Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial

Halvorsen JO, Stenmark H, Neuner F, Nordahl HM (2014)
Behaviour Research and Therapy 57: 21-28.

Zeitschriftenaufsatz | Veröffentlicht | Englisch
Es wurden keine Dateien hochgeladen. Nur Publikationsnachweis!
Halvorsen, Joar Overaas; Stenmark, Hakon; Neuner, FrankUniBi; Nordahl, Hans M.
Abstract / Bemerkung
Dissociative symptoms, especially depersonalisation and derealisation, are often perceived as a contraindication for exposure-based treatments of posttraumatic stress disorder (PTSD) despite limited empirical evidence. The present paper examines whether derealisation and depersonalisation influence the treatment outcomes of narrative exposure therapy (NET) and treatment as usual (TaU) among severely traumatised asylum seekers and refugees. We performed a secondary analysis of a recently published randomized controlled multicentre trial comparing NET and TaU for the treatment of PTSD in asylum seekers and refugees. In order to investigate whether depersonalisation and derealisation moderate treatment outcomes, a number of moderated multiple, blockwise regression analyses were conducted. Missing data were handled with multiple imputation. The main finding from intention-to-treat analyses is that derealisation and depersonalisation overall do not moderate the treatment outcomes of either NET or Tall The treatment condition was the most stable predictor of residual gain scores across outcome measures, with NET being associated with lower residual gain scores indicating better treatment outcomes. The present study substantiates and extends previous research indicating that dissociative symptoms such as derealisation and depersonalisation do not moderate the treatment outcome of exposure-based treatments for PTSD. (C) 2014 Elsevier Ltd. All rights reserved.
Moderators; Derealisation; Depersonalisation; Narrative exposure therapy; Posttraumatic stress disorder; Treatment outcome
Behaviour Research and Therapy
Page URI


Halvorsen JO, Stenmark H, Neuner F, Nordahl HM. Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy. 2014;57:21-28.
Halvorsen, J. O., Stenmark, H., Neuner, F., & Nordahl, H. M. (2014). Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy, 57, 21-28. doi:10.1016/j.brat.2014.03.010
Halvorsen, J. O., Stenmark, H., Neuner, F., and Nordahl, H. M. (2014). Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy 57, 21-28.
Halvorsen, J.O., et al., 2014. Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy, 57, p 21-28.
J.O. Halvorsen, et al., “Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial”, Behaviour Research and Therapy, vol. 57, 2014, pp. 21-28.
Halvorsen, J.O., Stenmark, H., Neuner, F., Nordahl, H.M.: Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behaviour Research and Therapy. 57, 21-28 (2014).
Halvorsen, Joar Overaas, Stenmark, Hakon, Neuner, Frank, and Nordahl, Hans M. “Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial”. Behaviour Research and Therapy 57 (2014): 21-28.

21 Zitationen in Europe PMC

Daten bereitgestellt von Europe PubMed Central.

Augmentation of Extinction and Inhibitory Learning in Anxiety and Trauma-Related Disorders.
Lebois LAM, Seligowski AV, Wolff JD, Hill SB, Ressler KJ., Annu Rev Clin Psychol 15(), 2019
PMID: 30698994
Assessing the structure and meaningfulness of the dissociative subtype of PTSD.
Ross J, Baník G, Dědová M, Mikulášková G, Armour C., Soc Psychiatry Psychiatr Epidemiol 53(1), 2018
PMID: 29043375
The Range and Impact of Postmigration Stressors During Treatment of Trauma-Affected Refugees.
Bruhn M, Rees S, Mohsin M, Silove D, Carlsson J., J Nerv Ment Dis 206(1), 2018
PMID: 29194088
The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD.
Haagen JFG, van Rijn A, Knipscheer JW, van der Aa N, Kleber RJ., Br J Clin Psychol 57(2), 2018
PMID: 29315737
Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD.
Zoet HA, Wagenmans A, van Minnen A, de Jongh A., Eur J Psychotraumatol 9(1), 2018
PMID: 29805779
Brain circuit dysfunction in post-traumatic stress disorder: from mouse to man.
Fenster RJ, Lebois LAM, Ressler KJ, Suh J., Nat Rev Neurosci 19(9), 2018
PMID: 30054570
The role of clinical experience, diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders: A vignette and survey investigation.
Dorahy MJ, Lewis-Fernández R, Krüger C, Brand BL, Şar V, Ewing J, Martínez-Taboas A, Stavropoulos P, Middleton W., J Trauma Dissociation 18(2), 2017
PMID: 27673351
Structural brain aberrations associated with the dissociative subtype of post-traumatic stress disorder.
Daniels JK, Frewen P, Theberge J, Lanius RA., Acta Psychiatr Scand 133(3), 2016
PMID: 26138235
Psychosocial predictors of treatment outcome for trauma-affected refugees.
Sonne C, Carlsson J, Bech P, Vindbjerg E, Mortensen EL, Elklit A., Eur J Psychotraumatol 7(), 2016
PMID: 27251179
Computer-Assisted In Sensu Exposure for Posttraumatic Stress Disorder: Development and Evaluation.
Görg N, Priebe K, Deuschel T, Schüller M, Schriner F, Kleindienst N, Ludäscher P, Schmahl C, Schmahl C, Bohus M., JMIR Ment Health 3(2), 2016
PMID: 27277899
State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder.
Kleindienst N, Priebe K, Görg N, Dyer A, Steil R, Lyssenko L, Winter D, Schmahl C, Bohus M., Eur J Psychotraumatol 7(), 2016
PMID: 27396380
Coping strategies, hope, and treatment efficacy in pharmacoresistant inpatients with neurotic spectrum disorders.
Ociskova M, Prasko J, Kamaradova D, Grambal A, Kasalova P, Sigmundova Z, Latalova K, Vrbova K., Neuropsychiatr Dis Treat 11(), 2015
PMID: 26028972
Trauma-related altered states of consciousness in women with BPD with or without co-occurring PTSD.
Frewen P, Kleindienst N, Lanius R, Schmahl C., Eur J Psychotraumatol 5(), 2014
PMID: 25206942
Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?
Brand BL, Lanius RA., Borderline Personal Disord Emot Dysregul 1(), 2014
PMID: 26401297

62 References

Daten bereitgestellt von Europe PubMed Central.

American, 1994

American, 2013
The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD
Armour, Social Psychiatry and Psychiatric Epidemiology (), 2014
A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD.
Becker CB, Zayfert C, Anderson E., Behav Res Ther 42(3), 2004
PMID: 14975770
Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis.
Bisson JI, Ehlers A, Matthews R, Pilling S, Richards D, Turner S., Br J Psychiatry 190(), 2007
PMID: 17267924
The development of a Clinician-Administered PTSD Scale.
Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, Keane TM., J Trauma Stress 8(1), 1995
PMID: 7712061
A multidimensional meta-analysis of psychotherapy for PTSD.
Bradley R, Greene J, Russ E, Dutra L, Westen D., Am J Psychiatry 162(2), 2005
PMID: 15677582
Is dissociation a multidimensional construct? Data from the Multiscale Dissociation Inventory.
Briere J, Weathers FW, Runtz M., J Trauma Stress 18(3), 2005
PMID: 16281216
Does dissociation further our understanding of PTSD?
Bryant RA., J Anxiety Disord 21(2), 2006
PMID: 17097264
Simplifying complex PTSD: comment on Resick et al. (2012).
Bryant RA., J Trauma Stress 25(3), 2012
PMID: 22729975
The testimony of political repression as a therapeutic instrument.
Cienfuegos AJ, Monelli C., Am J Orthopsychiatry 53(1), 1983
PMID: 6829726
Dissociation in posttraumatic stress disorder part II: how theoretical models fit the empirical evidence and recommendations for modifying the diagnostic criteria for PTSD
Dalenberg, Psychological Trauma: Theory, Research, Practice, and Policy 4(), 2012
PTSD, dissociation, and treatment
Feeny, 2004

Foa, 2007
Testing moderator and mediator effects in counseling psychology research
Frazier, Journal of Counseling Psychology 51(), 2004
Considering PTSD for DSM-5.
Friedman MJ, Resick PA, Bryant RA, Brewin CR., Depress Anxiety 28(9), 2010
PMID: 21910184
Mental health interventions for survivors of torture: current status and future directions
Ginzburg, Zeitschrift für Psychologie/Journal of Psychology 219(), 2011
A comparison of item-level and scale-level multiple imputation for questionnaire batteries
Gottschall, Multivariate Behavioral Research 47(), 2012
Missing data analysis: making it work in the real world.
Graham JW., Annu Rev Psychol 60(), 2009
PMID: 18652544

Graham, 2012
The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD.
Hagenaars MA, van Minnen A, Hoogduin KA., Behav Res Ther 48(1), 2009
PMID: 19766987
A rating scale for depression
Hamilton, Journal of Neurology, Neurosurgery and Psychiatry 23(), 1960
Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders.
Hien DA, Wells EA, Jiang H, Suarez-Morales L, Campbell AN, Cohen LR, Miele GM, Killeen T, Brigham GS, Zhang Y, Hansen C, Hodgkins C, Hatch-Maillette M, Brown C, Kulaga A, Kristman-Valente A, Chu M, Sage R, Robinson JA, Liu D, Nunes EV., J Consult Clin Psychol 77(4), 2009
PMID: 19634955
The epidemiology of depersonalisation and derealisation. A systematic review.
Hunter EC, Sierra M, David AS., Soc Psychiatry Psychiatr Epidemiol 39(1), 2004
PMID: 15022041

Institute, 2008
Influence of emotional engagement and habituation on exposure therapy for PTSD.
Jaycox LH, Foa EB, Morral AR., J Consult Clin Psychol 66(1), 1998
PMID: 9489273
Dissociation predicts poor response to Dialectial Behavioral Therapy in female patients with Borderline Personality Disorder.
Kleindienst N, Limberger MF, Ebner-Priemer UW, Keibel-Mauchnik J, Dyer A, Berger M, Schmahl C, Bohus M., J. Pers. Disord. 25(4), 2011
PMID: 21838560
Moderators of treatment outcomes
Kraemer, JAMA: The Journal of the American Medical Association 296(), 2006
Mediators and moderators of treatment effects in randomized clinical trials.
Kraemer HC, Wilson GT, Fairburn CG, Agras WS., Arch. Gen. Psychiatry 59(10), 2002
PMID: 12365874
The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications.
Lanius RA, Brand B, Vermetten E, Frewen PA, Spiegel D., Depress Anxiety 29(8), 2012
PMID: 22431063
Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype.
Lanius RA, Vermetten E, Loewenstein RJ, Brand B, Schmahl C, Bremner JD, Spiegel D., Am J Psychiatry 167(6), 2010
PMID: 20360318
Examining potential contraindications for prolonged exposure therapy for PTSD
van, European Journal of Psychotraumatology 3(), 2012
Inter-rater reliability of the Hamilton Depression Rating Scale as a diagnostic and outcome measure of depression in primary care.
Morriss R, Leese M, Chatwin J, Baldwin D; THREAD Study Group, Kendrick T, Brown G, Byng R, Craig T, Dowrick C, Gabbay M, Harris T, Mann A, McCrone P, Moore M, Peveler R, Tylee A., J Affect Disord 111(2-3), 2008
PMID: 18374987
A meta-analysis of the influence of comorbidity on treatment outcome in the anxiety disorders.
Olatunji BO, Cisler JM, Tolin DF., Clin Psychol Rev 30(6), 2010
PMID: 20510492
A meta-analytic review of prolonged exposure for posttraumatic stress disorder.
Powers MB, Halpern JM, Ferenschak MP, Gillihan SJ, Foa EB., Clin Psychol Rev 30(6), 2010
PMID: 20546985
A critical evaluation of the complex PTSD literature: implications for DSM-5.
Resick PA, Bovin MJ, Calloway AL, Dick AM, King MW, Mitchell KS, Suvak MK, Wells SY, Stirman SW, Wolf EJ., J Trauma Stress 25(3), 2012
PMID: 22729974
The impact of dissociation on PTSD treatment with cognitive processing therapy.
Resick PA, Suvak MK, Johnides BD, Mitchell KS, Iverson KM., Depress Anxiety 29(8), 2012
PMID: 22473922
The emerging evidence for Narrative Exposure Therapy: a review.
Robjant K, Fazel M., Clin Psychol Rev 30(8), 2010
PMID: 20832922
Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder.
Rufer M, Held D, Cremer J, Fricke S, Moritz S, Peter H, Hand I., Psychother Psychosom 75(1), 2006
PMID: 16361873
Multiple imputation: a primer.
Schafer JL., Stat Methods Med Res 8(1), 1999
PMID: 10347857
Missing data: our view of the state of the art.
Schafer JL, Graham JW., Psychol Methods 7(2), 2002
PMID: 12090408

Schauer, 2005
Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations
Schottenbauer, Psychiatry: Interpersonal and Biological Processes 71(), 2008
Personalized medicine for depression: can we match patients with treatments?
Simon GE, Perlis RH., Am J Psychiatry 167(12), 2010
PMID: 20843873
Changes in intrusive memories associated with imaginal reliving in posttraumatic stress disorder.
Speckens AE, Ehlers A, Hackmann A, Clark DM., J Anxiety Disord 20(3), 2006
PMID: 16564436
Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy.
Spitzer C, Barnow S, Freyberger HJ, Grabe HJ., Aust N Z J Psychiatry 41(8), 2007
PMID: 17620165
Dissociation in posttraumatic stress disorder: evidence from the world mental health surveys.
Stein DJ, Koenen KC, Friedman MJ, Hill E, McLaughlin KA, Petukhova M, Ruscio AM, Shahly V, Spiegel D, Borges G, Bunting B, Caldas-de-Almeida JM, de Girolamo G, Demyttenaere K, Florescu S, Haro JM, Karam EG, Kovess-Masfety V, Lee S, Matschinger H, Mladenova M, Posada-Villa J, Tachimori H, Viana MC, Kessler RC., Biol. Psychiatry 73(4), 2012
PMID: 23059051
Methodological issues in prediction of treatment outcome
Steketee, Clinical Psychology Review 12(), 1992
Outcome predictors for three PTSD treatments: exposure therapy, EMDR, and relaxation training
Taylor, Journal of Cognitive Psychotherapy 17(), 2003
Reliability of the Hamilton Rating Scale for Depression: a meta-analysis over a period of 49 years.
Trajkovic G, Starcevic V, Latas M, Lestarevic M, Ille T, Bukumiric Z, Marinkovic J., Psychiatry Res 189(1), 2011
PMID: 21276619

Warner, 2013
Clinician-administered PTSD scale: a review of the first ten years of research.
Weathers FW, Keane TM, Davidson JR., Depress Anxiety 13(3), 2001
PMID: 11387733
The dissociative subtype of PTSD: rationale, evidence, and future directions
Wolf, PTSD Research Quarterly 24(), 2013
The dissociative subtype of PTSD: a replication and extension.
Wolf EJ, Lunney CA, Miller MW, Resick PA, Friedman MJ, Schnurr PP., Depress Anxiety 29(8), 2012
PMID: 22639402
A latent class analysis of dissociation and posttraumatic stress disorder: evidence for a dissociative subtype.
Wolf EJ, Miller MW, Reardon AF, Ryabchenko KA, Castillo D, Freund R., Arch. Gen. Psychiatry 69(7), 2012
PMID: 22752235


Markieren/ Markierung löschen
Markierte Publikationen

Open Data PUB

Web of Science

Dieser Datensatz im Web of Science®


PMID: 24762779
PubMed | Europe PMC

Suchen in

Google Scholar