A cognitive behavioral model for dissociation: Conceptualization, empirical evidence and clinical implications

There is a lack of evidence-based models and treatment for dissociation. This article aims to fill this gap by providing a comprehensive evidence-based model for dissociation using a cognitive behavioral conceptualization. We postulate that, following an initial experience of dissociation, associative conditioning will increase the frequency and intensity of dissociative symptoms. Various mechanisms could facilitate dissociation: negative beliefs about emotion, beliefs about dissociation, emotional dysregulation, low attentional control and poor mindfulness skills. Based on this model, a range of clinical interventions can be proposed to reduce dissociation, including cognitive restructuring through reality testing, decisional balance and Socratic questioning, emotion regulation and attentional training, and mindfulness-based programs. The impact of these interventions on dissociation needs to be appraised using experimental methodologies (randomized controlled trials and intervention studies with outcome measures).