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Cited by 183Posttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology ResearchPsychosomatic Disorders and Their Treatments

AN EXAMINATION OF THE INFLUENCE OF A SEQUENTIAL TREATMENT ON THE COURSE AND IMPACT OF DISSOCIATION AMONG WOMEN WITH PTSD RELATED TO CHILDHOOD ABUSE: Research Article: PTSD, Dissociation and Sequential Treatment

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Cloitre, Marylène, Petkova, Eva, Wang, Jing, Lu Lassell, Feihan·2012·Depression and Anxiety
DOI 10.1002/da.21920
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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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  • The efficacy of some manualized treatments is diminished when dissociation is the primary, reflexive manner of coping.

    “For example, the efficacy of some manualized treatments is diminished when dissociation is the primary, reflexive manner of coping [76–82], as is the case in DID.”

    From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [78]

    The Introduction (page unavailable) proposes that significant dissociation may reduce the effectiveness of exposure and cognitive therapies, and the Discussion reports poorer follow-up outcomes for highly dissociative participants in one treatment condition. But the paper does not establish that treatment efficacy is diminished when dissociation is a primary, reflexive coping response. Its limitations section explicitly cautions against generalizing the findings to dissociative identity disorder. (LLM, conf=0.86)

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  • Attaining relative safety and stability is the foundation of stage 1 treatment of PTSD with complex presentations, as well as dissociative disorders.

    “Attaining relative safety and stability is the foundation of stage 1 treatment of PTSD with complex presentations (complex PTSD), as well as dissociative disorders, which are highly linked to developmental traumas (46, 84–87).”

    From The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines (2023) · cites this paper as [85]

    The Introduction (page unavailable) describes a proposed stage-based approach for PTSD patients with high dissociation: an initial phase builds self-soothing and connection to the environment before trauma-memory work. This supports the preparatory-stabilization idea, but the paper does not establish it as the foundation of treatment for complex PTSD or dissociative disorders generally; its study concerns women with PTSD related to childhood abuse. (LLM, conf=0.86)

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  • Other treatments for PTSD are not consistently effective for those with the dissociative subtype.

    “given that other treatments for PTSD are not consistently effective for those with the dissociative subtype”

    From MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study (2021) · cites this paper as [36]

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Research works printed but not linked: 2

  1. Maldonado JR, Spiegel D. Treatment of post traumatic stress dis- order. In: Lynn SJ, Rhue J, editors. Dissociation: Clinical, the- oretical, and Research Perspectives. New York: Guilford Press; 1994: 215-241.
  2. Cloitre M, Coehn LR, Koenen KC. Treating Survivors of Child- hood Abuse: Psychotherapy for the Interrupted Life. New York: Guilford Press; 2006.

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Authors
Cloitre, M., Petkova, E., Wang, J., & Lu Lassell, F.
Affiliations
  • 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
  • Nathan Kline Institute for Psychiatric Research (US)
  • NYU Langone Health (US)
  • Department of Psychiatry; New York University Langone Medical Center New York; New Yook
ORCID
Venue
Depression and Anxiety
Publisher
Hindawi Limited
Published
2012-05-01
Volume
29
Issue
8
Pages
709-717
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.21920
OpenAlex
W2131505132
Cited by
183
References
16
Citations by year
2026: 6 · 2025: 9 · 2024: 9 · 2023: 11 · 2022: 12 · 2021: 10 · 2020: 14 · 2019: 11 · 2018: 17 · 2017: 16 · 2016: 8 · 2015: 16 · 2014: 24 · 2013: 10 · 2012: 7
FWCI
20.70
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 1218 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords
post-traumatic stress disorder, childhood abuse, dissociation, dissociative symptoms, trauma-focused psychotherapy, supportive counseling, sequential therapy, dissociative subtype of PTSD, women, treatment outcomes
MeSH terms
Adult, Dissociative Disorders, Female, Humans, Interpersonal Relations, Middle Aged, Prognosis, Psychotherapy, Stress Disorders, Post-Traumatic, Time Factors, Women, Comorbidity, Randomized Controlled Trials as Topic, Treatment Outcome, Disease Progression, Adult Survivors of Child Abuse, Narrative Therapy

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