How to Improve Treatment Adherence in Dissociative Disorders
How can clinicians use this study's findings to improve treatment adherence in patients with dissociative disorders?
For patients with dissociative disorders, adherence appears to depend most on whether they believe treatment will help and whether obstacles make follow-through difficult. The study points to a belief-informed, engagement-focused approach rather than a demographic or severity-based one.
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Strengthen belief that treatment can help
During visits, purposefully explore and reinforce the expected benefits of therapy and medication for dissociative symptoms. The article states that enhancing perceived benefits through targeted psychoeducation, motivational interviewing, and therapeutic alliance building may improve adherence, and perceived benefit was the strongest positive predictor in the study.
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Identify the barriers the patient perceives
Ask the patient what makes treatment difficult to start or continue, with particular attention to stigma, cost, side effects, limited access to specialized care, and psychosocial or logistical obstacles noted by the authors. Because perceived barriers were significantly and negatively associated with adherence, this discussion should be a routine part of adherence-focused care.
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Reduce modifiable obstacles with practical support
Respond to identified barriers with problem-solving interventions, practical support, and continuity of care, as recommended in the article. The authors specifically note that reducing perceived barriers through these approaches can strengthen treatment engagement.
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Prioritize early connection to ongoing treatment
Facilitate early linkage to therapeutic services and maintain consistent follow-up when possible. The study found that current therapy status and current medication use were both strongly associated with higher adherence, supporting an emphasis on sustained treatment involvement.
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Use empathetic and culturally sensitive communication
Frame adherence work within an empathetic therapeutic relationship and use culturally sensitive communication when discussing treatment beliefs and obstacles. The discussion and conclusion emphasize empathetic care and culturally sensitive communication as clinically relevant ways to improve adherence in this population.
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Revisit beliefs over time rather than focusing on demographics
Regularly reassess whether the patient still expects benefit from treatment and whether new barriers have emerged. The article recommends regularly revisiting patient beliefs and indicates that demographic variables did not meaningfully predict adherence, so individualized belief-informed care plans are more useful.
Clinical Considerations
- The article suggests adherence-enhancing strategies based on associations observed in a cross-sectional study, so the effectiveness of any specific intervention was not directly tested.
- Some barriers discussed clinically, such as stigma and family beliefs, were not directly measured in the study.
- The absence of qualitative data limits detailed understanding of patients' personal narratives around benefits and barriers.
- Findings come from a single-center sample and may not fully generalize to all dissociative disorder populations.
Bottom Line
To improve adherence in dissociative disorders, explicitly increase the patient's belief that treatment will help and actively remove perceived barriers while keeping the patient engaged in ongoing care.
