Integrating choice points into mindfulness training for the dissociative subtype of PTSD: A case report

About 15-30% of people with PTSD also have high dissociation, a dissociative subtype (PTSD-D). Best practices for offering mindfulness-based interventions (MBIs) to these patients are unclear. This case study from a larger randomized controlled trial describes a patient with PTSD-D who completed an 8-week MBI while actively dissociating. Follow-up interviews and pre/post assessments showed the patient had a positive experience and improved self-regulation. The training may have been safe and effective because it integrated choice points and promoted structural safety. Six influencing factors that contributed to the outcome are discussed to guide clinicians and researchers.

Study at a glance

Abstract

Approximately 15-30 % of individuals diagnosed with PTSD experience high levels of dissociation, a condition categorized in the DSM-V as a dissociative subtype of PTSD (PTSD-D). Despite the rising number of studies supporting mindfulness-based interventions (MBIs) for the treatment of PTSD, literature on mindfulness and dissociation remains scarce and discording. While best practices for offering mindfulness for dissociative patients remain unclear, integrating choice points into MBIs may be aligned with trauma-informed principles and effective in countering loss of self-agency associated with trauma. In this article, we present a case study from a larger randomized controlled trial of an individual with PTSD-D who successfully completed an 8-week MBI while displaying active dissociation symptoms throughout the group. Follow-up interviews with stakeholders in the patient's care as well as pre-and post-intervention assessments indicate that the patient had a positive experience with the mindfulness training and improved self-regulation. Analysis of the case study suggests that the mindfulness training may have been safe and effective for this patient due to the integration of choice points throughout the mindfulness training and promotion of structural safety. We expand on this by further discussing six influencing factors that contributed to the outcome of the case study and can serve as a reference for clinicians, researchers, and instructors who wish to offer MBIs safely to patients with PTSD-D.