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J Trauma Stress. 2019 Feb;32(1):156-166. doi: 10.1002/jts.22370. Epub 2019 Jan 30.

An Online Educational Program for Individuals With Dissociative Disorders and Their Clinicians: 1-Year and 2-Year Follow-Up.

Author information

Department of Psychology, Towson University, Towson, Maryland, USA.
California Department of State Hospitals, Napa, California, USA.
The Department of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina, USA.
Sheppard Pratt Health System and University of Maryland School of Medicine, Baltimore, Maryland, USA.
Family and Children's Services, Bel Air, Maryland.
Modum Bad Psychiatric Center, Vikersund, Norway.
Bascous, France.
Atlanta, Georgia.
University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
Western University, London, Ontario, Canada.


in English, Chinese, Spanish

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54-1.04 vs. |d|s  = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.


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