Integrating Individual Deep Brain Reorienting With a Supportive Group Intervention for Complex Dissociative Disorders: A 16-Week Feasibility and Pilot Study

Integrating Individual Deep Brain Reorienting with a Supportive Group Intervention for Complex Dissociative Disorders:

A 16-Week Feasibility and Pilot Study

1. Background and current state of knowledge Complex dissociative disorders (CDD), including dissociative identity disorder (DID) and other specified dissociative disorders (OSDD), are severe conditions that often develop as a consequence of early, repeated, and overwhelming traumatic events. Patients frequently present with extensive dissociative symptoms such as amnesia and identity confusion, emotional dysregulation, relational difficulties, and marked functional impairment. Despite high levels of burden for both patients and health services, there is very limited research-based knowledge about effective treatment for this group.

For PTSD in general, trauma-focused exposure treatment is recommended as first choise (NICE guidelines). There is increasing evidence that such approaches may also be useful in more complex traumatization (Oprel et al., 2021; Raabe et al., 2022; Sele et al., 2023; van Vliet et al., 2021), while some studies suggest that patients with particularly high levels of dysregulation often need a more phase-oriented approach (e.g., Bohus et al., 2020). For complex dissociative disorders, there are currently only two randomized controlled trials (RCTs) that specifically target this patient group. In Brand et al. (2025), a psychoeducational skills training program ("Finding Solid Ground") as the first phase of treatment showed a significant effect over and above usual individual therapy. In another RCT, where a 20-week psychoeducational group intervention was compared with standard individual therapy, both groups showed improved functioning, but there was no additional effect of the group and no clear symptom reduction (Bækkelund et al., 2022). There are no RCTs testing the effect of trauma-focused exposure treatment for individuals with CDD.

International guidelines (ISSTD, 2011; Brand et al., 2012) recommend a phase-oriented approach to treatment of CDD. In phase 1, work focuses on stabilization and skills training before progressing to more direct trauma processing. A central clinical dilemma is that these treatment courses often become very long, and many patients never reach phase 2, where the traumatic memories themselves are processed. The field lacks methods that can safely address the core of the trauma before patients have built substantial capacity through long-term stabilization work.