Engagement with Psychoeducation Exercises Linked with Coping Skill Use and Treatment Outcomes in a Web-Based Program for Dissociative Individuals

The Treatment of Patients with Dissociative Disorders (TOP DD) Network Study offered psychoeducation and exercises to help patients with complex trauma-related dissociation and their therapists learn how to reduce symptoms and increase adaptive capacities. This paper examines whether 227 dissociative disorder (DD) patients' engagement with TOP DD Network Study program exercises was associated with improvements in coping skill use, symptom severity, and adaptive functioning. Multilevel modeling techniques revealed that more engagement in written and practice exercises than usual for participants was associated with greater coping skill use across weeks in the study when controlling for time. Further, to the extent that participants reported more coping skill use than was typical for them, their mental health symptoms and dissociative symptoms decreased at a faster rate than would be expected as a function of time. More than usual use of coping skills was also associated with increased self-kindness and adaptive functioning, controlling for time. Finally, a Monte Carlo method for assessing mediation revealed that more engagement with the program's exercises was linked with improved treatment outcomes through their association with greater than average use of coping skills, controlling for weeks spent in the study. Completion of relevant written and practice exercises appears useful in encouraging coping skill use for individuals with dissociative disorders. Further, results suggest that the educational components of the TOP DD Network Study contributed to participants' ability to reduce symptoms, increase self-kindness, and develop adaptive capacities.