This is a qualitative research project aimed at understanding the factors contributing to change and improvement for individuals with Complex Dissociative Disorder (CDD).

Ingunn Holbæk Clinical Psychologist, PhD Candidate Academic Affiliation: Department of Psychology, University of Oslo; Research Institute at Modum Bad.

About the Project

The outpatient Traumaclinic at Modum Bad in Oslo has offered psychoeducative groups for individuals with complex dissociative disorders since 2008. A randomized controlled study (RCT) of this 20-week group treatment was conducted and published in 2022 (Bækkelund et al., 2022)(1). Limited research exists on therapy outcomes for this group of patients. We also don’t know much about change mechanisms and other factors leading to improvement for individuals with dissociative disorder. Instruments assessing traditional symptoms, may not capture the nuances of change in these patients’ treatment processes. This project explores the in-depth experiences of individuals with Complex Dissociative Disorder participating in a 20-week psychoeducative group treatment.

Objectives

The aim of the study is to understand more about change processes for people with a Complex Dissociative Disorder. What kind of changes do they long for? How do they experience and describe it? What are the necessary prerequisites for change to take place? What kind of variation do we find in the way the participants describe change? What inhibits and promotes a constructive process?

Background

There has been little focus on individuals with dissociative disorders in research and mental health care, despite the significant suffering and high costs associated with this condition. Many individuals with this disorder have received complex services over an extended period without necessarily achieving the desired improvement.

The treatment intervention studied in this project, developed by Suzette Boon, is a group treatment program for individuals with Complex Dissociative Disorder. The manual, “Coping with trauma-related dissociation” (Boon, Steele & Hart, 2011, 2014)(2), focuses on stabilizing patients through psychoeducation and skills training based on the theory of structural dissociation. Treatment goals include self-discovery and increased internal collaboration.

Sub-Projects:

The PhD project focus on change in treatment. Four master theses are connected to this project, focusing on various aspects of living with a dissociative disorder. Ingunn Holbæk was a co-supervisor.

• Opsvik, Y. Ø., Holbæk, I., Arefjord, K., & Hjeltnes, A. (2022). The challenge of being present with yourself: Exploring the lived experience of individuals with complex dissociative disorders. European Journal of Trauma & Dissociation, 6(2), 100250. DOI: 10.1016/j.ejtd.2021.100250
• ”Alt er bedre enn å stå i det derre… trøkket»” – En kvalitativ studie av hvordan personer med dissosiative lidelser selv opplever at deres symptomer kan ha en funksjon. 2020 Lerfaldet, Ragnar.  http://urn.nb.no/URN:NBN:no-85252
• “Det er som om du går på tynn is” – En kvalitativ studie av kroppslige erfaringer hos mennesker med dissosiativ lidelse. 2021. Grimsgaard, Carina Schjem og Mehl, Tonje Tessem http://urn.nb.no/URN:NBN:no-92681
• “Å være uforståelig for seg selv og andre”: En kvalitativ studie av hvordan det kan oppleves å leve med en kompleks dissosiativ lidelse. 2023. Haarvik, Regine Birgitsdatter https://hdl.handle.net/11250/3071693

Funding

The project is internally funded by Modum Bad.

Tools

Interviews were conducted with 26 of the 59 participants in the RCT six months and two years after treatment. We have a qualitative design analyzing the semi-structured interviews with an Interpretative methodological approach.

Collaboration

International Collaboration:

• Suzette Boon, Netherlands

National:

Ingunn Holbæk is a member of the professional committee for the international conference on Trauma, Dissociation, and Psychosis. TraumaConference

Contact Information

Project Contact: Ingunn Holbæk

You can also reach us through the Modum Bad telephone service: 32 74 97 00.

References:
(1) Bækkelund, H., Ulvenes, P., Boon-Langelaan, S., & Arnevik, E. A. (2022). Group treatment for complex dissociative disorders: a randomized clinical trial. BMC psychiatry, 22(1), 338. https://doi.org/10.1186/s12888-022-03970-8

(2) Boon, S., Steele, K., & Van Der Hart, O. (2011). Coping with trauma-related dissociation: Skills training for patients and therapists. WW Norton & Company.

Project participants

• Margrethe Seeger Halvorsen (Supervisor, University of Oslo)
• KariAnne Vrabel (Co-supervisor, Research Director at Modum Bad)

Publications

• Opsvik, Y. Ø., Holbæk, I., Arefjord, K., & Hjeltnes, A. (2022). The challenge of being present with yourself: Exploring the lived experience of individuals with complex dissociative disorders. European Journal of Trauma & Dissociation, 6(2), 100250. DOI: 10.1016/j.ejtd.2021.100250

Researchers studying trauma disorder at Modum Bad: