A randomised multiple baseline single case experimental design series using CBT to target mechanisms of transdiagnostic dissociation in 16-to-25-year-olds.

Summary

Dissociative experiences—like depersonalization or derealization—are common in young people and linked to worse mental health, self-harm, and suicide. This study tested brief cognitive behavioral therapy (CBT) techniques targeting three mechanisms thought to drive dissociation: unhelpful beliefs about dissociation, repetitive thinking, and difficulty tolerating strong emotions. Nine NHS patients aged 16–23 each received four CBT sessions in a single case experimental design. Results were limited by unstable measurements but suggested that targeting unhelpful beliefs reduced distress about dissociation. Targeting repetitive thinking showed little effect, while targeting emotional intolerance showed a weak positive signal. Participants said the intervention needed more sessions and a broader approach. The findings guide future treatment development for dissociation in youth.

Study at a glance

Abstract

Dissociative experiences are prevalent in young people, where they are associated with greater clinical severity of co-occurring difficulties and increased risk of self-harm and suicide. Recent research suggests transdiagnostic dissociation plays a role in the development and maintenance of mental health problems such as anxiety, depression and psychosis, and may therefore constitute a novel early intervention target. The current study builds on our previous work developing an explanatory theoretical model of transdiagnostic dissociation by piloting therapeutic techniques that target implicated mechanisms. Our aim was to establish proof of concept, such that successful techniques could be incorporated into future treatment development. We recruited 9 NHS patients (ages 16 to 23) to a series of three multiple baseline single case experimental design (SCED) studies. Every participant received four sessions of individual CBT, with each SCED addressing a different mechanism implicated in the theoretical model: cognitive appraisals of dissociation, perseverative thinking, and affect intolerance. Results across all studies were limited by low phase stability of the target measures, but indicated successful targeting of cognitive appraisals, and partial success in targeting perseverative thinking and affect intolerance. Where cognitive appraisals improved, results suggested distress about dissociation also improved. There was negligible evidence of this for perseverative thinking, but a weak positive signal for affect intolerance. Qualitative feedback from participants illustrated the need to combine therapeutic strategies into a more comprehensive intervention with more sessions. These findings inform treatment development for transdiagnostic dissociation in youth and advance understanding of its causal aetiology, supporting future research.