Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder : meta-analysis

Background: any patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effectiveness of psychotherapy for PTSD is unresolved. 

Aims: To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD. 

Method: We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (preregistered at Prospero CRD42018086575). 

Results: Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson’s correlation coefficient 0.04, 95% CI −0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias. 

Conclusions: We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.



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Reference: 
C. M. Hoeboer, R. A. De Kleine, M. L. Molendijk, M. Schoorl, D. A. C. Oprel, J. Mouthaan, W. Van der Does and A. Van Minnen | 2020
In: BJPsych Open ; ISSN: 2056-4724 | 6 | 3 | e53
https://doi.org/10.1192/bjo.2020.30
Keywords: 
Dissociative Disorders, Group Psychotherapy, Individual Psychotherapy, Literature Review, Meta Analysis, Methodology, Posttraumatic Stress Disorder, Psychotherapy, Psychotrauma, PTSD (DSM-5), PTSD (en), Statistical Analysis