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      Assessing therapeutic change in patients with severe dissociative disorders: the progress in treatment questionnaire, therapist and patient measures Translated title: 评估中度分离障碍患者的治疗改变:治疗问卷、治疗师和病人报告的进展 Translated title: Evaluar el cambio terapéutico en pacientes con trastornos disociativos graves: el cuestionario del progreso del tratamiento, mediciones del terapeuta y los pacientes

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          ABSTRACT

          Background: Treatment research for dissociative identity disorder (DID) and closely related severe dissociative disorders (DD) is rare, and has been made more difficult by the lack of a reliable, valid measure for assessing treatment progress in these populations.

          Objective: This paper presents psychometric data for therapist and patient report measures developed to evaluate therapeutic progress and outcomes for individuals with DID and other DD: the Progress in Treatment Questionnaire – Therapist (PITQ-t; a therapist report measure) and the Progress in Treatment Questionnaire – Patient (PITQ-p; a patient self-report measure).

          Method: We examined the data of 177 patient–therapist pairs (total = 354) participating in the TOP DD Network Study, an online psychoeducation programme aimed at helping patients with DD establish safety, regulate emotions, and manage dissociative and posttraumatic symptoms.

          Results: The PITQ-t and PITQ-p demonstrated good internal consistency and evidence of moderate convergent validity in relation to established measures of emotional dysregulation, dissociation, posttraumatic stress disorder, and psychological quality of life, which are characteristic difficulties for DD patients. The measures also demonstrated significant relationships in the hypothesized directions with positive emotions, social relations, and self-harm and dangerous behaviours. The patient-completed PITQ-p, which may be used as an ongoing assessment measure to guide treatment planning, demonstrated evidence of stronger relationships with established symptom measures than the PITQ-t.

          Conclusions: The PITQ-t and PITQ-p merit use, additional research, and refinement in relation to the assessment of therapeutic progress with patients with DD.

          Translated abstract

          Planteamiento: La investigación del tratamiento para el trastorno de identidad disociativo (TID) y los trastornos disociativos (TD) graves que están estrechamente relacionados es poco frecuente y se ha dificultado por la falta de una medida fiable y válida para evaluar el progreso del tratamiento en estas poblaciones.

          Objetivo: Este artículo presenta los datos psicométricos de las medidas de informes de terapeutas y pacientes desarrolladas para evaluar el progreso terapéutico y los resultados en personas con TID y otros TD: El Cuestionario del progreso del tratamiento - terapeuta (PITQ-t, siglas en inglés de Progress in Treatment Questionnaire - Therapist; una medición mediante informe del terapeuta) y el Cuestionario del progreso del tratamiento - paciente (PITQ-p, siglas en inglés de Progress in Treatment Questionnaire - Patient; una medición mediante autoinforme del paciente).

          Método: Se examinaron los datos de 177 pares de pacientes-terapeutas (N total = 354) que participaron en el TOP DD Network Study, un programa de psicoeducación online destinado a ayudar a los pacientes con TD a establecer seguridad, regular emociones y manejar síntomas disociativos y postraumáticos.

          Resultados: El PITQ-t y PITQ-p demostraron buena consistencia interna y evidencia de una validez convergente moderada en relación a las medidas establecidas de desregulación emocional, disociación, trastorno por estrés postraumático y calidad de vida psicológica - dificultades características en pacientes con TD. Las medidas también demostraron relaciones significativas en el sentido establecido por la hipótesis en cuanto a emociones positivas, relaciones sociales, y conductas autolesivas y peligrosas. El PITQ-p completado por el paciente, que puede usarse como una medida de evaluación continua para guiar la planificación del tratamiento, evidenció relaciones más fuertes con las medidas establecidas de los síntomas que el PITQ-t.

          Conclusiones: El PITQ-t y PITQ-p justifican su uso, investigación adicional y refinamiento en relación con la evaluación del progreso terapéutico con pacientes con TD.

          Translated abstract

          背景:对分离身份障碍(DID)和与其紧密相关的分离障碍(DD)的治疗研究较少,缺少可靠有效的测量使评估这个群体的治疗进展更加困难。

          目标:本文呈现了治疗师报告和病人自我报告的心理测量数据用于评估DID和DD病人的治疗进展和结果:治疗进展问卷-医师版(PITO-t,治疗师报告)和治疗进展问卷-患者版(PITO-p,病人自我报告)。

          方法:我们分析了177对病人-医生组合参与TOP DD网络研究(一个帮助DD病人建立安全感、调控情绪和管理分离和创伤症状的网上心理教育项目)的数据(总体n=354)。

          结果:PITQ-t 和 PITQ-p显示了良好的内部一致性,与情绪失调、分离、创伤后应激障碍和心理生活质量-DD病人的特征性困难表现出中等的聚合效度。和假设一致,这个测量也表现出积极情绪、社会关系、自我伤害和危险行为的显著相关。病人完成的PITQ-p,可以用作持续的评估测量来指导治疗计划,与已成熟的测量工具之间比PITQ-t表现出更强的关联。

          结论:PITQ-t 和 PITQ-p和DD病人的治疗进展评估的关系说明它们是值得使用、可以用于研究中和进行改进的的工具。

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          Most cited references34

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          The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications.

          Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype. The relevant literature pertaining to the dissociative subtype of PTSD was reviewed. Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD. We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD. © 2012 Wiley Periodicals, Inc.
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            A Monte Carlo evaluation of tests for comparing dependent correlations.

            The authors conducted a Monte Carlo simulation of 8 statistical tests for comparing dependent zero-order correlations. In particular, they evaluated the Type I error rates and power of a number of test statistics for sample sizes (Ns) of 20, 50, 100, and 300 under 3 different population distributions (normal, uniform, and exponential). For the Type I error rate analyses, the authors evaluated 3 different magnitudes of the predictor-criterion correlations (rho(y,x1) = rho(y,x2) = .1, .4, and .7). For the power analyses, they examined 3 different effect sizes or magnitudes of discrepancy between rho(y,x1) and rho(y,x2) (values of .1, .3, and .6). They conducted all of the simulations at 3 different levels of predictor intercorrelation (rho(x1,x2) = .1, .3, and .6). The results indicated that both Type I error rate and power depend not only on sample size and population distribution, but also on (a) the predictor intercorrelation and (b) the effect size (for power) or the magnitude of the predictor-criterion correlations (for Type I error rate). When the authors considered Type I error rate and power simultaneously, the findings suggested that O. J. Dunn and V. A. Clark's (1969) z and E. J. Williams's (1959) t have the best overall statistical properties. The findings extend and refine previous simulation research and as such, should have greater utility for applied researchers.
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              Guidelines for treating dissociative identity disorder in adults, third revision.

              (2010)
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2017
                13 October 2017
                : 8
                : 1
                : 1380471
                Affiliations
                [ a ] Psychology Department, California Department of State Hospitals , Napa, CA, USA
                [ b ] Psychology Department, Towson University , Towson, MD, USA
                [ c ] Psychology Department, California Department of Corrections and Rehabilitation, California Correctional Institution , CA, Tehachapi, USA
                Author notes
                CONTACT Hugo Schielke Hugo.Schielke@ 123456gmail.com Psychology Department, California Department of State Hospitals , USA, CA
                Author information
                http://orcid.org/0000-0002-4786-8080
                Article
                1380471
                10.1080/20008198.2017.1380471
                5687799
                eeb581e6-1941-4c47-973e-1400d2f5418a
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 July 2017
                : 05 September 2017
                Page count
                Tables: 7, References: 45, Pages: 13
                Categories
                Research Article
                Research Article

                Clinical Psychology & Psychiatry
                dissociative identity disorder (did),dissociative disorders (dd),posttraumatic stress disorder (ptsd),ptsd,dissociative subtype,complex trauma,progress,outcome,assessment,questionnaires,trastorno de identidad disociativo (tid),trastornos disociativos (td),trastorno de estrés postraumático (tept),tept, subtipo disociativo,trauma complejo,progreso,resultado,evaluación,cuestionarios,分离身份障碍(did),分离障碍(dd),创伤后应激障碍(ptsd),ptsd分离亚型,复杂创伤,进展,结果,评估,问卷

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