PhD candidate Ben-Gurion University of the Negev Ben-Gurion University of the Negev, Tel Aviv, Israel
Dissociation and disruptions in the sense of agency (SoA) are two phenomena that describe a distorted perception of reality and of the self. Dissociation is an experience of disintegration between mental processes, such as memory, affect, sense of self, and behavior. Disruption in the SoA is the feeling that actions simply “happen” rather than being initiated. Despite their conceptual closeness, the relationship between these constructs has been neglected in the literature, as they are usually studied within separate domains. The presented study aimed to examine their daily interplay, as well as their association with background levels of post-traumatic symptoms, specifically, symptoms of either post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CTPSD). It was hypothesized that (H1) dissociation and SoA will be inversely related concurrently, such that momentary samples in which there are increases in dissociation will also be characterized, accordingly, with decreases in SoA. It was also hypothesized that (H2) level of posttraumatic symptoms, whether PTSD or CPTSD, will be associated with high average state dissociation and low average state SoA. N=110 adults, prescreened for over-sampling trauma, completed a battery of trait questionnaires, including measures for PTSD and CPTSD. Within a week, they answered experience-sampling momentary items assessing state dissociation and SoA four times a day for seven days. As hypothesized (H1), a strong and significant within-subjects concurrent inverse relationship was found between state dissociation and state SoA. In other words, momentary samples where dissociation was high (compared to the respondent’s own personal average) were, accordingly, characterized by low SoA (again, compared to the respondent’s own average SoA). H2 was partially supported, but notably, CPTSD emerged as a stronger and more stable predictor of state dissociation and disrupted state SoA. Specifically, only CPTSD, and not PTSD, predicted high state levels of dissociation, and although both PTSD and CPTSD symptoms significantly predicted low levels of state SoA, this effect was stronger for CPTSD. These findings support the notion that CPTSD is qualitatively different from PTSD; Specifically, CPTSD may affect individuals as they go on about their lives feeling less agentic and perhaps more helpless and passive, experiencing events as happening on their own without intentional action on their part. These findings may reflect how in CPTSD, the trauma impacts the ability to actively engage in the world. This experience of passiveness may affect mood and self-worth. In addition, the robust inverse relationship found between SoA and dissociation suggests that SoA may be a functional component of dissociation. The measurement of state dissociation mainly reflects perception of reality, whereas SoA adds information about people’s interactions with reality. This information has clinical implications; For example, interventions that emphasize functioning (which imply high SoA), such as behavioral activation, seem essential, but may also be overwhelming, for dissociative patients. Additionally, in approaches which may evoke dissociation, such as prolonged exposure, the level of SoA should be monitored, to ensure patients experience themselves as the initiators and executors of their actions and achievements. Clinical vignettes illustrating these implications will be presented alongside the findings.
Learning Objectives:
At the conclusion of this session participants will be able to:
Describe the key elements of Sense of Agency, and the relevancy of addressing it in psychotherapy for dissociative individuals
Provide patients with psychoeducation regarding the nature of dissociative experiences, SoA disruptions, and their relations to a traumatic background
Explain how certain therapeutic interventions may be affected by the dissociation-SoA association
Compare between CPTSD and PTSD, in terms of assessment, etiology and impact on the individual’s daily life
Discuss the advantages and challenges of an experience-sampling design in the study of dissociation