Treatment of Patients with Dissociative Disorders Study

There have been few studies assessing how patients with dissociative disorders (DD)
respond to treatment. The paucity of research contributes to the limited awareness
of DD and the lack of training for treatment providers. The goal of the Treatment of Patients with Dissociative Disorders studies is to assess treatment outcome among people with DD, and, ultimately, to
learn how to provide the most effective treatment to them. So far, the TOP DD research
team has conducted two studies, one a prospective, naturalistic study of treatment
outcome among DD patients from around the world (hence forward called the “TOP DD
study”), and another which surveyed DD experts for their recommendations of specific
treatment interventions that are effective at various stages in DD treatment.

Thanks to the generous sharing of time and treatment experiences by our TOP DD participants,
the TOP DD naturalistic treatment study was very successful. We were able to recruit
approximately 290 therapists and their patients from 19 countries around the world.
This makes the TOP DD study the largest and only international study of dissociative
disorders (DD). The TOP DD study collected data at four points across 30 months of
treatment. The patients showed less depression, dissociation, PTSD, and general distress
over 30 months of treatment, as well as decreases in suicide attempts, self-injurious
behaviors, and hospitalizations. Additionally, therapists rated patients as having
higher adaptive functioning over time. The consistent reports of both the patients
and the therapists in the TOP DD study demonstrated that DD treatment is associated
with decreased symptoms and improved functioning. The study has important implications
for the mental health field because DD are prevalent and associated with severe symptoms
and dysfunction, as well as high treatment costs.

READ:  Joseph Kraemer | Towson University

The TOP DD study is providing fascinating insights into how DD patients respond to
treatment and the variables that are associated with different treatment outcomes
such as age, revictimization, and stressors. Although data collection for the first
TOP DD study is complete, we will continue to analyze the data to learn more about
DD treatment. We anticipate that in addition to the seven papers already published
or in press based on the TOP DD data, we will have additional papers about the impact
of therapeutic alliance on treatment outcome and the costs of treatment. See a listing
of the TOP DD publications.  

The TOP DD study received IRB approval through Towson University and Sheppard Pratt
Health System.


The Next Phase

The great success of the TOP DD study highlights the need for further inquiry into
the treatment outcomes of DD patients. The research team has launched a follow-up
study to the TOP DD study entitled TOP DD Network.

While the first study was a naturalistic study that did not alter the treatment that
patients were receiving, the new study allows patients to participate in a web-based
educational program that has been specifically developed to target the enhancement
of safety for DD patients. All patients participating in the TOP DD Network study
will need to be in individual therapy; in addition, both the patient and his or her
therapist must also participate in the study in order to be eligible. This requirement
insures that DD patients have clinical help in case of a crisis. The TOP DD Network
study cannot provide clinical advice or consultation.

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Using the original TOP DD study participants as a control group, patients in the new
study will be statistically matched to those in the original TOP DD study. The TOP
DD Network participants will view a series of 5 minute educational video discussions
created by the TOP DD research team. These short video segments will discuss educational
topics related to safety including reasons why DD patients are unsafe and how to begin
to get control over unsafe behaviors. The TOP DD team includes expert clinicians who
have decades of experience in specifically treating DD patients. They have selected
the topics, as well as the written reflection assignments and practical exercises
that they have found to be the most effective in their clinical work. The video scripts
have also been reviewed by a focus group of individuals diagnosed with DID who have
worked closely with the TOP DD team and provided useful feedback that has improved
the material presented in the study. The focus of the TOP DD Network intervention
will be on establishing and maintaining safety, as well as related skills such as
safely managing emotions, maintaining an awareness of the present moment, and grounding
skills to increase control over dissociation.

The goal of the TOP DD Network study is to determine whether a web-based intervention,
in combination with individual psychotherapy, is more effective for DD patients than
individual psychotherapy alone. This is an exciting study because it will be the first
systematic, controlled study of treatment for outpatients with DD. As a web-based
intervention for DD patients, it has the potential to benefit DD patients around the
world by providing a free intervention that may reduce their symptoms and improve
their functioning. It will also provide training to therapists about how to help stabilize
DD patients’ safety. Finding the most beneficial and cost effective interventions
for DD patients is crucial because DD are associated with severe symptoms, considerable
suffering for DD individuals, serious impairment in functioning, and high treatment

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TOP DD Network Book

The results of the TOP DD Network study are so promising that we are busy writing
a book based on the TOP DD Network study that will serve as the treatment manual for
the next TOP DD study. The book will be published by Oxford University Press. Updates
about the book publication will be posted here and on our Facebook page.

If you would like to be informed about the publication of the book, please contact
us via email at TOPDD AT_TOWSON.

Thank you for your interest!

Participation in TOP DD Studies

We have completed the TOP DD Network study. Thank you to all participants!

If you are interested in participating in future studies, please contact us via email

Thank you for your interest!

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