Treatment Effectiveness of High Intensity Trauma Therapy for Patients with the Dissociative Subtype of PTSD

Objective: Many individuals with posttraumatic stress disorder (PTSD) experience dissociative symptoms, yet research is inconclusive on how dissociation impacts treatment outcomes. This study investigated whether patients with the dissociative subtype of PTSD (PTSD-DS) benefited equally from high intensity trauma therapy (HITT) compared to patients with classic PTSD. The aim was to determine whether dissociation interferes with the effectiveness of trauma therapy. Methods: This clinical cohort study included 360 patients with persistent PTSD symptoms of whom 142 diagnosed with PTSD-DS and 218 with classic PTSD. A diagnosis of PTSD, including the presence of the dissociative subtype, was determined using the Life Events Checklist (LEC-5) and Clinician Administered PTSD Scale for DSM-5 (CAPS-5). PTSD symptom severity was measured with the PTSD Scale for DSM-5 (PCL-5). Patients underwent a 5-day inpatient treatment program consisting of psychoeducation, two daily therapy sessions, and...Show moreObjective: Many individuals with posttraumatic stress disorder (PTSD) experience dissociative symptoms, yet research is inconclusive on how dissociation impacts treatment outcomes. This study investigated whether patients with the dissociative subtype of PTSD (PTSD-DS) benefited equally from high intensity trauma therapy (HITT) compared to patients with classic PTSD. The aim was to determine whether dissociation interferes with the effectiveness of trauma therapy. Methods: This clinical cohort study included 360 patients with persistent PTSD symptoms of whom 142 diagnosed with PTSD-DS and 218 with classic PTSD. A diagnosis of PTSD, including the presence of the dissociative subtype, was determined using the Life Events Checklist (LEC-5) and Clinician Administered PTSD Scale for DSM-5 (CAPS-5). PTSD symptom severity was measured with the PTSD Scale for DSM-5 (PCL-5). Patients underwent a 5-day inpatient treatment program consisting of psychoeducation, two daily therapy sessions, and trauma sensitive yoga. The therapy included either two sessions of EMDR or a combination of prolonged exposure and EMDR. Multilevel modeling was performed to analyze and compare the development of PTSD symptoms over time of patients from both subgroups. Results: Overall, patients with PTSD-DS exhibited more severe PTSD symptoms compared to those with classic PTSD (b = 4.01, t = 3.33). Exploratory analyses revealed that intrusive symptoms (p = .001, d = .43) and changes in cognitions and mood (p = .010, d = .28) were elevated within the PTSD-DS subgroup. When controlling for PTSD severity, patients from both subgroups showed similar reductions in PTSD symptoms over time (b = -.55, t = -.55). However, on average patients still scored within the clinical range of PTSD at posttreatment and follow-up. Conclusion: Patients with PTSD-DS and classic PTSD equally benefited from the HITT. These findings provide support for the effectiveness of intensive trauma treatments for patients with PTSD DS, highlighting the potential for reducing non-response and enhancing treatment outcomes within this population.Show less

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Treatment Effectiveness of High Intensity Trauma Therapy for Patients with the Dissociative Subtype of PTSD