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Cited by 105Posttraumatic Stress Disorder ResearchPersonality Disorders and PsychopathologyPsychoanalysis and Psychopathology Research

State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder

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Kleindienst, Nikolaus, Priebe, Kathlen, Görg, Nora, Dyer, Anne, Steil, Regina, Lyssenko, Lisa, Winter, Dorina, Schmahl, Christian +1 more·2016·European Journal of Psychotraumatology
DOI 10.3402/ejpt.v7.30375PMC PMC4938890
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Abstract

BackgroundPatients with posttraumatic stress disorder (PTSD) are prone to dissociation, which in theory should interfere with successful treatment. However, most empirical studies do not substantiate this assumption.ObjectiveThe primary objective was to test whether state dissociation predicts the success of an adaptation of dialectical behavior therapy designed for the treatment of patients with PTSD after childhood sexual abuse (CSA) (DBT-PTSD). We further explored whether the operationalization of dissociation as state versus trait dissociation made a difference with respect to prediction of improvement.MethodsWe present a hypothesis-driven post hoc analysis of a randomized controlled trial on the efficacy in patients with PTSD after CSA. Regression analyses relating pre–post improvements in the Clinician-Administered PTSD Scale (CAPS) and the Posttraumatic Diagnostic Scale (PDS) to dissociation were applied to the women who participated in the active treatment arm (DBT-PTSD). Multivariate models accounting for major confounders were used to relate improvements in both the CAPS and the PDS to (1) state dissociation as assessed after each treatment session and (2) trait dissociation as assessed at baseline.ResultsState dissociation during psychotherapy sessions predicted improvement after DBT-PTSD: patients with low state dissociation during treatment had a higher chance to show substantial improvement. This relation consistently emerged across subgroups of PTSD patients with and without borderline personality disorder. The operationalization of dissociation as state versus trait dissociation made a difference as improvement was not significantly predicted from trait dissociation.ConclusionsDissociation during treatment sessions may reduce success with trauma-focused therapies such as DBT-PTSD. Accordingly, clinical studies aimed at improving ways to address dissociation are needed.Highlights of the articleThe article investigates whether state dissociation during psychotherapeutic sessions moderates the success of an established treatment for PTSD.Patients were much more likely to substantially improve with respect to PTSD symptomatology if state dissociation during psychotherapeutic sessions was low.The article suggests that the relation between low dissociation and good response in highly symptomatic patients is stronger than previously thought.Future studies investigating the extent to which outcome might be improved when treating dissociation more vigorously than usually are necessary.

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  • Dissociation can impede the emotional learning necessary to extinguish fear and shame around traumatic experiences by disrupting immersion and attention to the traumatic memories.

    “Specifically, dissociation can impede the emotional learning that is necessary to extinguish fear and shame around these experiences by disrupting immersion and attention to the traumatic memories.”

    From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [76]

    The paper’s Highlights of the article section says state dissociation during exposure therapy could inhibit emotional learning, and the Discussion links dissociation during sessions to poorer improvement. It does not establish that this occurs by disrupting immersion and attention to traumatic memories, or specifically describe the extinction of fear and shame. (LLM, conf=0.84)

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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 [76]

    The Results and Discussion report that greater state dissociation during DBT-PTSD sessions predicted less improvement in women with PTSD, with or without borderline personality disorder. The paper does not establish that dissociation was their primary, reflexive coping response, and its direct finding concerns one treatment rather than manualized treatments generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Dissociative symptoms can interfere with effective trauma processing.

    “However, dissociative symptoms can interfere with effective trauma processing (e.g., [76]).”

    From Treatment of dissociative identity disorder: leveraging neurobiology to optimize success (2024) · cites this paper as [76]

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Authors
Kleindienst, N., Priebe, K., Görg, N., Dyer, A., Steil, R., Lyssenko, L., Winter, D., Schmahl, C., & Bohus, M.
Affiliations
  • Heidelberg University (DE)
  • University of Mannheim (DE)
  • Goethe University Frankfurt (DE)
  • University of Antwerp (BE)
Corresponding author
Kleindienst, Nikolaus
ORCID
Venue
European Journal of Psychotraumatology
Publisher
Informa UK Limited
Published
2016-07-06
Volume
7
Issue
1
Pages
30375-30375
ISSN
2000-8066 (ISSN-L)
DOI
10.3402/ejpt.v7.30375
PMC
PMC4938890
OpenAlex
W2472694591
Cited by
105
References
41
Citations by year
2026: 9 · 2025: 7 · 2024: 8 · 2023: 15 · 2022: 13 · 2021: 14 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 9 · 2016: 4
FWCI
13.83
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Psychotraumatology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Figshare (cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
state dissociation, trait dissociation, post-traumatic stress disorder, dialectical behavior therapy, child sexual abuse, borderline personality disorder, treatment response, trauma-focused psychotherapy, women

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