Disentangling the Link Between Mindfulness and Dissociation in PTSD: The Mediating Role of Attention and Emotional Acceptance

Group Dissociation-Focused Cognitive Behavioral Therapy (DF-CBT) in Patients Suffering from a Dissociative Subtype of PTSD: An Exploratory Study

Dissociation is a widespread difficulty among patients suffering from Posttraumatic Stress Disorder (PTSD). However, there is no gold standard treatment for dissociative symptoms. Recent studies propose a cognitive and behavioral conceptualization for dissociation. The aim of this study was to explore the efficacy of a group program of Dissociation-Focused Cognitive Behavior Therapy (DF-CBT) on dissociative symptoms. We recruited 27 patients suffering from a dissociative subtype of PTSD in a university hospital trauma center. Participants completed questionnaires evaluating dissociation, PTSD, mindfulness abilities, beliefs about emotions, beliefs about dissociation, emotion regulation difficulties, anxiety and depression. Following an initial evaluation, participants undertook 7 sessions of DF-CBT, and were reevaluated after the last session using the same questionnaires. We found a significant reduction of dissociative, PTSD, anxiety, and depression symptoms following DF-CBT. The effect size was noticeable for all variables (.61 Collapse

Key Words

• CBT
• PTSD
• beliefs about dissociation
• beliefs about emotion
• cognition
• dissociation
• emotion regulation

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Affiliation(s)

Alexis Vancappel Department of psychiatry, CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France Département de Psychologie, UR 1901 QualiPsy, Qualité de vie et santé psychologique, Université de Tours, Tours, France
Claudie Chavigny Department of psychiatry, CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
Lyna Chami Department of psychiatry, CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France
François Kazour Service de Psychiatrie et d'Addictologie, CHU Angers, Angers, France Department of psychiatry, UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
Wissam El-Hage Department of psychiatry, CHRU de Tours, Pôle de Psychiatrie-Addictologie, Tours, France Department of psychiatry, UMR 1253, iBrain, Université de Tours, Inserm, Tours, France

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Esketamine-induced post-traumatic stress disorder flashbacks during treatment-resistant depression indication: is it just a side effect?

Background

Posttraumatic stress disorder (PTSD) is a severe and frequent affection that is highly comorbid to major depressive disorder. Comorbid PTSD and depression are usually treatment-resistant, with a high risk of functional impairment and suicide. Esketamine nasal spray is a recent validated treatment for treatment-resistant depression (TRD), but its efficacy on comorbid TRD-PTSD remains insufficiently documented. In particular, flashbacks can occur during esketamine administration and their influence on clinical outcomes is unknown.

Objectives

Our main objective was to describe esketamine-induced traumatic flashbacks and their impact on clinical trajectories within a sample of patients with comorbid TRD-PTSD.

Methods

We retrospectively collected clinical data of patients receiving esketamine nasal spray for TRD with comorbid PTSD who experienced at least one flashback of their trauma during esketamine sessions across 11 psychiatric departments.

Results

Between February 2020 and March 2023, 22 adult patients with TRD met inclusion criteria. In sixteen patients (72.7%) flashbacks disappeared as the sessions progressed. In six patients (27.3%), esketamine treatment was stopped because of persistent flashbacks. When esketamine was continued, clinical response was observed both for depression and PTSD (depression response rate: 45.5% and remission rate: 22.7%; PTSD response rate: 45.5% and remission: 18.2%).

Limitations

The retrospective design of the study and the absence of a comparator group are the main limitations of our study.

Conclusions

Our results suggest that the occurrence of esketamine-induced traumatic flashbacks does not hinder clinical response. On the contrary, when managed appropriately and combined with targeted psychotherapy, it could even contribute to positive outcomes.