AN EXAMINATION OF THE INFLUENCE OF A SEQUENTIAL TREATMENT ON THE COURSE AND IMPACT OF DISSOCIATION AMONG WOMEN WITH PTSD RELATED TO CHILDHOOD ABUSE

Authors

  • Marylène Cloitre Ph.D.,

    Corresponding author
    • Dissemination and Training Division, National Center for, PTSD, Palo Alto VA Health Care System, Palo Alto, California, and Department of Psychiatry, New York University Langone Medical Center, New York, New York
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  • Eva Petkova Ph.D.,

    1. Department of Psychiatry, New York University Langone Medical Center, New York, New York and Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
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  • Jing Wang M.S.,

    1. Department of Psychiatry, New York University Langone Medical Center New York, New Yook
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  • Feihan Lu (Lassell)

    1. Department of Psychiatry, New York University Langone Medical Center New York, New Yook
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Correspondence to: Marylene Cloitre, Dissemination and Training Division of the National Center for PTSD, NC-PTSD/334, VAPAHCS, 795 Willow Road, Menlo Park, CA 94025. E-mail: marylene.cloitre@va.gov

Abstract

Background

It has been proposed that posttraumatic stress disorder (PTSD) patients who experience significant dissociation upon exposure to traumatic reminders may do less well in trauma-focused therapies. We explored whether a sequenced two-component treatment in which an emotion regulation skills training module preceding exposure would improve outcomes for those with significant dissociation.

Methods

Analyses were conducted on data from an RCT in which 104 women with PTSD related to childhood abuse were assigned to one of three treatment conditions: Skills Training in Affective and Interpersonal Regulation (STAIR) followed by Narrative Story Telling (NST; STAIR/NST), STAIR followed by supportive counseling (SC; STAIR/SC), or SC followed by NST (SC/NST).

Results

Baseline dissociation was associated with differential outcome such that at low levels of dissociation the three treatments were equally effective but at higher levels STAIR/NST resulted in greater reductions in dissociative symptoms. Level of baseline dissociation did not moderate the effect of the treatments on PTSD outcome. At all levels of baseline dissociation, STAIR/NST produced better PTSD outcome. At posttreatment, however, participants with high dissociation treated with STAIR/NST continued to improve during follow-up, those treated with STAIR/SC maintained gains, and those treated with SC/NST experienced loss of posttreatment PTSD symptom gains.

Conclusions

The differential results observed among the treatments depending on severity of dissociation at baseline and at posttreatment suggest the potential clinical utility of identifying a dissociative subtype of PTSD and of the benefits of sequenced, phase-oriented treatment approaches.

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