Contents
Week 2: Dissociation ......................................................................................................................... 2
Week 3: Complicated grief ............................................................................................................. 16
Week 4: Anxiety disorders ............................................................................................................. 32
Week 5: Addictions ......................................................................................................................... 44
Week 6: Eating disorders ............................................................................................................... 59
Week 7: Sexual dysfunction ........................................................................................................... 70
1
,Week 2: Dissociation
Article 1: Group treatment for complex dissociative disorders: a randomized clinical
trial – Baekkelund et al. (2022)
Dissociative identity disorder (DID) is the most severe of the dissociative disorders
mentioned in the DSM-V. People with this disorder have different dissociative identities,
which are often perceived as different parts or selves. People with dissociative disorders
report dissociative amnesia (forgetting what the other part/self was doing). When there are
problems, without enough symptoms for a DID diagnoses, a patient can have Other Specified
Dissociative Disorders (OSDD). Both DID and OSDD fit under the umbrella term Complex
Dissociative Disorders (CDD). CDDs are associated with early traumatic memories
(childhood sexual abuse). Dissociation is seen as a response to severe trauma, that allows the
person to cope with what is happening in the moment. This can lead to development of
dissociative disorders in the future. The personality amnesia characteristics are seen as a way
for the individual to defend against or compartmentalize memories and feelings related to the
trauma.
There are no evidence-based guidelines for treatment of DID at the moment. The best we
have right now are the practice-based guidelines developed by the International Society of
Trauma and Dissociation (ISSTD) where a phased approach is recommended. The first stage
(stabilization) focuses on safety, learning to manage emotions and building trust before
talking about trauma. The second phase (trauma processing) is where traumatic memories are
confronted, processed and linked to the present. The third stage (integration and
rehabilitation) aims to bring the different parts of the self together and strengthen the identity
of the patient. With the intent to improve daily life and relationships.
Earlier research showed that psychotherapy can help reduce symptoms like dissociation,
PTSD and self-harm. However, most studies where small, not randomized and lacked control
groups. Improvements were found, but treatments often took many years and required a lot of
effort from both therapist and patient. Therefore the current study tests a structured group
treatment based on the ISSTD guidelines. The program focused on stabilization and skills
training and was added to regular individual therapy. Researchers expected that patients
receiving both group and individual therapy would show greater improvement in functioning
and fewer psychiatric symptoms than those receiving only individual treatment.
The study took place at a Norwegian outpatient trauma clinic that treats adults with histories
of childhood abuse and trauma. Patients were between 18-65 years old and met the DSM-V
criteria for DID or OSDD. People with psychosis, severe substance abuse or acture crises
were excluded. A total of 59 patients were included and randomly assigned across one of two
groups. The first group (experimental) received 20 sessions of structured group therapy in
combination with individual therapy. The second group (control) got individual therapy at
first and received the same group program later on (delayed-treatment design). The group
sessions lasted 90 minutes and focused on the first phase of treatment. The main outcome was
overall psychosocial functioning and the secondary outcomes included PTSD outcomes,
general psychological distress, dissociation and interpersonal problems. These were measured
with standard questionnaires. Multilevel mixed models were used to examine change over
time and compare groups.
2
,The study found no immediate differences between the experimental and control group.
However, after six months, both groups showed clear improvements in daily functioning and
group therapy participants scored a bit higher at follow-up. PTSD and general psychological
symptoms also improved slightly, especially in the control group. Dissociative symptoms and
interpersonal problems stayed mostly the same. Almost a quarter of the participants dropped
out, mostly during the group phase. Group treatment did not lead to faster results, but
overtime was linked to better overall functioning, even though core dissociative symptoms
remained the same. The trial shows that adding a short, skills-focused stabilization group to
usual individual therapy did not give faster benefits, but functioning improved overtime. Core
dissociative symptoms barely changed, suggesting patients may need longer treatment and
more individualized delivery (instead of in a fixed group) to impact dissociation. The study
also used 20 instead of the usual 43 sessions, which could limit effects on deeper symptoms.
The limitations of this study were small sample size, missing self-report data, uncontrolled
individual therapies and the delayed treatment design that makes some long-term
comparisons indirect. Overall the study supports that psychotherapy can help functioning in
CDD, but highlights it needs more strong RCTs to test phase-based vs. trauma-focused
approaches and test longer or individualized formats of treatment.
3
, Article 2: The dissociation-Related Beliefs About Memory Questionnaire (DBMQ):
Development and psychometric properties. – Huntjens et al. (2023)
Dissociative symptoms include depersonalization, derealization and lapses in memory. These
are also found in posttraumatic stress disorder (PTSD). Discontinuities in memory can be
memory disorganization (not being able to retrieve a certain memory) and also dissociative
amnesia, where the person reports not remembering personal information, sometimes related
to a specific identity. Although individuals subjectively report strong amnesia, scientific
studies show that the information is often transferred between identities. The reported
memory gaps may be influenced by metamemory beliefs (ideas people hold about how their
memory works). These beliefs can play a role in dissociative amnesia and hinder the
processing and retrieval of certain memories. The dissociative avoidance hypothesis states
that individuals with high dissociation tend to avoid painful memories and emotions, which
can strengthen these metamemory beliefs and contribute to the feeling of memory failure. To
understand these beliefs better, the researchers created a new questionnaire. The DBMQ is
used to measure what people believe about their memory and how these beliefs might affect
dissociation.
Study 1 was about creating and testing the first version of the DBMQ. The researchers made
a list of 24 statements about beliefs people might have about their memory. These itmes were
based on theory, clinical experience and what “made sense” on the topic of dissociation and
memory. The participants were 162 psychology students at a New Zealand university (mostly
woman and an average age of 23 years old). They filled in the questionnaire online and reated
each statement from 1 to 5 (not at all – very much). The researchers found out that the items
clustered into four types of beliefs. 1. Fragmentation: The belief that memories are broken
into pieces rather than whole 2. Positive beliefs about amnesia: Seeing forgetting as
something helpful and protective 3. Lack of self-reference: believing that the distressing
memories belong to someone else 4. Fear of losing control: Believing that remembering will
be overwhelming or lead to losing control. This study showed that the first 24-item version of
the DBMQ works well (Cronbach’s alfa = .79 and 62% explained variance) and measures
four clear kinds of dissociation-related beliefs about memory.
In study 2 the researchers wanted to make a shorter version of the DBMQ and check if it was
still a good and reliable questionnaire. They reduced the questionnaire to 16 items by keeping
the best items for each of the four beliefs. This study was done with Dutch psychology
students (n = 571). They checked whether the same four-factor structure from study 1 would
appear again and it did. The same four beliefs were present with the same explained variance
(62%) and good reliability (Cronbach’s alfa = 0.78 – 0.89). Next they looked how DBMQ
scores related to trait dissociation, Posttraumatic stress symptoms and trauma history. They
found that higher DBMQ scores were linked to more dissociative experiences, more PTSD
symptoms (especially avoidance) and small to medium links with trauma history. In the last
part of study 2, the researchers examined what best predicts strong dissociation0related
beliefs about memory (high DBMQ scores). Childhood abuse on it’s own explained only 2%,
meaning that trauma history is not enough to explain these beliefs. When they added current
trait dissociation and PTSD symptoms the explained variance got up to 30%. This means that
people who currently dissociate more and actively avoid painful memories/emotions are
much more likely to hold strong negative beliefs about their memory. Childhood abuse was
not significant when adding the other variables meaning that how someone is currently
4
Week 2: Dissociation ......................................................................................................................... 2
Week 3: Complicated grief ............................................................................................................. 16
Week 4: Anxiety disorders ............................................................................................................. 32
Week 5: Addictions ......................................................................................................................... 44
Week 6: Eating disorders ............................................................................................................... 59
Week 7: Sexual dysfunction ........................................................................................................... 70
1
,Week 2: Dissociation
Article 1: Group treatment for complex dissociative disorders: a randomized clinical
trial – Baekkelund et al. (2022)
Dissociative identity disorder (DID) is the most severe of the dissociative disorders
mentioned in the DSM-V. People with this disorder have different dissociative identities,
which are often perceived as different parts or selves. People with dissociative disorders
report dissociative amnesia (forgetting what the other part/self was doing). When there are
problems, without enough symptoms for a DID diagnoses, a patient can have Other Specified
Dissociative Disorders (OSDD). Both DID and OSDD fit under the umbrella term Complex
Dissociative Disorders (CDD). CDDs are associated with early traumatic memories
(childhood sexual abuse). Dissociation is seen as a response to severe trauma, that allows the
person to cope with what is happening in the moment. This can lead to development of
dissociative disorders in the future. The personality amnesia characteristics are seen as a way
for the individual to defend against or compartmentalize memories and feelings related to the
trauma.
There are no evidence-based guidelines for treatment of DID at the moment. The best we
have right now are the practice-based guidelines developed by the International Society of
Trauma and Dissociation (ISSTD) where a phased approach is recommended. The first stage
(stabilization) focuses on safety, learning to manage emotions and building trust before
talking about trauma. The second phase (trauma processing) is where traumatic memories are
confronted, processed and linked to the present. The third stage (integration and
rehabilitation) aims to bring the different parts of the self together and strengthen the identity
of the patient. With the intent to improve daily life and relationships.
Earlier research showed that psychotherapy can help reduce symptoms like dissociation,
PTSD and self-harm. However, most studies where small, not randomized and lacked control
groups. Improvements were found, but treatments often took many years and required a lot of
effort from both therapist and patient. Therefore the current study tests a structured group
treatment based on the ISSTD guidelines. The program focused on stabilization and skills
training and was added to regular individual therapy. Researchers expected that patients
receiving both group and individual therapy would show greater improvement in functioning
and fewer psychiatric symptoms than those receiving only individual treatment.
The study took place at a Norwegian outpatient trauma clinic that treats adults with histories
of childhood abuse and trauma. Patients were between 18-65 years old and met the DSM-V
criteria for DID or OSDD. People with psychosis, severe substance abuse or acture crises
were excluded. A total of 59 patients were included and randomly assigned across one of two
groups. The first group (experimental) received 20 sessions of structured group therapy in
combination with individual therapy. The second group (control) got individual therapy at
first and received the same group program later on (delayed-treatment design). The group
sessions lasted 90 minutes and focused on the first phase of treatment. The main outcome was
overall psychosocial functioning and the secondary outcomes included PTSD outcomes,
general psychological distress, dissociation and interpersonal problems. These were measured
with standard questionnaires. Multilevel mixed models were used to examine change over
time and compare groups.
2
,The study found no immediate differences between the experimental and control group.
However, after six months, both groups showed clear improvements in daily functioning and
group therapy participants scored a bit higher at follow-up. PTSD and general psychological
symptoms also improved slightly, especially in the control group. Dissociative symptoms and
interpersonal problems stayed mostly the same. Almost a quarter of the participants dropped
out, mostly during the group phase. Group treatment did not lead to faster results, but
overtime was linked to better overall functioning, even though core dissociative symptoms
remained the same. The trial shows that adding a short, skills-focused stabilization group to
usual individual therapy did not give faster benefits, but functioning improved overtime. Core
dissociative symptoms barely changed, suggesting patients may need longer treatment and
more individualized delivery (instead of in a fixed group) to impact dissociation. The study
also used 20 instead of the usual 43 sessions, which could limit effects on deeper symptoms.
The limitations of this study were small sample size, missing self-report data, uncontrolled
individual therapies and the delayed treatment design that makes some long-term
comparisons indirect. Overall the study supports that psychotherapy can help functioning in
CDD, but highlights it needs more strong RCTs to test phase-based vs. trauma-focused
approaches and test longer or individualized formats of treatment.
3
, Article 2: The dissociation-Related Beliefs About Memory Questionnaire (DBMQ):
Development and psychometric properties. – Huntjens et al. (2023)
Dissociative symptoms include depersonalization, derealization and lapses in memory. These
are also found in posttraumatic stress disorder (PTSD). Discontinuities in memory can be
memory disorganization (not being able to retrieve a certain memory) and also dissociative
amnesia, where the person reports not remembering personal information, sometimes related
to a specific identity. Although individuals subjectively report strong amnesia, scientific
studies show that the information is often transferred between identities. The reported
memory gaps may be influenced by metamemory beliefs (ideas people hold about how their
memory works). These beliefs can play a role in dissociative amnesia and hinder the
processing and retrieval of certain memories. The dissociative avoidance hypothesis states
that individuals with high dissociation tend to avoid painful memories and emotions, which
can strengthen these metamemory beliefs and contribute to the feeling of memory failure. To
understand these beliefs better, the researchers created a new questionnaire. The DBMQ is
used to measure what people believe about their memory and how these beliefs might affect
dissociation.
Study 1 was about creating and testing the first version of the DBMQ. The researchers made
a list of 24 statements about beliefs people might have about their memory. These itmes were
based on theory, clinical experience and what “made sense” on the topic of dissociation and
memory. The participants were 162 psychology students at a New Zealand university (mostly
woman and an average age of 23 years old). They filled in the questionnaire online and reated
each statement from 1 to 5 (not at all – very much). The researchers found out that the items
clustered into four types of beliefs. 1. Fragmentation: The belief that memories are broken
into pieces rather than whole 2. Positive beliefs about amnesia: Seeing forgetting as
something helpful and protective 3. Lack of self-reference: believing that the distressing
memories belong to someone else 4. Fear of losing control: Believing that remembering will
be overwhelming or lead to losing control. This study showed that the first 24-item version of
the DBMQ works well (Cronbach’s alfa = .79 and 62% explained variance) and measures
four clear kinds of dissociation-related beliefs about memory.
In study 2 the researchers wanted to make a shorter version of the DBMQ and check if it was
still a good and reliable questionnaire. They reduced the questionnaire to 16 items by keeping
the best items for each of the four beliefs. This study was done with Dutch psychology
students (n = 571). They checked whether the same four-factor structure from study 1 would
appear again and it did. The same four beliefs were present with the same explained variance
(62%) and good reliability (Cronbach’s alfa = 0.78 – 0.89). Next they looked how DBMQ
scores related to trait dissociation, Posttraumatic stress symptoms and trauma history. They
found that higher DBMQ scores were linked to more dissociative experiences, more PTSD
symptoms (especially avoidance) and small to medium links with trauma history. In the last
part of study 2, the researchers examined what best predicts strong dissociation0related
beliefs about memory (high DBMQ scores). Childhood abuse on it’s own explained only 2%,
meaning that trauma history is not enough to explain these beliefs. When they added current
trait dissociation and PTSD symptoms the explained variance got up to 30%. This means that
people who currently dissociate more and actively avoid painful memories/emotions are
much more likely to hold strong negative beliefs about their memory. Childhood abuse was
not significant when adding the other variables meaning that how someone is currently
4
