Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial.
Dissociative symptoms, especially depersonalisation and derealisation, are often perceived as a contraindication for exposure-based treatments of posttraumatic stress disorder (PTSD) despite limited empirical evidence. The present paper examines whether derealisation and depersonalisation influence the treatment outcomes of narrative exposure therapy (NET) and treatment as usual (TaU) among severely traumatised asylum seekers and refugees. We performed a secondary analysis of a recently published randomized controlled multicentre trial comparing NET and TaU for the treatment of PTSD in asylum seekers and refugees. In order to investigate whether depersonalisation and derealisation moderate treatment outcomes, a number of moderated multiple, blockwise regression analyses were conducted. Missing data were handled with multiple imputation. The main finding from intention-to-treat analyses is that derealisation and depersonalisation overall do not moderate the treatment outcomes of either NET or TaU. The treatment condition was the most stable predictor of residual gain scores across outcome measures, with NET being associated with lower residual gain scores indicating better treatment outcomes. The present study substantiates and extends previous research indicating that dissociative symptoms such as derealisation and depersonalisation do not moderate the treatment outcome of exposure-based treatments for PTSD.


BACKGROUND
NCT00218959.
Department of Psychology, Norwegian University of Science and Technology, N-7491 Trondheim, Norway. Electronic address: joar.halvorsen@svt.ntnu.no.
Joar Øveraas
JØ
Halvorsen
Centre on Violence, Traumatic Stress and Suicide Prevention, Mid-Norway, St. Olavs University Hospital, Schwacks gt. 1, N-7030 Trondheim, Norway.
Håkon
H
Stenmark
Department of Clinical Psychology and Psychotherapy, Bielefeld University, 33501 Bielefeld, Germany.
Frank
F
Neuner
Department of Psychology, Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
Hans M
HM
Nordahl
D000328:Adult; D003861:Depersonalization / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D012036:Refugees / Q000523:psychology; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
Depersonalisation; Derealisation; Moderators; Narrative exposure therapy; Posttraumatic stress disorder; Treatment outcome