Article

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
Source: PubMed

ABSTRACT 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.

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    • "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. "
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    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.
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    • "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. "
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