The Case for Cognitive Behavior Therapy to Treat Dissociative Identity Disorder

Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder

Harkness, Kate L.; Bagby, R. Michael; Kennedy, Sidney H

Journal of Consulting and Clinical Psychology, Vol 80(3), Jun 2012, 342-353

Objective: A substantial number of patients with major depressive disorder (MDD) do not respond to treatment, and recurrence rates remain high.

The purpose of this study was to examine a history of severe childhood abuse as a moderator of response following a 16-week acute treatment trial, and of recurrence over a 12-month follow-up.

Method: Participants included 203 adult outpatients with MDD (129 women; age 18–60). The design was a 16-week single-center randomized, open label trial of interpersonal psychotherapy, cognitive-behavioral therapy, or antidepressant medication, with a 12-month naturalistic follow-up, conducted at a university psychiatry center in Canada.

The main outcome measure was Hamilton Depression Rating Scale scores at treatment end point. Childhood maltreatment was assessed at the completion of treatment using an interview-based contextual measure of childhood physical, sexual, and emotional abuse. Multiple imputation was adopted to estimate missing values.

Results: Patients with severe maltreatment were significantly less likely to respond to interpersonal psychotherapy than to cognitive-behavioral therapy or medication (OR = 3.61), whereas no differences among treatments were found in those with no history of maltreatment (ORs < 1.50). Furthermore, maltreatment significantly predicted a shorter time to recurrence over follow-up across treatment conditions (OR = 3.04).These findings were replicated in the sample with complete case data.

Conclusions: Patients with a history of childhood abuse may benefit more from antidepressant medication or cognitive-behavioral therapy than from interpersonal psychotherapy. However, these patients remain vulnerable to recurrence regardless of treatment modality.

Supporting Article

A Rating Scale for Depression
By M. Hamilton,
Journal of Neurology, Neurosurgery, and Psychiatry 23:56-62, 1960
This is the original publication of the HAM-D.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

It appears that talk therapy to heal/mend/cure/treat the development of multiple personalities would be better treated using other methods namely Cognitive-Behavioral Therapy (CBT).

Why do few, if any, dissociative identity disorder patients get help using Cognitive Behavioral Therapy with the treatment packages they purchase? JB

Resources:

  1. Beck Institute for Cognitive Behavior Therapy  http://www.beckinstitute.org/what-is-cognitive-behavioral-therapy/

Cognitive Behavior Therapy

Developed by Dr. Aaron T. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems.

Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. Cognitive therapy has been found to be effective in more than 1000 outcome studies for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders.

It has also been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia. Cognitive therapy has been extended to and studied for adolescents and children, couples, and families.

Its efficacy has also been established in the treatment of certain medical disorders, such as irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, noncardiac chest pain, cancer, diabetes, migraine, and other chronic pain disorders.

2. The Hamilton Depression Rating Scale http://healthnet.umassmed.edu/mhealth/HAMD.pdf

has proven useful for determining the level of depression before, during, and after treatment.

It is based on the clinician’s interview with the patient and probes symptoms such as depressed mood, guilty feelings, suicide, sleep disturbances, anxiety levels and weight loss.

The interview and scoring takes about 15 minutes. The rater enters a number for each symptom construct that ranges from 0 (not present) to 4 (extreme symptoms).

* alterations in pagination by blogger

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14 Comments

  1. Some Bloke

     /  12/17/2015

    Hello stranger!
    Wow, 3 years since our conversation about this. Doesn’t time fly! I know this blog has not been terribly active this year, I hope that you are keeping well?
    I know this post is old, but I’ve had quite a CBT journey since then, and if any people with DID still read your blog, I think they ought to know this.
    3 years on, much of this time I have been having high intensity CBT. When I last wrote I was already advocating it heavily, but I didn’t realise then how profound these changes would be. Honestly? This therapy is AMAZING, and I would like to recommend it to any multiple anywhere in the world. CBT leaves you with the ultimate toolkit to understand and manage yourself, while keeping the patient in control and not forcing you to dig into ‘territories unknown’. It’s safe (as long as the therapist is using it properly), it’s scientifically based (as all therapy should be) and it teaches SELF dependence, not the usual therapist dependence that DID therapy so encourages.
    Through completing the course, my ‘system’ has decreased in number as I’ve been working through my unhealthy mechanisms, PTSD symptoms are decreased (not gone, but more manageable) and switches now are infrequent due to such an increase in emotional stability. Judging by current progress this is only going to continue on an upward trend.
    Don’t try it and give up. Go into it open minded, be prepared to work damn hard at it, even when it feels like it’s never going to work KEEP AT IT and one day, you will realise the astounding difference in how you manage. It will change your life if you let it. Keep. At. It.
    I must be one of CBTs biggest advocates, although for good reason I think. I’ve seen both sides, DID therapy almost killed me, CBT has saved my life on numerous occasions. It’s given me back the reins to my life and has given me control of myself. I think I should get off my high horse now, but I hope this helps someone to find the right path.
    Only wanted to revisit this to make the point about how this therapy is STILL saving my life and sanity three years on. It will work for people for as long as they keep working the toolkit. This isn’t short term. If you work it it will, very much for the better, CHANGE YOUR LIFE!
    I do miss your regular posts and insight, and I hope that you are living well and most importantly, are happy.
    All the very best.

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    • Good to hear from you! I agree with you totally. Learning that intense emotions can be calmed down is amazing. I once thought CBT was another boring “workbook”. As you said, making a commitment to use it and apply it it could change your life and allow you to live with less pain in my opinion.

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  2. Some Bloke

     /  07/10/2012

    Hi Jeanette,

    Sorry for taking so long to respond to this. I have been incredibly busy, and had completely forgotten to check back.

    In regards to your comment “You hit that one square on the head! I, for one, was reinforced for falling apart and not being able to function. It was horrible to be alone, in distress, and unable to care for myself. All I could do is lie in bed and hope I could stay asleep.” – I remember almost exactly this. And being told that being kicked out of university was a good thing, giving me time to focus on my ‘recovery’. You know the more I read of your blog, and the more I learn of you and your experiences the more parallels I see. I may not agree with every word you say (but then who DOES agree 100% with anyone), but I certainly agree with what you are trying to do. Yes I believe in DID, but I also believe the mental health industries are downright harmful, and this has GOT to be STOPPED. As I believe I have said on this blog before, getting AWAY from the mental health services was my saving grace.

    And yes, cognitive therapy does work, but as you say there needs to be the commitment. It is difficult, so difficult, and it takes a fair old while for the changes to stick, but it so, SO worthwhile. I wish more people would bite the bullet and give it a real go. So many people have told me it doesn’t work. It does, it just doesn’t work quickly and people always seem to want a quick fix.

    I’m glad you liked my use of words. That seems to be all these therapies do though. It is like digging a massive hole in your garden, but never filling it in, so it’s always there for you to fall face down into.

    I recently bumped into the last therapist I saw. Prior to me firing him, he always said there was boundary issues, made out that I was too attached to him etc. However at this chance meeting, I found it fascinating that while I stood there awkwardly wishing I could just stop talking and get back to work, he was there saying ‘I miss our work’ and when asked how he was, answered ‘Better for seeing you.’ Doesn’t sound to me like the boundary issues were ever mine.

    Still. I’ve gone off on a bit of a tangent here, so I shall leave it there. Again, sorry for such a delayed response. I hope you are well.

    Like

    Reply
    • Hello Some Bloke. In our conversation of June you stated

      “I remember I used to go to therapy on a Thursday, went to pieces every thursday night, spent the next 6 days ‘recovering’ to go back and do it all over again, while on a slow but steady downward spiral. And the professionals said this was good!”

      This happens to most people in MPD/DID therapy, parts therapy, internal family systems therapy and others based on the premise that the mind has the capacity to split into other selves based on sexual abuse trauma that has either been forgotten, partially remembered or is somehow stored in one’s brain.

      This model of trauma leading to multiple personalities, when based on scientific scrutiny of how the brain works, does not hold together. Facts about neuroscience has had little, if any impact on those who embrace this model of mental dysfunction. If neuroscience was embraced, the therapy would need to stop.

      The classic saying: you have to get worse before you get better – is alive and well. Not true, nonetheless alive and well.

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      Reply
  1. Cognative behavioral therapy online

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