Radboud University Nijmegen, Behavioural Science Institute (BSI), the Netherlands; Research department PSYTREC, Bilthoven, the Netherlands.
HSK Groep B.V., Centre of Expertise Functional Movement Disorders, Woerden, The Netherlands.
J Behav Ther Exp Psychiatry. 2021 Sep;72:101655. doi: 10.1016/j.jbtep.2021.101655. Epub 2021 Apr 2.
We described a new treatment model for Posttraumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID), based on cognitive-behavioural principles. In this model, dissociation is seen as a maladaptive avoidant coping strategy. In addition, we stress that patients have dysfunctional beliefs about dissociation. Both elements, avoidance behaviour and dysfunctional beliefs, are challenged during the brief, intensive trauma-focused treatment. When the PTSD-symptoms decrease, the patient is offered a fare-well ritual to say goodbye to their identities in one or more additional sessions.
We illustrate this treatment approach with a case report of a woman with PTSD as a result of sexual abuse in her childhood, and DID with four identities. Treatment outcome was measured at intake, at pre-treatment, at post-treatment and at 3 and 6 months follow-up.
After the short treatment of only 2 weeks, she no longer fulfilled the DSM-5 diagnostic criteria for PTSD nor DID. These results were maintained at the follow-ups.
Although we included a baseline-controlled time phase, it was not a controlled study, and only one patient was treated.
This new treatment model for DID-patients is promising but results should be interpreted cautiously since we described only one patient.
我们基于认知行为原则，为创伤后应激障碍（PTSD）和分离性身份障碍（DID）患者描述了一种新的治疗模式。在该模型中，分离被视为一种适应不良的回避应对策略。此外，我们强调患者对分离存在功能失调的信念。在短暂、密集的以创伤为重点的治疗过程中，回避行为和功能失调的信念这两个因素都会受到挑战。当 PTSD 症状减轻后，患者会在一个或多个额外的疗程中进行告别仪式，与一个或多个身份道别。
我们通过一位童年时期遭受性虐待后患有 PTSD 和 DID 的女性的病例报告来说明这种治疗方法。治疗结果在纳入时、治疗前、治疗后以及 3 个月和 6 个月随访时进行测量。
经过仅 2 周的短期治疗，她不再符合 DSM-5 诊断标准中 PTSD 或 DID 的诊断标准。这些结果在随访中得以维持。
尽管我们纳入了一个基线对照时间阶段，但这不是一项对照研究，并且仅治疗了一名患者。
这种针对 DID 患者的新治疗模式很有前景，但由于我们仅描述了一名患者，因此结果应谨慎解释。
