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 Table of Contents    
BRIEF RESEARCH COMMUNICATION  
Year : 2016  |  Volume : 58  |  Issue : 3  |  Page : 326-328
Role of mindfulness in dissociative disorders among adolescents


1 Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India

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Date of Web Publication12-Oct-2016
 

   Abstract 

Context: Dissociation is understood as maladaptive coping and is common in children and adolescents. Treatment outcome studies show improvement in comorbid conditions suggesting the need to implement programs that target dissociative pathology.
Aim: To study the effect of practicing mindfulness among adolescents diagnosed with dissociative disorders.
Settings and Design: It was a hospital-based repeated measures design.
Materials and Methods: 7 adolescents participated in a mindfulness-based therapeutic program for 6 weeks.
Statistical Analysis: Scores were expressed as mean ± standard deviation. Friedman test was used to assess significance of the difference in scores at various assessment phases. Wilcoxon signed rank test was used for post hoc analysis.
Results: Participants were mostly female adolescents from rural, Eastern India. There was a significant reduction in dissociative experiences and significant improvement in mindfulness.
Conclusions: Incorporating mindfulness in clinical practice may prove effective in reducing dissociation and promoting adaptive functioning.

Keywords: Adolescents, dissociation, Eastern India, female, mindfulness, rural

How to cite this article:
Sharma T, Sinha VK, Sayeed N. Role of mindfulness in dissociative disorders among adolescents. Indian J Psychiatry 2016;58:326-8

How to cite this URL:
Sharma T, Sinha VK, Sayeed N. Role of mindfulness in dissociative disorders among adolescents. Indian J Psychiatry [serial online] 2016 [cited 2020 Feb 25];58:326-8. Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/3/326/192013



   Introduction Top


Dissociation is understood as a coping mechanism to deal with intense stressors accompanied by avoidant information processing style.[1] The prevalence rate of dissociative disorders in psychiatric settings is around 10% and is more common in adolescents.[2] Dissociative disorders in children and adolescents usually coexist with other childhood psychiatric conditions [3] and the available treatment modalities are effective in reducing only these comorbidities. Dissociative pathology remains untreated and impairment is still seen among the treated, in many areas of life.[4],[5],[6]

Being mindful is becoming aware and nonjudgmentally accepting towards the present moment experiences. This is contradictory to the state of experiential avoidance seen among patients with dissociative disorders. Mindfulness can help predict and control dissociation through building awareness of dissociative processes. Interventions based on mindfulness may thus, be useful in targeting dissociative pathology and promoting adaptive functioning.


   Materials and Methods Top


The study was conducted in Centre for Child and Adolescent Psychiatry, Central Institute of Psychiatry, Ranchi, India. Sample consisted of 7 adolescents fulfilling the International Classification of Diseases-10 Diagnostic Criteria for Research for dissociative/conversion disorder [7] with no comorbid psychiatric disorder (except, mild to moderate anxiety and depression), psychoactive substance use (except, nicotine and caffeine), severe medical, neurological, physical illness, or mental retardation/developmental disorder. None of the participants was exposed to any form of psychological intervention. The selection was done from inpatient and outpatient services of the institute through purposive sampling after obtaining informed consent from the guardians.

Sociodemographic details and clinical data on age, gender, habitat, symptoms were obtained followed by baseline assessment on Adolescent Dissociative Experience Scale (ADES)[8] and Child Acceptance and Mindfulness Measure (CAMM).[9] ADES is a 30 item self-report instrument that reliably measures pathological dissociation in adolescents. CAMM is a well-validated 25 item self-report inventory used for assessment of mindfulness skills in adolescents and children.

A therapeutic program comprising of weekly sessions of mindfulness practice spread over 6 weeks was adapted from the Mindfulness Based Stress Reduction (MBSR) program [10] and administered in an individualized format. The sessions focused on understanding the attitudinal factors in mindfulness by practicing formal mindfulness techniques of body scan, sitting meditation and yoga. Informal mindfulness practices such as mindful eating and mindful walking were also introduced to encourage the practice of mindfulness in everyday life. Homework assignments included practicing the techniques learnt in each session. Didactic instructions on using mindfulness in daily life and reflective discussions were done in each session. ADES and CAMM were again administered after 3 weeks and at the termination of the therapeutic program. Data analysis was done using Statistical Package for Social Sciences version 16.


   Results Top


The average age of adolescent participants was found to be 13 ± 2.5 years, majority of which were females (86%), hailing from rural background (57.1%). There were significant reductions in scores of dissociative experiences and significant improvement in scores of mindfulness from pre- to post-assessment [Table 1]. However, significant decrease in dissociative experience scores was observed only from mid- to post-assessment while significant increase in mindfulness scores was observed from pre- to mid-assessment.
Table 1: Comparison of change of scores on Adolescent Dissociative Experience Scale and Child Acceptance and Mindfulness Measure across time

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   Discussion Top


Dissociative disorders are common among adolescents and young adults. More so in females from rural background and low socioeconomic status.[11],[12] In this study also, majority of the participants were female adolescents hailing from rural background of Eastern India. In a patriarchal society, like in India, men have a greater say and tend to dominate over women which leaves little opportunity for the latter to express their views. Dissociation may then, serve as means to express self. Furthermore, a higher level of economic stress experienced by people from low socioeconomic status may explain the development of dissociative symptoms as means of coping.

Participants in the study had symptoms characteristic of and significant enough to diagnose dissociative/conversion disorder. However, the dissociative experience mean scores were found to be subclinical. The use of defense mechanisms such as denial and repression which is commonly seen in dissociation [13] is reflected in under-reporting of symptoms on a self-report measure such as ADES.

Over the years, several new psychotherapies have been developed that are rooted in the concept of mindfulness. Mindfulness is defined as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experiences, moment by moment.”[14] In practicing mindfulness, one becomes aware of the current internal and external experiences, observes them carefully, accepts them, and allows them to be let go of to attend to another present moment experience. Mindfulness-based interventions are found to be effective in a number of physical conditions such as fibromyalgia, mixed cancer diagnoses, coronary artery diseases, obesity [15] as well as in psychiatric conditions such as anxiety and depression.[16] However, there is dearth of researches on efficacy of MBSR or other mindfulness based interventions in dissociation among adolescents and children.[17] Avoiding emotions, thoughts, and aspects of personal experiences are common in many forms of psychopathology and such experiential avoidance is the core of dissociation. Intentionally attending with openness and nonjudgmental attitude leads to a shift in perspective and creates an attitude of acceptance toward uncontrollable events. This causes experiential avoidance to become less automatic.[18]

Consistent with the previous studies, this study also shows that practicing mindfulness is associated with an increase in mindfulness skills as evident by the significant increase in mindfulness scores over the course of the program. However, it is interesting to note that changes in mindfulness occurred during the first 3 weeks of the therapeutic program unlike the significant change in dissociative experiences which did not occur until week 3 suggesting that decrease in dissociation might have occurred only after participants had begun to experience improvement in mindfulness. The pattern of findings is generally consistent with the widely held view that mindfulness training should increase the ability to respond mindfully to the experiences of daily life, which in turn should lead to improvements in a variety of mental health outcomes.[19] In the present study, it may be concluded that inculcating mindfulness led to increased awareness, providing ways to intervene and presenting an alternative to dissociation.

To the best of our knowledge, this is the only study empirically assessing the role of mindfulness-based program among adolescents with dissociative disorders. Few of the previous researches are either case reports on adult cases,[5] or theoretical framework explaining the possible utility of mindfulness in dissociation,[19] or have studied the effectiveness of mindfulness-based programs in other disorders such as borderline personality disorder where dissociative symptoms may be observed.[20]

The study has limitations such as small sample size, lack of a control (comparison) group and no assessments made at follow-up. For future studies, use of randomized controlled trials on relatively larger sample sizes, and assessing long term effects of practicing mindfulness is encouraged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Bremner JD. Cognitive processes in dissociation: Comment on Giesbrecht et al. (2008). Psychol Bull 2010;136:1-6.  Back to cited text no. 1
[PUBMED]    
2.
Sar V. Epidemiology of dissociative disorders: An overview. Epidemiol Res Int 2011;2011:1-8.  Back to cited text no. 2
    
3.
Hornstein NL. Complexities of psychiatric differential diagnosis in children with dissociative symptoms and disorders. In: Silberg JL, editor. The Dissociative Child: Diagnosis, Treatment and Management. 2nd ed. Lutherville, MD: Sidran Press; 1998.  Back to cited text no. 3
    
4.
Brand BL, Classen CC, McNary SW, Zaveri P. A review of dissociative disorders treatment studies. J Nerv Ment Dis 2009;197:646-54.  Back to cited text no. 4
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5.
Baslett G, James H. Case report: Brief mindfulness-based psychotherapeutic intervention during hospitalization in a patient with conversion and dissociation. Clin Case Stud 2011;10:95-109.  Back to cited text no. 5
    
6.
Emslie GJ, Mayes TL, Laptook RS, Batt M. Predictors of response to treatment in children and adolescents with mood disorders. Psychiatr Clin North Am 2003;26:435-56.  Back to cited text no. 6
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7.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. Geneva, Washington, DC: World Health Organization; 1993.  Back to cited text no. 7
    
8.
Armstrong JG, Putnam FW, Carlson EB, Libero DZ, Smith SR. Development and validation of a measure of adolescent dissociation: The adolescent dissociative experiences scale. J Nerv Ment Dis 1997;185:491-7.  Back to cited text no. 8
[PUBMED]    
9.
Greco L, Baer RA, Smith GT. Assessing mindfulness in children and adolescents: Development and validation of the child and adolescent mindfulness measure (CAMM). Psychol Assessment 2011;23:606-14.  Back to cited text no. 9
    
10.
Kabat-Zinn J. Full Catastrophe Living Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York: Dell Publishing; 1990.  Back to cited text no. 10
    
11.
Chattopadhyay P, Ghosh S, Nayak A, Das P, Bandyopadhyay A. Sociodemographic profile of normal EEG-dissociative disorder (convulsion) patients. J Indian Med Assoc 2009;107:549-50, 559.  Back to cited text no. 11
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12.
Coskun M, Bozkurt H, Ayaydin H. Clinical and sociodemographic features of adolescents hospitalized in the psychiatric inpatient unit of a university hospital. Turk J Child Adolesc Ment Health 2012;19:17-24.  Back to cited text no. 12
    
13.
Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994;151:1132-6.  Back to cited text no. 13
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14.
Kabat-Zinn J. Mindfulness based interventions in context: Past, present and future. Clin Psychol Sci Pract 2003;10:144-56.  Back to cited text no. 14
    
15.
Hayes S. Acceptance, mindfulness and science. Clin Psychol Sci Pract 2002;9:101-6.  Back to cited text no. 15
    
16.
Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 2004;57:35-43.  Back to cited text no. 16
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17.
Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol 2010;78:169-83.  Back to cited text no. 17
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18.
Brown KW, Ryan RM, Creswell JD. Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychol Inq 2007;18:211-37.  Back to cited text no. 18
    
19.
Zerubavel N, Messman-Moore TL. Staying present: Incorporating mindfulness into therapy for dissociation. Mindfulness 2013;6:303-14.  Back to cited text no. 19
    
20.
Koons CR, Robins CJ, Tweed JL, Lynch TR, Gonzalez AM, Morse JQ, et al. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther 2001;32:371-90.  Back to cited text no. 20
    

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Correspondence Address:
Tanya Sharma
Department of Clinical Psychology, Central Institute of Psychiatry, Kanke, Ranchi - 834 006, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.192013

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