https://orcid.org/0000-0003-4491-9492
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ABSTRACT
Objective:
Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms.
Method:
Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated.
Results:
Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome.
Conclusion:
The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.
HIGHLIGHTS
This study investigated the role of dissociation-related beliefs about memory on trauma-focused treatment.
Dissociation-related beliefs were related to post-traumatic and dissociative symptoms, and were especially prominent in patients with the dissociative subtype of post-traumatic stress disorder.
Dissociation-related beliefs about memory do not impact the effectiveness of trauma-focused treatment. In fact, trauma-focused treatment effectively decreased these beliefs, suggesting that dissociation-related beliefs about memory should not be a determining factor in withholding patients from receiving trauma-focused therapy.
Objetivo: Las cogniciones disfuncionales juegan un papel central en el desarrollo del trastorno de estrés postraumático (TEPT). Sin embargo, el papel de creencias específicas sobre los recuerdos relacionados con la disociación no ha sido investigado previamente. Este estudio tuvo como objetivo investigar el papel de las creencias relacionadas con la disociación sobre el recuerdo en el tratamiento centrado en el trauma. Se planteó la hipótesis que los pacientes con el subtipo disociativo de TEPT mostrarían niveles más altos de creencias relacionadas con la disociación, las creencias relacionadas con la disociación sobre los recuerdos disminuirían después del tratamiento centrado en el trauma y las creencias relacionadas con la disociación más altas antes del tratamiento se asociarían con menos cambios en los síntomas de TEPT.
Método: Se evaluaron los síntomas postraumáticos, síntomas disociativos y creencias relacionadas con la disociación sobre los recuerdos en una muestra de pacientes diagnosticados con TEPT (n = 111), o el subtipo disociativo de TEPT (n = 61). Se sometieron a una terapia intensiva centrada en el trauma que consistía en cuatro u ocho días de tratamiento consecutivos. En cada día de tratamiento, los pacientes recibieron 90 minutos de exposición prolongada (EP) individual, en las mañanas y 90 minutos de terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR) en las tardes. Se investigó la relación entre las creencias relacionadas con la disociación sobre los recuerdos y los efectos del tratamiento centrado en el trauma.
Resultados: Las creencias relacionadas con la disociación sobre los recuerdos se asociaron significativamente con TEPT y sus síntomas disociativos. Además, consistente con nuestra hipótesis, los pacientes con el subtipo disociativo de TEPT obtuvieron puntuaciones significativamente más altas en las creencias relacionadas con la disociación sobre los recuerdos antes del tratamiento que aquellos sin el subtipo disociativo. Además, la severidad de esas creencias disminuyó significativamente después del tratamiento centrado en el trauma. Contrario a nuestra hipótesis, las creencias elevadas relacionadas con la disociación no influyeron negativamente los resultados del tratamiento.
Conclusión: Los resultados del presente estudio sugieren que las creencias relacionadas con la disociación no influyen los resultados del tratamiento centrado en el trauma, y que el tratamiento centrado en el trauma no necesita modificarse específicamente para los pacientes que experimentan más creencias relacionadas con la disociación sobre los recuerdos porque estas creencias disminuyen en asociación con el tratamiento.
目的：认知功能失调在创伤后应激障碍（PTSD）的发展中发挥着核心作用。然而先前尚未研究过与记忆相关的特定解离相关信念的作用。本研究旨在调查关于记忆的解离相关信念在创伤聚焦治疗中的作用。据推测，患有 PTSD 解离亚型的患者会表现出较高水平的解离相关信念，创伤聚焦治疗后关于记忆的解离相关信念会减少，治疗前较高的解离相关信念将与PTSD 症状较少改变相关。
方法：对诊断为 PTSD (n = 111) 或 PTSD 解离亚型 (n = 61) 的患者样本进行创伤后症状、解离症状和关于记忆的解离相关信念评估。 他们接受了为期四到八天的连续创伤聚焦强化治疗。在每个治疗日，患者早上接受 90 分钟的个人延长暴露 (PE) 治疗，下午接受 90 分钟的个人眼动脱敏与再加工 (EMDR) 治疗。研究了关于记忆的解离相关信念与创伤聚焦治疗效果之间的关系。
结果：关于记忆的解离相关信念与创伤后应激障碍（PTSD）及其解离症状显著相关。 外，与我们的假设一致，患有 PTSD 解离亚型的患者在记忆预处理的解离相关信念方面得分显著高于非解离亚型的患者。此外，在创伤相关治疗后，这些信念的严重程度显著降低。 与我们的假设相反，解离相关信念的升高不会对治疗结果产生负面影响。
结论：当前研究的结果表明，解离相关信念不会影响创伤聚焦治疗的结果，并且对于经历更多关于记忆的解离相关信念的患者，不需要专门改变创伤聚焦治疗，因为这些信念随着治疗而减少。
Data availability statement
Data available on request due to privacy/ethical restrictions. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants. Furthermore, participants were not asked to give consent of saving their data in a public data repository.
Disclosure statement
Agnes Van Minnen receives income for published book chapters on PTSD and for the training of postdoctoral professionals in prolonged exposure. Ad de Jongh receives income from published books on EMDR therapy and for the training of postdoctoral professionals in this method. The other authors do not have competing interests.
Notes
1. See Van Woudenberg et al. (Citation2018) for detailed information about the treatment program, and Bongaerts et al., 2021 for more details about the online delivery of intensive treatment.