Examining the 4-D Model in Persons Enrolled in the Top DD Internet Intervention

ABSTRACT

The 4-dimensional (4-D) model of trauma-related dissociation differentiates between dissociative experiences involving trauma-related altered states of consciousness and symptoms of distress that do not appear to involve alterations in normal waking consciousness across four phenomenological dimensions (i.e., our experience of time, thought, body, and emotions). The current study evaluated hypotheses associated with the 4-D model using analyses of variance and correlation analyses in individuals with a primary diagnosis of a trauma-related dissociative disorder who were participating in the TOP DD internet study involving a combination of in-person psychotherapy and an online psychoeducational program (n = 111). Intrusive memories of traumatic events were more frequently endorsed than flashbacks, but emotional numbing was more frequently endorsed than other forms of affect dysregulation. Negative thoughts and emotion dysregulation were more strongly intercorrelated than were voice hearing and emotional numbing. Distress symptoms were more strongly associated with PTSD symptoms and difficulties in emotion regulation, whereas experiences of depersonalization were more strongly associated with dissociative self-states. Greater reduction in distress symptoms was also seen in comparison with trauma-related altered states of consciousness over the course of the combined psychotherapy and internet-based psychoeducational intervention. Overall, results continue to suggest that measures of distress and dissociative experiences can be distinguished by measures of symptom frequency, co-occurrence, and convergence with other measures of distress vs. dissociation albeit that results varied across the four phenomenological dimensions that were surveyed.

KEYWORDS:

• Dissociation
• posttraumatic stress disorder
• internet intervention

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/15299732.2022.2079794

Notes

¹ We should note that, in the present sample, it was not possible to assess correlations between TRASC and childhood trauma history even at baseline due to the latter exhibiting little variability in the sample (i.e., ceiling effect; nearly all participants endorsed childhood trauma history). Measures of childhood trauma history were obtained in response to specific yes/no questions at baseline referring to various forms of abuse and neglect as follows: “Was the patient physically abused as a child?” (only 9% “no”); “Did the patient witness domestic violence as a child?” (only 22% “no”); “Was the patient sexually abused as a child?” (only 5% “no”); “Was the patient emotionally or psychologically abused as a child?” (only 3% “no”); “Was the patient neglected as a child?” (Only 11% “no”). In short, relatively little variability in response to the questions was observed, with the majority of the sample reporting such histories, as indicated. As a result, conducting correlations between response to these questions and other measures such as TRASC and NWC-Distress symptom severity did not seem to be meaningful in the current sample and so was not conducted.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.