Therapeutic and social interventions for conversion and diss | Figure 1

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Therapeutic and social interventions for conversion and dissociative disorders

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The aim of this review is to provide a better understanding of what is an effective and useful intervention (treatment) for people with conversion disorders and dissociative disorders. The interventions we look at are non‐medical. Instead they concern therapy or social interventions.

Background

Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms (relating to the nerves and nervous system) or changes in awareness or identity. Neurological disease or other medical conditions cannot explain these clinical signs; often a psychological (affecting or arising in the mind) stressor or trauma is present. The symptoms are real and can cause distress or problems with functioning in everyday life for the people experiencing them.

This review seeks to help these patients, as well as the clinicians, policy makers and healthcare services working with these disorders.

Review question

What is the evidence for psychosocial (relating to social factors and individual thought and behaviour) intervention of conversion and dissociative disorders?

Search date

We searched medical databases between 16 July and 16 August 2019.

Results of search

We read 3048 summaries of articles, resulting in 17 studies that met our criteria for the conditions, the groups of people, the interventions and the types of studies that are the focus of this review.

The 17 studies had 894 participants, and each study was relatively small.

More studies are under way, and we will include them in updates of this review.

Study characteristics

The studies took place in nine different countries worldwide, with adults aged 18 to 80 years, who had a diagnosis of conversion or dissociative disorder for any length of time. Some studies were conducted in either psychiatric or neurological settings. Some included people already in hospital, some included people attending outpatient clinics.

The interventions were all psychosocial, meaning that they focused on psychological or social interventions such as therapy, hypnosis or simply teaching people about their illness. The number of sessions varied.

The included studies all compared the intervention to a control group to see if the interventions made any difference. The control groups received a different psychosocial intervention, medication or the care that people would normally get if they had the same condition but were not part of a research study.

The primary outcome we looked for was a reduction in physical signs.

Key results

We investigated the effect of different types of psychosocial interventions, ranging from hypnosis to behavioural therapy. None of the studies were conducted to a high enough standard to be able to say anything conclusive about the evidence of the results.

There was a reduction in physical signs at the end of treatment for three interventions.

Hypnosis reduced the severity of impairment compared to people on a wait list for treatment; behavioural therapy, given on top of routine care to inpatients, reduced the number of weekly seizures (fits) and symptom severity compared with people receiving routine care alone; and psychotherapy preceded by motivational interviewing (a talking therapy that attempts to move an person away from a state of indecision or uncertainty to positivity) compared with psychotherapy alone reduced seizure frequency.

Quality of the evidence

Most of the included studies had methodological flaws and the quality of evidence used to assess the effectiveness of the different treatments was judged as low or very low. Due to this low‐quality evidence, we cannot say how reliable the results are.

Conclusion

The results of the meta‐analysis and reporting of single studies suggest that there is lack of evidence regarding the effects of any psychosocial intervention of conversion and dissociative disorders in adults. Therefore, it is not possible to draw any conclusions about potential benefits or harms from the included studies.

However, the review shows that research in this area is possible.

Read the full Cochrane Review here

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