Is the dissociative adult suggestible? A test of the trauma and fantasy models of dissociation

Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy

OBJECTIVE

We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET).

DESIGN

Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach.

METHODS

Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery.

RESULTS

NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability.

CONCLUSIONS

Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.

Psychometrics of Three Dissociation Scales: Reliability and Validity Data on the DESR, DES-II, and DESC

The current study assessed the reliability and validity of three measures of dissociation. Three hundred students completed the Dissociative Experiences Scale Revised (DESR), the Dissociative Experiences Scale-II (DES-II), and the Dissociative Experiences Scale Comparison (DESC); an additional 252 community adults evaluated clarity of instructions. Findings revealed that the three dissociation measures showed acceptable test-retest reliability and Cronbach's alphas. The DESR and DES-II strongly intercorrelated, but the DESC correlated only moderately with the two remaining dissociation measures, sharing less than 10% of the variance with the original scale. Additionally, the DESR and DES-II showed stronger convergent validity (correlation with measures of alexithymia and post-traumatic stress disorder) than did the DESC. The DESC was the only measure unrelated to trauma history. Participants reported substantially greater difficulty in understanding and utilizing the metric offered by the DESC. In conclusion, evidence supports the DES-II and DESR as alternate measures, but the DESC requires more investigation.

A systematic review of the relationship between emotion and susceptibility to misinformation

Inaccurate memory reports can have serious consequences within forensic and clinical settings, where emotion and misinformation are two common sources of memory distortion. Many studies have investigated how these factors are related; does emotion protect memory or leave it more vulnerable to the distorting effects of misinformation? The findings remain diffused. Thus, the present review aimed to clarify the relationship between emotion and susceptibility to misinformation. 39 eligible studies were reviewed. Results varied according to the type and dimension of emotion measured. Level of arousal may be unrelated to susceptibility to misinformation when retrieval occurs without delay; studies including delayed retrieval were limited. Stimuli valence may be associated with increased susceptibility to peripheral misinformation but unrelated to other misinformation. The following results were reported by limited studies: short-term distress and moderate levels of stress may decrease susceptibility, while anger and greater cortisol response to stress may increase susceptibility to misinformation. Source memory may also be unaffected by emotion. The results have important potential implications for forensic and clinical practice, for example by highlighting the value of enquiring witnesses' source memory. Methodological recommendations for future studies are made.

The path to dissociative experiences: A direct comparison of different etiological models

Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

Firebug! Dissociative Identity Disorder? Malingering? Or …? An Intensive Case Study of an Arsonist

Courts struggle with questions of how to assess competency to stand trial (CTS) and not guilty by reason of insanity (NGRI) in dissociative identity disorder (DID). Concerns about CTS include dissociative amnesia and unpredictable switching behaviors that could cause inconsistent information transfer across self states, with the defendant unable to access important legal information about his/her defense and to collaborate with his/her attorney; DID defendants could not conform their conduct to the law or know right from wrong due to dissociative amnesia, the seemingly independent actions of self states, and the disruption of reality testing by switching. The author presents the case of a woman charged with both a witnessed and an unwitnessed burglary and arson, the latter at the home of her former therapist. The author was the fourth forensic evaluator in the case. Disagreements included whether the defendant met diagnostic criteria for DID or was malingering, and whether she was CTS and/or NGRI. In clinical work with DID, “the whole human being” is held responsible for all behavior, despite reported amnesia or lack of subjective agency. The Discrete Behavioral States (DBS) model of DID avoids reification of the DID self states and their conflation as separate “people.” This model supports evaluating the defendant at the level of specific self states, the self-state system, and that of the whole human being. The author concluded that the defendant met diagnostic criteria for DID and also was malingering its severity. She was competent to stand trial and legally sane.

Treatment of Trauma: Imaginative Minds of Dissociative Identify Disorder

If childhood trauma leads to dissociation, then this coping mechanism is powered by the imagination, creativity, consciousness, and similar areas of cognitive function. The goal of this article is to promote the treatment of trauma with particular emphasis on humanistic psychotherapy and behavioral therapy, such as “Play Therapy” for pediatric populations. It will thoroughly describe the multiple personality states within dissociative identity disorder, including the individualized sense of “self.” The diagnostic criteria of this mental disorder will be covered, along with assessment techniques that evoke a deeper understanding of dissociative disorders. It will also discuss comorbidities that present with dissociative disorders, such as posttraumatic stress disorder. This scholarly article suggests that dissociative disorders may result from experiencing tragic events and therefore need treatment for trauma to relieve negative symptoms of dissociation. The multidimensional aspects of dissociation are emphasized in their relation to the treatment of trauma.

Multigenerational Dissociation: A Framework for Building Narrative

This paper presents the concept of Multigenerational Dissociation (MGD), a behavior pattern that occurs in families in which violence and abuse are re-enacted from one generation to the next, accompanied by denial that the trauma occurred, or if it did, that it was destructive. While revictimization, reenactment, and the intergenerational transmission of trauma are discussed extensively in the literature, MGD helps to view them within a broad historical framework. This is useful for conceptualizing cases therapeutically, and it can also contribute to research on dissociation and recovered memories of trauma and abuse by demonstrating the value of narrative clinical data. Case material is used to illustrate how MGD occurs in people's lives and affects their memories, demonstrating how it becomes a frame within which to convey the dynamics of how traumatic experiences are remembered. This also demonstrates that when clinicians contribute their own narrative data to research on traumatic memory, the science is more accurate, relevant, and comprehensible to clinical and nonclinical researchers.

Protecting scientists, science, and case protagonists: a discussion of the Taus v. Loftus commentaries

This article is a discussion of the articles by Nicole Taus Kluemper, Erna Olafson, Frank Putnam, Laura Brown, Ross Cheit, and Gerald Koocher. The papers center on the issues raised by a decision by two psychologists to break the confidentiality of a case study published by David Corwin and Erna Olafson to gather information to support an alternative theoretical view of the case. The article reviews best understandings of the justifications proposed by the psychologists, who saw themselves as investigative reporters, discusses the papers that have been submitted, and proposes enhanced ethical guidelines and increased professional discussion of these issues.