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Millman LSM, Huang X, Wainipitapong S, Medford N, Pick S. Behavioural, autonomic, and neural responsivity in depersonalisation-derealisation disorder: A systematic review of experimental evidence. Neurosci Biobehav Rev 2024; 163:105783. [PMID: 38944228 DOI: 10.1016/j.neubiorev.2024.105783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/28/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024]
Abstract
Depersonalisation-derealisation disorder (DDD) is characterised by distressing experiences of separation from oneself and/or one's surroundings, potentially resulting from alterations in affective, cognitive, and physiological functions. This systematic review aimed to synthesise current experimental evidence of relevance to proposed mechanisms underlying DDD, to appraise existing theoretical models, and to inform future research and theoretical developments. Studies were included if they tested explicit hypotheses in DDD samples, with experimental manipulations of at least one independent variable, alongside behavioural, subjective, neurological, affective and/or physiological dependent variables. Some evidence for diminished subjective responsivity to aversive images and sounds, and hyperactivation in neurocircuits associated with emotional regulation when viewing aversive images emerged, corroborating neurobiological models of DDD. Inconsistencies were present regarding behavioural and autonomic responsivity to facial expressions, emotional memory, and self-referential processing. Common confounds included small sample sizes, medication, and comorbidities. Alterations in affective reactivity and regulation appear to be present in DDD; however, further research employing more rigorous research designs is required to provide stronger evidence for these possible mechanisms.
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Affiliation(s)
- L S Merritt Millman
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Xi Huang
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Sorawit Wainipitapong
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom; Department of Psychiatry and Center of Excellence in Transgender Health, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nick Medford
- Lishman Unit, Bethlem Royal Hospital, London, United Kingdom
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
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Hunter ECM, Wong CLM, Gafoor R, Lewis G, David AS. Cognitive Behaviour Therapy (CBT) for Depersonalization Derealization Disorder (DDD): a self-controlled cross-over study of waiting list vs. active treatment. Cogn Behav Ther 2023; 52:672-685. [PMID: 37711065 DOI: 10.1080/16506073.2023.2255744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Depersonalisation-Derealisation Disorder (DDD) has a prevalence of around 1% but is under-recognised and often does not respond to medical intervention. We report on a clinical audit of 36 participants with a diagnosis of chronic DDD who were sequentially recruited from a specialist DDD National Health Service clinic in London, United Kingdom, and who completed Cognitive Behavioural Therapy specifically adapted for DDD. The sample population had a mean age of 38.7 years (s.d. = 13.4), 61% were male and 69% were of White ethnicity. Three outcomes were assessed (Cambridge Depersonalisation Scale [CDS], Beck Depression Inventory [BDI], and the Beck Anxiety Inventory [BAI]) at three time points in a naturalistic, self-controlled, cross-over design. Hierarchical longitudinal analyses for outcome response clustered by patient were performed using scores from baseline, beginning, and end of therapy. All scores showed improvement during the treatment period, with medium effect sizes. CBT may be an effective treatment for DDD. However, treatment was not randomly assigned, and the sample was small. More research is needed, including the use of randomisation to assess the efficacy of CBT for DDD.
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Affiliation(s)
- Elaine C M Hunter
- Department of Academic Psychiatry, University College London, London, UK
| | | | - Rafael Gafoor
- Department of Academic Psychiatry, University College London, London, UK
| | - Glyn Lewis
- Department of Academic Psychiatry, University College London, London, UK
| | - Anthony S David
- Department of Academic Psychiatry, University College London, London, UK
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Lofthouse MK, Waite P, Černis E. Developing an understanding of the relationship between anxiety and dissociation in adolescence. Psychiatry Res 2023; 324:115219. [PMID: 37119790 DOI: 10.1016/j.psychres.2023.115219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
Anxiety is a common problem in adolescence which is hypothesised to be associated with dissociation, a range of distressing symptoms linked to reduced psychosocial functioning. Yet, to date, research into the mechanisms of dissociation in adolescents has been limited. The present study investigated the link between trait anxiety and dissociative experiences (depersonalisation and 'felt sense of anomaly') using an online survey. Cognitive appraisals of dissociation, perseverative thinking, and body vigilance were assessed as potential mediating factors of this relationship. 1211 adolescents aged 13-18 years were recruited via social media advertisements and local schools. Linear regression showed a moderate positive relationship between trait anxiety and both dissociation constructs. Hierarchical regression indicated that cognitive appraisals of dissociation and perseverative thinking mediated the relationship between trait anxiety and both dissociation constructs, but trait anxiety was a significant predictor for felt sense of anomaly but not depersonalisation after including the mediators. The final models accounted for 58.7% of variance in depersonalisation and 68.4% of variance in felt sense of anomaly. These results support the hypothesis that dissociation is associated with anxiety in adolescence. They also demonstrate that cognitive-behavioural conceptualisations may be valid for understanding dissociation in adolescence.
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Affiliation(s)
- Miss Katie Lofthouse
- University of Oxford, Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University of East Anglia, Norwich Medical School, Chancellors Drive, Norwich NR4 7TJ, United Kingdom
| | - Polly Waite
- University of Oxford, Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom; University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Emma Černis
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Oxford OX3 7JX, United Kingdom; University of Birmingham School of Psychology, Edgbaston, Birmingham B15 2TT, United Kingdom
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Millman LM, Hunter EC, Terhune DB, Orgs G. Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder. Complement Ther Clin Pract 2023; 51:101749. [PMID: 37018935 DOI: 10.1016/j.ctcp.2023.101749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/09/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Depersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body, dance/movement therapy could provide an innovative treatment approach. MATERIALS AND METHODS We developed two online dance tasks to reduce detachment either by training body awareness (BA task) or enhancing the salience of bodily signals through dance exercise (DE task). Individuals with DDD (n = 31) and healthy controls (n = 29) performed both tasks individually in a cross-over design. We assessed symptom severity (Cambridge Depersonalization Scale), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness - II), mindfulness (Five Facet Mindfulness Questionnaire), and body vigilance (Body Vigilance Scale) before, during and after the tasks. RESULTS At baseline, individuals with DDD exhibited elevated depersonalization-derealization symptoms alongside lower levels of interoceptive awareness and mindfulness compared to controls. Both tasks reduced symptoms in the DDD group, though dance exercise was perceived as easier. The DE task increased mindfulness in those with DDD more than the BA task, whereas controls showed the opposite pattern. In the DDD group, within-subject correlations showed that lower levels of symptoms were associated with task-specific elevations in interoceptive awareness and mindfulness. CONCLUSION Individual and structured dance/movement practice, performed at home without an instructor present, offers an effective tool to reduce symptoms in DDD and can be tailored to address specific cognitive components of a mindful engagement with the body.
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Millman LSM, Hunter ECM, David AS, Orgs G, Terhune DB. Assessing responsiveness to direct verbal suggestions in depersonalization-derealization disorder. Psychiatry Res 2022; 315:114730. [PMID: 35870293 DOI: 10.1016/j.psychres.2022.114730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/03/2022] [Accepted: 07/16/2022] [Indexed: 10/17/2022]
Abstract
The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF10 = .11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r = -.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r = .25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology.
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Affiliation(s)
- L S Merritt Millman
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, United Kingdom.
| | - Elaine C M Hunter
- Institute of Mental Health, University College London, Maple House, 149 Tottenham Court Rd, Fitzrovia, London W1T 7BN, United Kingdom
| | - Anthony S David
- Institute of Mental Health, University College London, Maple House, 149 Tottenham Court Rd, Fitzrovia, London W1T 7BN, United Kingdom
| | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, United Kingdom
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London SE14 6NW, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, United Kingdom
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French NJ, Eberle JW, Teachman BA. Anxiety sensitivity, distress intolerance, and negative interpretation bias strengthen the relationship between trait anxiety and depersonalization. ANXIETY, STRESS, AND COPING 2022; 35:395-408. [PMID: 34524043 PMCID: PMC8920942 DOI: 10.1080/10615806.2021.1977797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND OBJECTIVES Depersonalization is common in anxiety disorders, but little is known about factors that influence co-occurring anxiety and depersonalization. DESIGN We investigated trait moderators of the relationships between state and trait anxiety and depersonalization to better understand their co-occurrence and to identify potential points of intervention. METHODS Adults recruited on Amazon Mechanical Turk (N = 303) completed two computer tasks designed to increase variability in state anxiety and depersonalization as well as several self-report questionnaires. RESULTS As hypothesized, anxiety positively predicted depersonalization at both a state level and trait level. Moreover, as hypothesized, the trait anxiety-trait depersonalization relationship was strengthened by greater anxiety sensitivity; distress intolerance; and negative interpretation bias for anxiety sensations, and for depersonalization sensations. None of these hypothesized trait moderators significantly strengthened the state anxiety-state depersonalization relationship. CONCLUSIONS These findings suggest that, on a trait level, anxiety and depersonalization more frequently co-occur when people catastrophically misinterpret their symptoms or have lower emotional distress tolerance.
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Affiliation(s)
- Noah J French
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy W Eberle
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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Gatus A, Jamieson G, Stevenson B. Past and Future Explanations for Depersonalization and Derealization Disorder: A Role for Predictive Coding. Front Hum Neurosci 2022; 16:744487. [PMID: 35321264 PMCID: PMC8934883 DOI: 10.3389/fnhum.2022.744487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Depersonalization (DP) and derealization (DR) refer to states of dissociation in which one feels a sense of alienation in relation to one's self and environment, respectively. Whilst transient episodes often diminish without treatment, chronic experiences of DP and DR may last for years, with common treatments lacking a strong evidence base for their efficacy. We propose a theoretical explanation of DP and DR based on interoceptive predictive coding, and discuss how transient experiences of DP and DR may be induced in the non-clinical population using virtual reality. Further, we review the use of heartbeat evoked potentials in detecting the neural correlates of DP and DR allowing for an objective measure of these experiences in the non-clinical population. Finally, we discuss how the induction and detection of transient experiences of DP and DR in the non-clinical population could shed light on how the brain constructs one's sense of self and reality.
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Affiliation(s)
- Andrew Gatus
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW, Australia
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Millman LSM, Hunter ECM, Orgs G, David AS, Terhune DB. Symptom variability in depersonalization-derealization disorder: A latent profile analysis. J Clin Psychol 2021; 78:637-655. [PMID: 34487354 DOI: 10.1002/jclp.23241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups. METHOD We applied latent profile analysis to psychometric measures of anxiety, depersonalization-derealization, and dissociation in 303 DDD patients. RESULTS The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety. CONCLUSION These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD.
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Affiliation(s)
| | | | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK
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Černis E, Bird JC, Molodynski A, Ehlers A, Freeman D. Cognitive appraisals of dissociation in psychosis: a new brief measure. Behav Cogn Psychother 2020; 49:1-13. [PMID: 33446299 PMCID: PMC8293624 DOI: 10.1017/s1352465820000958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Accepted: 11/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Catastrophic cognitive appraisals, similar to those in anxiety disorders, are implicated in depersonalisation, a form of dissociation. No scales exist to measure appraisals of dissociative experiences. Dissociation is common in psychosis. Misinterpretations of dissociative experiences may maintain psychotic symptoms. Therefore, assessing appraisals in this context may be valuable. AIMS The primary aim was to develop a measure of key appraisals of dissociation in psychosis. Secondary aims were to test the relationship between appraisals and psychotic experiences (paranoia and hallucinations), and determine whether appraisals explain additional variance in psychotic symptoms above dissociative symptoms. METHOD Fifty items were generated from transcripts of interviews with patients. The measure was developed and psychometrically validated via factor analysis of data from 9902 general population participants and 1026 patients with psychosis. Convergent validity, test-re-test reliability, and internal reliability were assessed. Regression analyses tested relationships with psychotic symptoms. RESULTS A 13-item single-factor measure was developed. Factor analysis indicated good model fit [χ2(65) = 247.173, comparative fit index (CFI) = 0.960, root mean square error of approximation (RMSEA) = 0.052]. The scale had good convergent validity with a rumination (non-clinical: r = 0.71; clinical: r = 0.73) and dissociation measure (r = 0.81; r = 0.80), high internal consistency (α = 0.93; α = 0.93), and excellent 1-week test-re-test reliability [intraclass correlation (ICC) = 0.90]. It explained variance in psychotic symptoms (paranoia: 36.4%; hallucinations: 35.0%), including additional variance compared with dissociation alone (paranoia: 5.3%; hallucinations: 2.3%). CONCLUSIONS The Cognitive Appraisals of Dissociation in Psychosis (CAD-P) measure is a psychometrically robust scale identifying appraisals of dissociative experiences in psychosis and is associated with the presence of psychotic experiences. It is likely to prove useful for clinical assessment and research.
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Affiliation(s)
- Emma Černis
- Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jessica C. Bird
- Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Anke Ehlers
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Centre for Anxiety Disorders and Trauma, Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Millman LSM, Terhune DB, Hunter ECM, Orgs G. Towards a neurocognitive approach to dance movement therapy for mental health: A systematic review. Clin Psychol Psychother 2020; 28:24-38. [PMID: 32539160 DOI: 10.1002/cpp.2490] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/30/2020] [Accepted: 06/11/2020] [Indexed: 01/17/2023]
Abstract
Dance movement therapy (DMT) has become an increasingly recognized and used treatment, though primarily used to target psychological and physical well-being in individuals with physical, medical or neurological illnesses. To contribute to the relative lack of literature within the field of DMT for clinical mental health disorders, using a narrative synthesis, we review the scope of recent, controlled studies of DMT in samples with different psychiatric disorders including depression, schizophrenia, autism and somatoform disorder. A systematic search of electronic databases (PubMed, Science Direct, World of Science and Clinicaltrials.gov) was conducted to identify studies examining the effects of DMT in psychiatric populations. Fifteen studies were eligible for inclusion. After reviewing the principal results of the studies, we highlight strengths and weaknesses of this treatment approach and examine the potential efficacy of using bodily movements as a tool to reduce symptoms. We conclude by placing DMT within the context of contemporary cognitive neuroscience research, drawing out implications of such an orientation for future research and discussing potential mechanisms by which DMT might reduce psychiatric symptoms. DMT has clear potential as a treatment for a range of conditions and symptoms, and thus, further research on its utility is warranted.
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Affiliation(s)
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK
| | | | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, London, UK
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Schweden TLK, C. Konrad A, Hoyer J. Die Cambridge Depersonalisation Scale-Situational (CDS-S) zur Erfassung von situationsabhängigem Depersonalisationserleben. DIAGNOSTICA 2019. [DOI: 10.1026/0012-1924/a000232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Depersonalisations- / Derealisationssymptome sind während der Konfrontation mit angstbesetzten Reizen oder Situationen häufig. Zur Erfassung dieses situationsbezogenen Depersonalisationserlebens wurde die Cambridge Depersonalisation Scale adaptiert. Die psychometrischen Gütekriterien der CDS-Situational (CDS-S) wurden in 2 Studien untersucht. 53 Patientinnen und Patienten mit Sozialer Angststörung und 32 gesunde Kontrollprobandinnen und Kontrollprobanden führten zweimal im Abstand von 4 Monaten den Trier Social Stress Test durch und schätzten anschließend die Schwere der Depersonalisation / Derealisation (CDS-S) und der Angst während des Tests ein. Ferner bearbeiteten 26 Studierende mit Prüfungsangst und 43 Studierende ohne Prüfungsangst die CDS-S direkt nach einer mündlichen Prüfung sowie 7 Tage später. Je nach Studie waren Cronbachs α (α ≥ .88), Item-Trennschärfen, Split-Half-Reliabilität ( rtt ≥ .74) und Retest-Reliabilität ( rtt = .40 – .88) zufriedenstellend bis sehr gut. Die Überprüfung der Veränderungssensitivität, Konstruktvalidität und faktoriellen Validität ergab zufriedenstellende Ergebnisse. Die CDS-S erfasste in 2 Studien situationsbezogenes Depersonalisations- / Derealisationserleben hinreichend reliabel und valide und ist zur Messung von Depersonalisations- / Derealisationssymptomen im sozialen und Leistungskontext zu empfehlen.
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Affiliation(s)
- Tabea L. K. Schweden
- Institut für Klinische Psychologie und Psychotherapie der Technischen Universität Dresden
| | - Annika C. Konrad
- Institut für Klinische Psychologie und Psychotherapie der Technischen Universität Dresden
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie der Technischen Universität Dresden
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Michal M, Adler J, Reiner I, Wermke A, Ackermann T, Schlereth T, Birklein F. Association of Neglect-Like Symptoms with Anxiety, Somatization, and Depersonalization in Complex Regional Pain Syndrome. PAIN MEDICINE 2018; 18:764-772. [PMID: 27605590 DOI: 10.1093/pm/pnw214] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Many patients with complex regional pain syndrome (CRPS) report some foreignness of the affected limb, which is referred to as "neglect-like symptoms" (NLS). Despite similarities of the NLS reports to symptoms of body image disturbances in mental disorders, no study has been conducted to examine such associations. Methods We investigated 50 patients with CRPS and 45 pain control patients (N = 27, chronic limb pain; N = 18, migraine headache). NLS, anxiety, depression, depersonalization, and somatization were assessed using validated questionnaires. Results Seventy-two percent of the CRPS patients reported at least one NLS vs 29.6% and 33.3% in the two patient control groups. In limb pain controls, NLS correlated with pain intensity. In CRPS patients, NLS correlated with anxiety (rho = 0.658, P < 0.001), somatization (rho = 0.616, P < 0.001), depersonalization (rho = 0.634, P < 0.001), and pain catastrophizing (rho = 0.456, P < 0.01), but not with intensity of pain, duration of pain, or pain disability. Conclusions In CRPS patients, NLS could be a result of somatization, depression, anxiety, and depersonalization, but probably not of pain. Whether these associations are causative must be clarified in longitudinal psychological studies.
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Affiliation(s)
- Matthias Michal
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Julia Adler
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Iris Reiner
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Andreas Wermke
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | | | - Frank Birklein
- Neurology, University Medical Center Mainz, Mainz, Germany
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Tibubos AN, Grammes J, Beutel ME, Michal M, Schmutzer G, Brähler E. Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms. J Affect Disord 2018; 227:571-579. [PMID: 29172049 DOI: 10.1016/j.jad.2017.11.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/14/2017] [Accepted: 11/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the relationships of common emotion regulation strategies (suppression and reappraisal) to self-reported fatigue and depersonalization/derealization symptoms. Specifically, we tested the moderating effect of suppression and reappraisal on the link of fatigue with depersonalization and derealization symptoms. Opposite effects were expected for both emotion regulation strategies assuming that cognitive reappraisal has an adaptive buffering effect, while suppression intensifies the association of fatigue and depersonalization/derealization experiences. METHODS In a representative study (N = 2524) we assessed emotion regulation strategies, fatigue, depersonalization/derealization, distress, and demographic variables via questionnaires. 55.5% of the participants were female, mean age was 49.4 (SD = 18.2) years with age groups represented in comparable proportions. RESULTS In line with the assumptions, moderated regression analyses revealed an interaction effect of emotion regulation strategies and fatigue. Simple slope analyses indicated a buffering effect of cognitive reappraisal on the positive relation of fatigue with depersonalization and derealization symptoms. In contrast, suppression fosters the positive correlation of fatigue and depersonalization and derealization experiences. LIMITATIONS Our study is limited to these two habitual emotion regulation strategies employing a cross sectional design. CONCLUSION Our findings provide comprehensive empirical data investigating depersonalization/derealization symptoms from the perspective of emotion regulation research. Cognitive reappraisal might help people suffering from fatigue to prevent depersonalization and derealization tendencies.
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Affiliation(s)
- Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany.
| | - Jennifer Grammes
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
| | - Gabriele Schmutzer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Zahlbacher Str. 8, D-55131 Mainz, Germany
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14
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Merckelbach H, Boskovic I, Pesy D, Dalsklev M, Lynn SJ. Symptom overreporting and dissociative experiences: A qualitative review. Conscious Cogn 2017; 49:132-144. [PMID: 28187372 DOI: 10.1016/j.concog.2017.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 10/05/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.
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Affiliation(s)
- H Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands.
| | - I Boskovic
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - D Pesy
- Department of Neurology, Franziskus Hospital, Mönchengladbach, Germany
| | - M Dalsklev
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - S J Lynn
- Binghamton University - State University of New York, Binghamton, NY, USA
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15
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Reduction of depersonalization during social stress through cognitive therapy for social anxiety disorder: A randomized controlled trial. J Anxiety Disord 2016; 43:99-105. [PMID: 27648752 DOI: 10.1016/j.janxdis.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/30/2016] [Accepted: 09/13/2016] [Indexed: 11/23/2022]
Abstract
Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome. In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT (n=20) or a waitlist period (n=20) and were compared to healthy controls (n=21). Self-reported depersonalization was measured immediately after each stress test. Depersonalization significantly decreased following CT, especially in treatment responders (ηp2=0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety. Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy.
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16
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Farrelly S, Peters E, Azis M, David A, Hunter EC. A brief CBT intervention for depersonalisation/derealisation in psychosis: study protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2016; 2:47. [PMID: 27965864 PMCID: PMC5154060 DOI: 10.1186/s40814-016-0086-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depersonalisation is the experience of being detached or disconnected from one's experience. Studies suggest that clinically significant levels of depersonalisation are common in individuals who have psychotic symptoms and are associated with increased impairment. However, to date, there have been no studies that have investigated an intervention designed to target clinically significant depersonalisation in such patient groups. This study aims to determine the feasibility and acceptability of a brief intervention targeting clinically significant depersonalisation in those who also have current psychotic symptoms. METHODS/DESIGN The feasibility of delivering six sessions of cognitive behavioural therapy for depersonalisation in psychosis patients will be evaluated using a single-blinded randomised controlled trial with a treatment as usual control condition. Participants will be assessed at baseline and then randomised to either the treatment or control arm. Participants randomised to the treatment arm will be offered six sessions of individual cognitive behavioural therapy delivered over a maximum of 10 weeks. Therapy will focus on an individualised shared formulation of depersonalisation experiences and behavioural, cognitive, emotional regulation and thinking process strategies to decrease distress associated with depersonalisation. Participants will be assessed again at a 10-week (post-randomisation) follow-up assessment. The primary outcomes of interest will be those assessing the feasibility and acceptability of the intervention including rates of referral, eligibility and acceptance to participate; attendance at therapy sessions and completion of homework tasks; satisfaction with the intervention; maintenance of blinding; and therapist competence. Secondary outcomes will be data on clinical outcome measures of depersonalisation and positive symptoms of psychosis, anxiety, depression and post-traumatic stress. DISCUSSION This study will determine the feasibility of delivering six sessions of cognitive behavioural therapy for individuals with current psychotic symptoms who also experience clinically significant levels of depersonalisation. The results will provide information to inform a larger randomised trial to assess intervention efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT02427542.
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Affiliation(s)
- Simone Farrelly
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony David
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elaine C Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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17
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Nestler S, Jay EL, Sierra M, David AS. Symptom profiles in depersonalization and anxiety disorders: an analysis of the Beck Anxiety Inventory. Psychopathology 2015; 48:84-90. [PMID: 25401973 DOI: 10.1159/000367600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depersonalization disorder (DPD) entails distressing alterations in self-experiencing. However, it has long been recognized that depersonalisation symptoms occur in other disorders, particularly anxiety and panic. One strand of research proposes that depersonalization phenomenology arises through altered autonomic arousal in response to stress. SAMPLING AND METHODS We sought to examine profiles of anxiety symptoms through a secondary data analysis of individual items and factor subscales on the Beck Anxiety Inventory (BAI), comparing two relatively large patient samples with DPD or with a variety of anxiety conditions, respectively. The DPD sample (n = 106) had a lower overall BAI score than the combined anxiety disorders group (n = 525). RESULTS After controlling for this as well as for potential confounders such as age and gender, the DPD group presented significantly lower scores on the panic subscale, marginally lower scores on the autonomic subscale and significantly higher scores on the neurophysiological subscale of the BAI. CONCLUSIONS These differences imply similarities between the cognitive components of DPD and anxiety disorders while physiological experiences diverge. The findings encourage future research looking at direct physiological measures and longitudinal designs to confirm the mechanisms underlying different clinical manifestations of anxiety.
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Affiliation(s)
- Steffen Nestler
- Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
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