatment of Patients with Dissociative Disorders Study

Academic journal article European Journal of Psychotraumatology

Six-Year Follow-Up of the Treatment of Patients with Dissociative Disorders Study

Article excerpt

Patients with dissociative disorders (DDs) suffer from severe psychiatric symptoms, complex emotional, social, and physical health difficulties, and high levels of functional impairment related to chronic, severe childhood trauma (Foote, Smolin, Kaplan, Legatt, & Lipschitz, 2006; Johnson, Cohen, Kasen, & Brook, 2006; Putnam, 1997; Sar, AkyüZ, & Doğan, 2007). The severity and chronicity of patients' impairment underscores the importance of studying the burden of disease and effective DD treatments. Reviews and meta-analyses have found that trauma-focused treatment can be particularly beneficial for adult survivors of childhood trauma, including DD patients (Brand, Classen, McNary, & Zaveri, 2009; Sachsse, Vogel, & Leichsenring, 2006). Inpatient treatment studies have found that specialized treatment programmes reduce posttraumatic, dissociative, interpersonal, and general psychiatric problems among dissociative patients (Ali & Smartt, 2009; Jepsen, Bad, Langeland, Sexton, & Heir, 2014; Jepsen, Svagaard, Thelle, McCullough, & Martinsen, 2009; Lampe, Hofmann, Gast, Reddemann, & Schüßler, 2014; Rosenkranz & Muller, 2011; Steil, Dyer, Priebe, Kleindienst, & Bohus, 2011). Outpatient DD treatment is also associated with enduring gains over time, including decreased dissociative, depressive and posttraumatic symptoms, self-destructiveness, and symptoms of comorbid disorders, as well as increased adaptive functioning (see Brand et al., 2009). Longitudinal studies have been conducted with DD patients, with durations of 1-10 years (Coons & Bowman, 2001; Coons & Millstein, 1986; Ellason & Ross, 1997; Jepsen et al., 2014, 2009; Kluft, 1984/1985; Lampe et al., 2014). These studies found that patients who remain in treatment generally show improvement in social, psychological, and occupational functioning.

The prospective, longitudinal Treatment of Patients with Dissociative Disorders (TOP DD) study is the largest treatment outcome study conducted with DD patients. TOP DD followed a large, international naturalistic sample of DD patients treated by outpatient community therapists. Results were consistent with previous studies in demonstrating the beneficial outcomes of DD treatment. (For a summary of study findings, see Supplemental data Table 1). Over 30 months, therapists reported decreases in patients' dissociative, depressive, and posttraumatic symptoms; decreased incidence of self-harm; suicide attempts, drug use, and hospitalization; and increases in productive and social activities (Brand et al., 2013). In the current study, TOP DD therapists report on patients' safety, quality of life, global functioning, interpersonal victimization, and stressors six years after having enrolled in the study.

1. Methods

7.7. Participants

Participants at the six-year follow-up (T5) included 61 clinicians enrolled in the original TOP DD study; details on recruitment, eligibility, and methodology are available (Brand et al., 2013). Any therapist who provided baseline (T1) data was contacted by email in September 2013, approximately six years from the time recruitment for the TOP DD study began, and was invited to complete a brief, web-based survey. TOP DD patients were not contacted to participate due to minimal contact information and concern that some patients no longer in treatment might experience distress about reporting on their current status. This study received IRB approval from Towson University and Sheppard Pratt Health System.

The TOP DD study initially collected data at four time points (T1-T4) over 30 months. Sample sizes for clinicians at each time point were as follows: T1 N = 295; T2 N = 189 (64% retention); T3 N =174 (59% retention); T4 N = 135 (46% retention). At T1, clinicians in the current study reported that they had worked with their patients for an average of 6.5 years (SD = 4.5, range = 2-21 years).

7.2. Procedure

After providing informed consent, therapists indicated whether their TOP DD patients were still in treatment with them. …

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