Insight from the TOP DD Network Study: Unsafe Behaviors, Progress in Treatment, and Beyond
The Treatment of Patients with Dissociative Disorders (TOP DD) research team led two treatment studies examining the outcomes of dissociative disorder patients. In our TOP DD Network Study, we found that patients receiving specialized, dissociation-specific treatment experienced decreases in their unsafe behaviors, hospitalizations, and trauma-related symptoms, and showed improved abilities to regulate their emotions and function in more adaptive ways. We wondered why some patients made faster progress than others, so we explored how life stressors and patient resistance influenced their progress in treatment. We also looked at patients’ emotion dysregulation patterns and identified factors that led patients to engage in unsafe behaviors. In this symposium, we will share our most recent findings, and discuss how clinicians can intervene and treat dissociative patients. We will discuss our upcoming randomized control trial and two books, which present the educational program that was the basis for the successful TOP DD Network study.
(1) An Examination of the Relationship Between Emotion Dysregulation, Dissociation, and Non-Suicidal Self-injury Among Dissociative Disorder Patients
Dissociative disorders (DDs) are associated with emotion dysregulation and high rates of non-suicidal self-injury (NSSI). Given that dissociation and NSSI are mechanisms of coping with trauma and difficult emotional experiences, we investigated the relationship between emotion dysregulation and these coping strategies. In the TOP DD Network Study, patient participants reported their recent emotion dysregulation and dissociation symptoms. Clinicians reported on the patients’ recent NSSI. In this paper, we will discuss the findings from this study – which revealed that emotion dysregulation predicted NSSI history, and patients with recent NSSI demonstrated severe emotion dysregulation and dissociation. In addition, we explore which elements of emotion dysregulation patients struggle with most and discuss implications for how to address NSSI and emotion dysregulation in treatment.
(2) To Feel Real Pain: What Triggers Dissociative Disorder Patients to Engage in Unsafe Behaviors
Dissociative disorder (DD) patients often report engaging in unsafe behaviors. In fact, up to 86% of DD patients self-injure and up to 72% attempt suicide at some point in their lifetime. In this study, we explored data collected from DD patients in the TOP DD Network Study. At their intake into the study, patients listed three reasons that trigger them to engage in unsafe behaviors. A thematic analysis resulted in identifying several themes of triggers which include trauma-related cues, dissociative experiences, emotion dysregulation, among others. We review the overarching themes, share specific examples of what triggers DD patients’ unsafe behaviors, and discuss how these findings can be applied to clinical practice.
(3) Finding Solid Ground: The Educational Program Developed for the TOP DD Network Study and Randomized Control Trial
After the TOP DD Network study results showed that patients with dissociative disorders (DD) showed symptom improvements, stabilization of unsafe behaviors, and improved adaptive capacities, the research team received many requests to share the educational materials we developed for the study. After further refining these materials with the benefit of Network study and in-person group participants’ feedback, we have now prepared them for publication and use in our randomized control trial (RCT). This presentation will provide an overview of the program, the process by which we refined it, and the therapist and patient books that we have prepared. It will also provide an overview of the RCT, and how to learn more about and/or sign up for the study.
(4) The Impact of Resistance and Life Stressors on Treatment Response for Patients with Dissociative Disorders
Life stressors are common among patients with dissociative disorders (DD), and resistance is recognized as a frequent challenge within DD treatment. In this paper, we consider the impact of resistance and life stressors on symptoms in patient participants of the TOP DD Network Study. Patients reported PTSD and dissociative symptoms across time. Therapists’ reported on patients’ stress including patient resistance, life stressors, difficulties with the treatment team, and revictimization. Analyses examining the relationship between these variables and symptomatology are discussed, and applications of these findings to clinical practice are considered.
This session was originally presented as a live conference session in April 2021.
At the conclusion of this session participants will be able to:
- Describe ways that non-suicidal self-injury and suicide may be used to cope with emotion dysregulation and dissociative symptoms
- List triggers that lead DD patients to engage in unsafe behaviors
- Identify facets of emotion dysregulation that dissociative disorder (DD) patients struggle with
- Describe the dynamic of patient resistance and the role of life stressors on DD patients and progress in treatment
- Summarize how the educational materials used in the research study called the TOP DD Network study were developed and refined
Presenter: Bethany Brand, PhD
Presenter Bio: Bethany Brand, PhD is a Professor at Towson University in Maryland and an expert in trauma disorders. She has served on several national task forces that developed guidelines for the assessment and treatment of trauma-related disorders. Dr. Brand is the Principal Investigator on three lines of research: a series of international dissociative disorders treatment studies; assessment methods for distinguishing dissociative disorders from other conditions including malingering; and the assessment of the accuracy and adequacy of textbooks’ coverage of trauma. In her private practice, she treats complex trauma patients and serves as an expert witness in trauma-related cases.
Presenter: Shae Nester, BS, MA Candidate
Presenter Bio: Shae Nester (they/them) is a second-year graduate student at Towson University. They have worked with trauma survivors and dissociative patients for five years. Their research focuses on enhancing the treatment of dissociative disorder patients and better understanding how and why trauma survivors cope, with a particular interest in self-destructive behaviors. Shae feels passionate about training mental health professionals with the goal of increasing access to specialized, dissociation-specific and trauma-informed care for individuals with dissociative disorders.
Presenter: Hugo Schielke, PhD, MS, MFT
Presenter Bio: Hugo Schielke, PhD, is passionate about advancing the care of those impacted by trauma through treatment-focused, participant-feedback-informed research and program development. Areas of particular interest include: treatment of complex trauma and dissociation; psychotherapy process and outcome; and dialogical processes in self-narratives and interpersonal relationships. Most recently, alongside Drs. Bethany Brand, Ruth Lanius, and Francesca Schiavone, he has been preparing a set of therapist- and patient-facing trauma treatment books for Oxford University Press that present a research-informed and -refined approach to the stabilization of trauma and dissociative disorders. As co-principal investigator with Dr. Brand, he is currently preparing a randomized clinical trial to evaluate this revision of the program.
Presenter: Amie Myrick, MS, LCPC
Presenter Bio: Amie Myrick is the National Training Director at Amatus Health and an Adverse Childhood Experiences (ACE) Master Presenter in the state of Maryland. Through these two roles, she provides education to professionals and community members throughout nationwide. Amie is a licensed clinical professional counselor in the state of Maryland and specializes in working with youth, adults, and families impacted by trauma. She has presented at local, national, and international conferences for over 15 years on topics related to trauma and advocacy. In addition to her clinical and training work, Amie has been a research consultant for groups interested in comprehensive treatment for populations affected by trauma. She is the co-author, author, and co-editor of theoretical and empirical peer-reviewed journal articles and several books, largely focused on working with traumatized and populations in need.
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- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program.
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