What Mindfulness can learn about Dissociation and what Dissociation can learn from Mindfulness

Psychedelic iatrogenic structural dissociation: an exploratory hypothesis on dissociative risks in psychedelic use

This paper introduces the hypothesis of Psychedelic Iatrogenic Structural Dissociation (PISD), proposing that psychedelics may reactivate dissociated traumatic material, increasing the risk of psychological destabilization in trauma-exposed individuals. Grounded in structural dissociation theory, this framework suggests that psychedelics can disrupt the balance between daily functioning (the Apparently Normal Personality, ANP) and trauma-related responses (the Emotional Personality, EP), leading to the resurfacing of unintegrated memories. A review of recent studies highlights persistent adverse effects associated with psychedelic use, including emotional dysregulation, identity fragmentation, derealization, and perceptual disturbances, particularly among individuals with early trauma histories. To mitigate these risks and facilitate trauma processing, integration practices, body-focused therapies, and structured social support systems are proposed as key interventions. Additionally, emerging neurophysiological models suggest that psychedelics may reconfigure dissociative processes through the modulation of entrenched patterns, potentially facilitating trauma integration or increasing vulnerability to destabilization, depending on individual and contextual factors. These findings underscore the necessity of trauma-informed screening, preparation, and integration protocols to enhance the safety and efficacy of psychedelic therapies, particularly for vulnerable populations.

Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation

Purpose

Dissociation is a necessary part of our threat response system, common to all animal species, normally temporarily activated under conditions of extreme or inescapable threat. Pathological dissociation, however, continues to occur after the initial threat has passed, in response to reminders or inaccessibility of safety and security. Present across the spectrum of psychiatric diagnoses, recurrent dissociative symptoms are linked to severe trauma exposure, insecure attachment, treatment non-response, and maladaptive coping behaviors such as substance use, suicidality, and self-harm. However, empirical studies testing treatments specific to dissociative processes remain scarce. This narrative review summarizes existing studies and provides theoretical, neurobiological, and evolutionary perspectives on dissociative processes and treatments for pathological dissociation.

Methods

A systematic search of five databases (MEDLINE, EMBASE, APA PsycINFO, CINAHL plus, Scopus) was conducted on April 13, 2023. Peer-reviewed clinical studies with adult participants, assessing intervention effects on dissociative symptoms, were included. Results were thematically analyzed and summarized.

Results

Sixty-nine studies were identified, mainly focused on posttraumatic stress disorder, trauma-exposed populations, and borderline personality disorder. Psychotherapy was studied in 72.5% of studies; other interventions included medications and neurostimulation. The majority reported positive outcomes, despite the heterogeneous spectrum of interventions. However, treatment of dissociative symptoms was the primary objective in only a minority.

Conclusion

Pathological dissociation is a complex phenomenon involving brain and body systems designed for perceiving and responding to severe threats, requiring an individualized approach. A literature is emerging regarding potentially evidence-based treatments to help those impacted by recurrent dissociative symptoms. When contextualized within a neurobiological and evolutionary perspective, these treatments can be understood as facilitating an internal and/or relational sense of safety, resulting in symptom reduction. Further studies are needed to explore effective treatments for dissociative symptoms.

The mediating role of trait mindfulness and dissociative experiences in the relationship between childhood emotional abuse and problematic internet use in Italian adolescents

There is clear evidence linking trauma, mindfulness, dissociation and problematic internet use (PIU). Nonetheless, little is known about the role trait mindfulness and dissociative experiences may have in the relationship between childhood emotional abuse (CEA) and PIU, as well as the role that gender may have in such relationships. In the current research, self-report questionnaires on CEA, trait mindfulness, dissociative experiences and PIU were administered to 1074 Italian adolescents (50% females) aged 14-17 years old, to test whether trait mindfulness and dissociative experiences mediated the relationship between CEA and PIU, and whether the proposed mediation was invariant across genders. Furthermore, the main analyses were controlled for background variables. The findings highlighted significant associations between all direct and indirect paths and invariance of the mediation model across boys and girls. The results of this study highlight that emotionally abused boys and girls with high levels of dissociation and inadequate mindful skills may be more exposed to dysfunctional online activities. Hence, developing dissociation-focused and mindfulness-based interventions for emotionally abused adolescents may be clinically effective when building tailored approaches for the prevention and management of PIU. Further implications are discussed.

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

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.

Disentangling the Link Between Mindfulness and Dissociation in PTSD: The Mediating Role of Attention and Emotional Acceptance

INTRODUCTION

A number of studies have investigated the relationship between mindfulness and dissociation and suggested that mindfulness-based interventions could be effective in the treatment of dissociative symptoms. A recent study in healthy volunteers found that attention and emotional acceptance mediates this relationship. However, no study has yet been performed among a clinical sample to assess this association.

METHOD

We recruited 90 patients (76 women) suffering from Posttraumatic Stress Disorder (PTSD). They completed self-report questionnaires to measure PTSD, dissociation, emotion regulation difficulties, childhood trauma, mindfulness abilities and cognitive abilities.

RESULTS

We found that mindfulness abilities, emotional difficulties, dissociation and attention-concentration were all related to each other. Using a step-by-step approach and bootstrapping techniques, we found a significant indirect effect of mindfulness abilities on dissociation through non-acceptance (confidence interval 95%=-.14 to -.01) and attentional difficulties (confidence interval 95%=-.23 to -.05).

CONCLUSION

Patients with higher levels of dissociative symptoms have less capacity for mindfulness. Our results support Bishop et al.'s model proposing that attention and emotional acceptance are the two active components of mindfulness. To extend our findings, clinical trials are required to evaluate a causal relationship and the effectiveness of mindfulness-based interventions for patients suffering from dissociation.

The Relationship Between Dissociation and Complex Post-Traumatic Stress Disorder: A Scoping Review

Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6-76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group.

Dissociative Dimensions and Their Implications for Emotional Dysregulation Underlying Borderline Personality Disorder Features

ABSTRACT

Emotion dysregulation is considered a core feature of borderline personality disorder (BPD). The role of dissociation in BPD has been discussed from different perspectives. Nevertheless, implications of dissociation for BPD features are not clear. The current study estimated mediation effects of dissociative dimensions on the relationships between several emotion regulation strategies (ERSs) and BPD features among 281 adults recruited from the general population. The online survey administered a comprehensive self-report battery for the assessment of maladaptive and adaptive ERSs together with dissociative dimensions. Borderline personality disorder features were also self-report screened. Results showed significant indirect effects of dissociation on the relationships between ERSs and BPD features. Dissociation was a full mediator of the relationship between deficits with problem-solving skills and BPD criteria. The study confirmed that emotion dysregulation is a core feature of BPD and that the dissociative dimensions should be included as relevant maladaptive mechanisms sustaining BPD emotional difficulties.

Prevalence, Clinical Features, and Psychological Characteristics of Dissociative Subtype of Posttraumatic Stress Disorder in Chinese Prisoners

This study aimed to examine prevalence, clinical symptoms, and psychological characteristics of D-PTSD in a sample of Chinese prisoners with probable PTSD. A total of 1458 male prisoners were recruited from a large prison in Guangdong, China. Participants completed self-administrated questionnaires that assessed PTSD and dissociative symptoms, psychopathology, emotion regulation, emotional expressivity, social pleasure, traumatic events, and social support. According to DSM-5 criteria, participants were classified into four groups: D-PTSD, PTSD only, derealization/depersonalization (DD) only, and neither. The proportions of D-PTSD, PTSD only, DD only and neither were 2.5%, 4.7%, 2.4%, and 92.2%, respectively. PTSD symptoms and emotion regulation difficulties were distinguishing for the four groups: PTSD symptoms declined gradually in the order of D-PTSD, PTSD only, DD only, and neither, while emotion regulation difficulties declined in an order from D-PTSD, DD only, and PTSD only to neither, all ps < .001. D-PTSD and DD only had higher depressive and dissociative symptoms than PTSD only and the neither groups, all ps < .001. D-PTSD also had more borderline personality symptoms, emotion regulation difficulties, and more negative emotional expressivity than PTSD only and DD only, all ps < .05. Logistic regressions indicated that D-PTSD reported lower social support compared to PTSD only (OR = 0.95, p < .01), DD only (OR = 0.96, p < .05) and neither (OR = 0.93, p < .001). D-PTSD is common in probable PTSD in prisoners and is associated with complex clinical presentations as well as emotional processing. Social support is an important protective factor of D-PTSD.

Building a More Diverse and Inclusive Science: Mindfulness-Based Approaches for Latinx Individuals

Objectives

This article represents a call to action for the mindfulness field to be more diverse and inclusive of Latinx individuals. Building a diverse and inclusive science around mindfulness-based approaches (MBAs) that considers important group-level cultural and contextual information is an important public health challenge in need of innovative solutions.

Methods

We describe ways that the Latinx population is poised to benefit from MBAs. We further elucidate challenges, describe potential solutions, and outline a research agenda that may hold promise for building a more inclusive mindfulness movement.

Results

Our recommendations center around developing nuanced cultural adaptations to MBAs, engaging Latinx individuals in research, increasing the rigor of scientific studies pertaining to Latinx individuals, relying on implementation science to develop innovative methods for disseminating MBAs to Latinx individuals, developing training and certification mechanisms to increase diversity and representation of Latinx mindfulness teachers, and creating mechanisms for the oversight of MBAs within this group.

Conclusions

There has been a lack of inclusivity of Latinx individuals in the field of MBAs with regards to research studies, barriers to access for economically disadvantaged groups, and lack of diversity in its workforce. Considering the recognition of adverse social drivers of health that generate chronic stress and health disparities, the Latinx population is especially poised to benefit greatly from MBAs. A diverse and inclusive mindfulness science holds promise to enhance the effectiveness, acceptability, feasibility, and wide-scale dissemination and implementation of MBAs.

Mindfulness Meditation Leads To Increased Dispositional Mindfulness And Interoceptive Awareness Linked To A Reduced Dissociative Tendency

Dissociation is an involuntary defensive mechanism to protect oneself by avoiding unbearable internal conflicts or overwhelming emotions. Cultivating mindful awareness could allow the development of voluntary processes that can offer part of the self-protective function of dissociation while favoring internal integration processes. The aim of the present study was to explore the effects of a 7-week Mindfulness Oriented Meditation (MOM) training on healthy individuals' self-reported dissociative experience, mindfulness skills and interoceptive awareness. After the training, in comparison to a waiting-list control group (N = 102), the MOM group (N = 110) showed reduced dissociative tendencies (p < .05), increased dispositional mindfulness (p < .001) and increased interoceptive awareness (in the aspects of not-worrying, self-regulation and body listening; p < .001). Moreover, correlational evidence showed that the more MOM participants increased in mindfulness skills after the training the more they reported increased interoceptive awareness and decreased dissociative functioning (p < .05). Mindfulness skills also improved with more home meditation practice executed by MOM participants (p < .05). These findings were attributed to a possible role of mindfulness meditation in enabling the development of volitional processes that afford psychological safety and integration, in contrast with the involuntary nature of dissociation.

Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment

BACKGROUND

Mindfulness has demonstrated strong utility for enhancing self-management and health outcomes in chronic illness. However, sensation-focused mindfulness techniques may not be appropriate for clinical populations with neurological injury. This study aimed to identify how expert mindfulness teachers with sensory loss/impairment naturalistically adapt and experience mindfulness. We aimed to highlight the rationale for and barriers to mindfulness practice when living with sensory loss.

METHODS

A qualitative, semi-structured interview design was used, analysed via Interpretative Phenomenological Analysis (IPA). Eight (5 females, 3 males) mindfulness teachers with neurological injury were recruited via a national registry of Mindfulness for Health teachers. Interviews (range: 50-93 min) were completed, transcribed verbatim and analysed idiographically for descriptive, linguistic and conceptual themes, before a cross-case analysis was completed.

RESULTS

Two superordinate themes were identified: (1) Overcoming a disrupted biography; and (2) Proactive self-management. These themes considered the challenge of reconciling, through grief, a past health status with the present reality of living with sensory loss due to Spinal Cord Injury, Multiple Sclerosis or Functional Neurological Disorder. Mindfulness was experienced as a method by which proactive choices could be made to maintain control and autonomy in health, reducing perceptions of suffering, psychological distress, cognitive reactivity and rumination.

CONCLUSIONS

Mindfulness was found to support the self-management of health after neurological injury/impairment. Mindfulness meditation presented an initial challenge as trauma and grief processes were (re-)activated during mindfulness sessions. However, mindfulness was found to support the resolution of these grief processes and encourage adaptive approach-based coping and acceptance of health and neurological impairment/injury.

Adverse Childhood Experiences and Mindfulness in Chinese College Students During the COVID-19 Pandemic

Mindfulness has been found to have many positive effects on life outcomes, including mental health and educational achievement. However, less is known about the antecedents of mindfulness, particularly in Chinese college students. This study examines the effect of adverse childhood experiences (ACEs) on mindfulness among Chinese college students in September 2020, during the COVID-19 pandemic. We hypothesized that ACEs negatively affected students' mindfulness. The data were collected from 1,871 college students from 12 colleges across China. The results aligned with our hypothesis that ACEs was negatively associated with mindfulness. In particular, emotional abuse and neglect in childhood appear to have the most negative effects on mindfulness compared to other dimensions of ACEs such as physical abuse and household challenges.