The role of dissociation-related beliefs about memory in trauma-focused treatment.

OBJECTIVE: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.

This study investigated the role of dissociation-related beliefs about memory on trauma-focused treatment.Dissociation-related beliefs were related to post-traumatic and dissociative symptoms, and were especially prominent in patients with the dissociative subtype of post-traumatic stress disorder.Dissociation-related beliefs about memory do not impact the effectiveness of trauma-focused treatment. In fact, trauma-focused treatment effectively decreased these beliefs, suggesting that dissociation-related beliefs about memory should not be a determining factor in withholding patients from receiving trauma-focused therapy.

Applicability of hypnosis to the treatment of Complex PTSD and dissociation.

In considering the applicability of hypnosis to treating Complex PTSD (C-PTSD) we examine the relationship between trauma, hypnosis, and dissociation, the latter being a common response to traumatization that is particularly salient in C-PTSD. We then provide an overview of the nature of C-PTSD, which research is beginning to demonstrate is considerably more prevalent than the more circumscribed PTSD syndrome depicted in the DSM. Building on this foundation, we discuss the reasons why hypnotically structured treatment is particularly well suited for C-PTSD, explaining how each of the major aspects of this syndrome can be addressed within a hypnotic framework.

[Inpatient Treatment of Complex PTSD Following Childhood Abuse: Effectiveness and Predictors of Treatment Outcome]. / Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs.

BACKGROUND: There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated. METHODS: 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response. RESULTS: The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5

Secondary trauma among trauma researchers: Lessons from the field.

OBJECTIVE: There is a substantial body of research that indicates that professionals treating traumatized clients or patients may suffer from burnout, compassion fatigue, vicarious trauma, or secondary traumatic stress and that those who are most empathic are most vulnerable. However, there is limited research on the effects of participant trauma on trauma researchers. This is the focus of the current study. METHOD: Drawing on case illustrations from a large trauma-related study, we demonstrate the effects of participant trauma on trauma interviewers. RESULTS: The experiences of fieldworkers in this study often mirror the syndromes found among "flooded" therapists, suggesting that it is the listening, and not so much the purpose for which one is listening, that can result in trauma-by-proxy. CONCLUSION: Recommendations: Ethics applications should include a provision for the proper care for trauma researchers, who may, without support, develop symptoms of secondary traumatic stress. Training and regular supervision should become a mandatory part of trauma research practice, and if trauma levels are high, the principal researcher may need to invite a trauma counselor to do debriefing. In contexts where trauma levels are as high as in South Africa, fieldworkers are entitled to debriefing by an appropriately trained professional. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.

This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments.

Motivación psicológica en los juegos de rol online: un estudio de jugadores españoles del World of Warcraft / Psychological motivation in online role-playing games: A study of Spanish World of Warcraft players

La popularidad de los videojuegos ha aumentado considerablemente en los últimos años, convirtiéndose en uno de los mayores productos de ocio siendo los Juegos de Rol Online (MMORPGs) uno de los mayores exponentes; sin embargo, también ha aumentado la sospecha y alarma social de que puedan poseer cierto potencial adictivo enmarcado en el contexto de las adicciones conductuales o que los usuarios puedan desarrollar conductas desadaptativas entorno a esta tecnología. El objetivo del presente estudio evalúa las motivaciones psicológicas para jugar al al World of Warcraft (WoW) y las relaciona con variables sociodemográficas y estilos de juego. Se aplicó un cuestionario para evaluar diferentes motivaciones online a un colectivo de jugadores de WoW. A partir de una muestra final de 253 jugadores españoles (hombres jóvenes) el análisis factorial mostró la presencia de cuatro motivos de juego: socialización, exploración, logro y disociación. Además, los jugadores españoles, preferían el entorno Jugador contar Jugador, un aspecto que parece prevenir las potenciales consecuencias negativas al impedir el juego solitario. Los resultados indican que una de las motivaciones más importantes es la socialización y el estilo de Jugador contra Jugador, lo cual indica en gran parte el uso de este juego se hace de forma psicológicamente adaptativo (AU)

The popularity of playing videogames has increased considerably during the last few decades, and has become one of the most popular leisure activities worldwide. Some of the most popular game types are the Massively Multiplayer Online Role-Playing Games (MMORPGs). However, there has also been increased suspicion and social alarm that these games may possess an addictive potential, similar to other behavioural addictions, and that the user may develop maladaptive behaviours with respect to these games. The purpose of the present study was to assess the psychological motivations of playing World of Warcraft (WoW) and to relate them to sociodemographic variables and gaming styles. A questionnaire for assessing these motivations was developed and applied online to a collective of games. The final sample comprised 253 Spanish WoW players (all young males). Factor analysis of the questionnaire scores showed the presence of four motivations for gaming: socialisation, exploration, achievement, and dissociation. Results indicated that socialisation was one of the main motivational factors and that the gamers preferred the Player-versus-Player environment. Both of these aspects appear to be factors that may prevent potentially negative outcomes by inhibiting solitary play (AU)

Evaluation of the evidence for the trauma and fantasy models of dissociation.

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

Hypnotic complications from hypnotic play with 35-year follow-up studies.

Although diverse cases on hypnosis and hypnotic complications have been reported, little on hypnotic play has been discussed. One exception that the author is aware of is a report by Orne (1965), which states that complications that arise from hypnotic play are minor in nature. Contrary to Orne's report, 2 clinical cases treated by the author were observed to have suffered from severe hypnotic complications over long periods of time after hypnotic play. In these cases, spontaneous rehypnotization, including dissociative symptoms, appeared and greatly disturbed the patients' academic as well as daily lives. Regressive symptoms and personality changes were also observed. When these cases were revisited 35 years later, however, none of those disturbances was reported to have lasted into the patients' adulthood. Both of these former patients were reported to be mentally and physically healthy, each living happily as the mother of 2 children.

Double dissociation between syntactic gender and picture naming processing: a brain stimulation mapping study.

Neural foundations of syntactic gender processing remain poorly understood. We used electrostimulation mapping in nine right-handed awake patients during surgery for a glioma within the left hemisphere, to study whether the cortico-subcortical structures involved in naming versus syntactic gender processing are common or distinct. In French, the article determines the grammatical gender. Thus, the patient was asked to perform a picture naming task and to give the appropriate article for each picture, with and without stimulation. Cortical stimulation elicited reproducible syntactic gender disturbances in six patients, in the inferior frontal gyrus (three cases), and in the posterior middle temporal gyrus (three cases). Interestingly, no naming disorders were generated during stimulation of the syntactic sites, while cortical areas inducing naming disturbances never elicited grammatical gender errors when stimulated. Moreover, at the subcortical level, stimulation of the white matter lateral to the caudate nucleus induced gender errors in three patients, with no naming disorders. Using cortico-subcortical electrical mapping in awake patients, we demonstrate for the first time (1) a double dissociation between syntactic gender and naming processing, supporting independent network model rather than serial theory, (2) the involvement of the left inferior frontal gyrus, especially the pars triangularis, and the posterior left middle temporal gyrus in grammatical gender processing, (3) the existence of white matter pathways, likely a sub-part of the left superior longitudinal fasciculus, underlying a large-scale distributed cortico-subcortical circuit which might selectively sub-serve syntactic gender processing, even if interconnected with parallel sub-networks involved in naming (semantic and phonological) processing.

Treatment of trauma- and abuse-related dissociative symptom disorders in children and adolescents.

TOPIC: Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists. PURPOSE: Modes of treatment for dissociation as it affects children and adolescents are described. SOURCES USED: Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed. CONCLUSIONS: Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery.

Maltreated children's memory: accuracy, suggestibility, and psychopathology.

Memory, suggestibility, stress arousal, and trauma-related psychopathology were examined in 328 3- to 16-year-olds involved in forensic investigations of abuse and neglect. Children's memory and suggestibility were assessed for a medical examination and venipuncture. Being older and scoring higher in cognitive functioning were related to fewer inaccuracies. In addition, cortisol level and trauma symptoms in children who reported more dissociative tendencies were associated with increased memory error, whereas cortisol level and trauma symptoms were not associated with increased error for children who reported fewer dissociative tendencies. Sexual and/or physical abuse predicted greater accuracy. The study contributes important new information to scientific understanding of maltreatment, psychopathology, and eyewitness memory in children.

Intrusive images and memories in major depression.

Individuals with current major depression were interviewed to investigate the prevalence of distressing intrusive mental imagery among depressed patients and study the phenomenology of these intrusions. Of the 39 currently depressed patients, 17 experienced some form of repetitive intrusive imagery (i.e., either an intrusive memory or image), with intrusive memories being more common than images. The intrusive imagery was experienced as highly uncontrollable and interfered significantly with patients' everyday lives. The intrusions were experienced with a sense of 'nowness', as well as physical and emotional re-experiencing. Despite high levels of re-experiencing, levels of dissociation were very low. The intrusive imagery was in some patients part of a wider network of key defining autobiographical memories, consistent with the idea that it is likely to play a significant role in maintaining the patient's depressive mood. Interventions targeting these intrusions could potentially result in a positive shift in depressed mood.

Dissociation reduction in body therapy during sexual abuse recovery.

The study purpose was to examine dissociation in body therapy for women receiving psychotherapy for childhood sexual abuse. An initial intervention study provided an opportunity to examine dissociation; the sample of 24 women received eight, 1-h body therapy sessions. The Dissociative Experiences Scale served as the predictor variable, and the outcome measures reflected psychological and physical health, and body connection. Repeated measures analysis of variance was used to examine dissociation reduction across time. Pearson correlations were used to describe associations between the relative change in dissociation and outcomes. The results demonstrated that the greatest change was the reduction of dissociation; there was an incremental effect across time and a strong association between change in dissociation and health outcomes. High dissociation at baseline (moderate levels) predicted positive outcomes. The results demonstrated the importance of moderate dissociation as an indicator of distress, and the central role of dissociation reduction in health and healing.

Dissociation and serenity induction.

Dissociation is a common experience during or immediately after a traumatic event; yet, most of the current knowledge regarding dissociation is retrospective in nature. The aim of the present study investigated a non-pharmacological method of dissociative induction with a clinical sample. Participants with PTSD and non-trauma exposed participants were randomly assigned to receive either a dissociative induction, or a serenity induction, based on modified Velten mood induction procedures. Participants receiving the dissociative induction reported higher state-dissociation than those receiving the serenity induction. The PTSD group reported greater state dissociation than the non-trauma exposed group, regardless of induction. State dissociation was related to trait dissociation, PTSD severity, and depression. The present results provide an initial demonstration of the viability for inducing state dissociation in the laboratory with a PTSD sample.

Alexithymia in PTSD: psychometric and FMRI studies.

Two studies examined correlates of alexithymia in posttraumatic stress disorder (PTSD). In study 1 (n = 77 individuals with PTSD and 45 controls) Toronto alexithymia scale (TAS-20) scores were positively correlated with PTSD symptoms, dissociation, and childhood abuse and neglect. In study 2, TAS-20 scores were examined as correlates of functional magnetic resonance imaging (fMRI) blood oxygen level dependent (BOLD) response to trauma script imagery. In 16 controls, TAS-20 scores correlated positively with response in medial prefrontal cortex (mPFC), and negatively with response in anterior cingulate cortex (ACC) and thalamus. In 26 individuals with PTSD, TAS-20 scores correlated positively with response in insula, posterior cingulate cortex (PCC), and thalamus, and negatively with response in ACC.

The induction of anomalous experiences in a mirror-gazing facility: suggestion, cognitive perceptual personality traits and phenomenological state effects.

Previous research suggests that mirror-gazing is efficacious for the facilitation of anomalous experiences. The present experiment tested the hypothesis that the incidence of such experiences is a function of the demand characteristics of the procedure. Participants were randomly allocated to one of two conditions and completed a battery of trait and state measures. Individuals who were given suggestions for anomalous experiences, relative to those who were not, reported a greater number of visual, and a suggestively greater number of vocal, hallucinations. The experience of a descriptively dissociative phenomenological state was the strongest predictor of the reporting of anomalous experiences, but only correlated with the experience of anomalous perceptions in the suggestion condition. Experients of visual apparitions were found to significantly differ from nonexperients in their preference for a visual cognitive style independently of condition.

Memory and suggestibility in maltreated children: age, stress arousal, dissociation, and psychopathology.

The present study was designed to assess children's memory and suggestibility in the context of ongoing child maltreatment investigations. One hundred eighty-nine 3-17-year-olds involved in evaluations of alleged maltreatment were interviewed with specific and misleading questions about an anogenital examination and clinical assessment. For the anogenital examination, children's stress arousal was indexed both behaviorally and physiologically. For all children, individual-difference data were gathered on intellectual and short-term memory abilities, general psychopathology, and dissociative tendencies. Interviewers' ratings were available for a subset of children concerning the amount of detail provided in abuse disclosures. Results indicated that general psychopathology, short-term memory, and intellectual ability predicted facets of children's memory performance. Older compared to younger children evinced fewer memory errors and greater suggestibility resistance. Age was also significantly related to the amount of detail in children's abuse disclosures. Neither dissociation nor stress arousal significantly predicted children's memory. Implications for understanding maltreated children's eyewitness memory are discussed.

Recommendations and illustrations for combining hypnosis and EMDR in the treatment of psychological trauma.

Three experienced therapists, trained in hypnosis and EMDR, distilled some tentative hypotheses about the use of hypnosis in EMDR from fifteen cases, two presented here. When a therapist uses hypnosis with EMDR, it seems that the client is having difficulty or the therapist anticipates that the client will have difficulty managing the experiences processed with EMDR. Hypnosis initiated either during the introduction to EMDR or within a therapy session prior to the initiation of EMDR seems to have served two functions. The first function is to activate inner work that prepares the client to use EMDR successfully, and the second function is to facilitate overtly the processing of the traumatic experience. Clients might have two kinds of difficulties in managing affect or distress: (1) they may have a long-standing, irrational and strongly held belief that interferes with managing affect or distress, and (2) they may never have developed the capacity to tolerate intense affect, distress or pain. Should a therapist use hypnosis during the closing down phase of a session without preparing the client with hypnosis during the introduction to EMDR, the therapist should seriously reconsider the pace and focus of EMDR and the client's resources to manage affect and distress.

A psychodynamic view of psychosomatic medicine.

OBJECTIVE: The objective of this article is to assess the relevance of psychodynamic observations and theory for psychosomatic medicine. METHODS: The evolution of the psychodynamic formulation of psychosomatic symptom formation is described in a brief historical review. RESULTS: There are two distinctly different pathways along which stress-induced psychological arousal is transformed into somatic symptoms. CONCLUSIONS: Psychodynamic observations and theory have important implications for psychosomatic research and treatment.

Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology.

OBJECTIVE: The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience. METHOD: To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed. RESULTS: Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process. CONCLUSIONS: High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.