The Treatment of Dissociative Identity Disorder with Cognitive Analytic Therapy: Experimental Evidence of Sudden Gains
Department of Clinical Psychology, Keresforth Centre, Barnsley S70 6RS, United Kingdom. Journal of Trauma & Dissociation
(Impact Factor: 1.72).
02/2005; 6(3):55-81. DOI: 10.1300/J229v06n03_03
The central aim of this study was to assess the effectiveness of cognitive analytic therapy (CAT) with a patient presenting with DID. The methodology employed an A/B single case experimental design with six-months continuous follow-up in seven experimental measures. A and B represent the assessment of seven dissociative experimental variables under two conditions: baseline (A) and treatment (B). Treatment consisted of 24 sessions of CAT with four follow-up sessions, which is standard within the CAT model for personality disorder patients. A battery of measures of general psychological functioning was also completed at assessment, termination, and follow-up. During treatment the intensity of a range of dissociative symptoms was observed to be reduced, with sudden gains evident due to specific CAT interventions in specific dissociative symptoms. The long-term effectiveness of the intervention was established by the illustration of either continued stability or continued improvement in experimental variables across the follow-up period. Analysis of the general measures illustrates clinically significant change across a variety of robust psychometric measures. The study illustrates the utility of single-case approaches with dissociative disorders and the potential for utilizing CAT generally with such presentations.
Available from: PubMed Central
- "A review of the literature examining treatments for dissociative disorders such as dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified shows a lack of standardized and well-designed studies.32 One controlled single case study did show improvement in dissociative pathology in a dissociative identity disorder patient with cognitive analytic therapy.33 No other controlled studies have been published for dissociative disorders. "
[Show abstract] [Hide abstract]
ABSTRACT: Psychogenic nonepileptic seizures (PNES) can significantly affect an individual's quality of life, the health care system, and even society. The first decade of the new millennium has seen renewed interest in this condition, but etiological understanding and evidence-based treatment availability remain limited. After the diagnosis of PNES is established, the first therapeutic step includes a presentation of the diagnosis that facilitates engagement in treatment. The purpose of this review is to present the current evidence of treatments for PNES published since the year 2000 and to discuss further needs for clinical treatment implementation and research. This article reviews clinical trials that have evaluated the efficacy of structured, standardized psychotherapeutic and psychopharmacological interventions. The primary outcome measure in clinical trials for PNES is event frequency, although it is questionable whether this is the most accurate indicator of functional recovery. Cognitive behavioral therapy has evidence of efficacy, including one pilot randomized, controlled trial where cognitive behavioral therapy was compared with standard medical care. The antidepressant sertraline did not show a significant difference in event frequency change when compared to placebo in a pilot randomized, double-blind, controlled trial, but it did show a significant pre- versus posttreatment decrease in the active arm. Other interventions that have shown efficacy in uncontrolled trials include augmented psychodynamic interpersonal psychotherapy, group psychodynamic psychotherapy, group psychoeducation, and the antidepressant venlafaxine. Larger clinical trials of these promising treatments are necessary, while other psychotherapeutic interventions such as hypnotherapy, mindfulness-based therapies, and eye movement desensitization and reprocessing may deserve exploration. Flexible delivery of treatment that considers the heterogeneous backgrounds of patients is emphasized as necessary for successful outcomes in clinical practice.
Neuropsychiatric Disease and Treatment 12/2012; 8:585-98. DOI:10.2147/NDT.S32301 · 1.74 Impact Factor
Available from: Bethany L Brand
- "One study tested a manualized brief intervention, although this study was not otherwise controlled (Goldstein et al., 2004). There was only 1 controlled study, a single case study (Kellett, 2005), which provided a description of the intervention and clear evidence of the benefit of cognitive analytic therapy for treating DID. More research of this caliber is needed. "
[Show abstract] [Hide abstract]
ABSTRACT: This review examines empirical reports of treatment for Dissociative Disorders (DD), including 16 DD treatment outcome studies and 4 case studies that used standardized measures. Collectively, these reports suggest that treatment for DD is associated with decreased symptoms of dissociation, depression, posttraumatic stress disorder, distress, and suicidality. Effect sizes, based on pre/post measures, are in the medium to large range across studies. Patients with dissociative disorder who integrated their dissociated self states were found to have reduced symptomatology compared with those who did not integrate. The magnitude of pre/post effect sizes for these DD studies are comparable to pre/post effect sizes in treatment studies of complex PTSD. There are significant methodological limitations in the current DD treatment outcome literature that reduce internal and external validity including regression towards the mean, limited sample sizes, and nonrandomized research designs. Implications for future research and treatment planning for patients suffering from DD are discussed.
The Journal of nervous and mental disease 09/2009; 197(9):646-54. DOI:10.1097/NMD.0b013e3181b3afaa · 1.69 Impact Factor
Available from: Peter Fonagy
- "An assessment of the impact of both the common and the different interventions could best be made through the use of hermeneutic single-case efficacy (Elliot, 2002) or Single Case Experimental Design studies (Turpin, 2001) applied to a series of patients. The latter method is illustrated by Kellet's study of the CAT treatment of a case of Dissociated Identity Disorder (Kellett, 2005). A study of CAT in group format with borderline subjects is currently under way. "
[Show abstract] [Hide abstract]
ABSTRACT: Mentalization Based Therapy (MBT) and Cognitive Analytic Therapy (CAT) are among a small number of psychotherapy approaches offering specific methods for the treatment of Borderline Personality Disorder (BPD). They share a number of features, notably both seek to integrate ideas and methods from psychoanalysis and cognitive psychology, pay attention to early attachment experiences and see harsh and inconsistent care, in combination with biological vulnerability, as playing an important part in the genesis of BPD offer treatment based on a developmental understanding of BPD, taking account of recent developments in observational research seek to provide therapy appropriate for use in the public service. These similarities, however, conceal a number of differences in underlying assumptions and emphases and are linked with contrasting therapeutic techniques. In this paper we present a discussion of key features of our models of normal and pathological development and a consideration of the conceptual underpinnings and of how far they are compatible with what is reliably known in the general field of psychology and how far it offers a model accessible to patients and clinician. Where our views diverge significantly, the reader will have some of the evidence on which to make a personal choice.
International Review of Psychiatry 03/2007; 19(1):51-62. DOI:10.1080/09540260601109422 · 1.80 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.