title: An examination of the influence of a sequential treatment on the course and impact of dissociation among women with PTSD related to childhood abuse.
abstract: BACKGROUND
  It has been proposed that posttraumatic stress disorder (PTSD) patients who experience significant dissociation upon exposure to traumatic reminders may do less well in trauma-focused therapies. We explored whether a sequenced two-component treatment in which an emotion regulation skills training module preceding exposure would improve outcomes for those with significant dissociation.
  
  
  METHODS
  Analyses were conducted on data from an RCT in which 104 women with PTSD related to childhood abuse were assigned to one of three treatment conditions: Skills Training in Affective and Interpersonal Regulation (STAIR) followed by Narrative Story Telling (NST; STAIR/NST), STAIR followed by supportive counseling (SC; STAIR/SC), or SC followed by NST (SC/NST).
  
  
  RESULTS
  Baseline dissociation was associated with differential outcome such that at low levels of dissociation the three treatments were equally effective but at higher levels STAIR/NST resulted in greater reductions in dissociative symptoms. Level of baseline dissociation did not moderate the effect of the treatments on PTSD outcome. At all levels of baseline dissociation, STAIR/NST produced better PTSD outcome. At posttreatment, however, participants with high dissociation treated with STAIR/NST continued to improve during follow-up, those treated with STAIR/SC maintained gains, and those treated with SC/NST experienced loss of posttreatment PTSD symptom gains.
  
  
  CONCLUSIONS
  The differential results observed among the treatments depending on severity of dissociation at baseline and at posttreatment suggest the potential clinical utility of identifying a dissociative subtype of PTSD and of the benefits of sequenced, phase-oriented treatment approaches.
authors.affiliation: Dissemination and Training Division, National Center for PTSD, Palo Alto VA Health Care System, Palo Alto, California, USA. marylene.cloitre@va.gov
authors.forename: Marylène
authors.initials: M
authors.lastname: Cloitre
authors.forename: Eva
authors.initials: E
authors.lastname: Petkova
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Feihan
authors.initials: F
authors.lastname: Lu Lassell
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D015897:Comorbidity; D018450:Disease Progression; D004213:Dissociative Disorders / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D062525:Narrative Therapy; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014930:Women / Q000523:psychology