Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis. Issue 3 (May 2020)

• Record Type: Journal Article
• Authors: Hoeboer, C. M.; De Kleine, R. A.; Molendijk, M. L.; Schoorl, M.; Oprel, D. A. C.; Mouthaan, J.; Van der Does, W.; Van Minnen, A.
• Is Part Of: BJPsych open. Volume 6:Issue 3(2020)
• Publication Date: 2020-05
• Subjects: Dissociative disorders, -- post-traumatic stress disorder, -- individual psychotherapy, -- group psychotherapy; Psychiatry -- Periodicals; Mental health -- Periodicals; 616.89005
• DOI: 10.1192/bjo.2020.30
• Languages: English
• ISSNs: 2056-4724

Abstract

Abstract : Background: Many 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 (pre-registered 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.