BACKGROUND: Approximately 30%-60% of patients with neurotic spectrum disorders remain symptomatic despite treatment. Identifying the predictors of good response to psychiatric and psychotherapeutic treatment may be useful for increasing treatment efficacy in neurotic patients. The objective of this study was to investigate the influence of hope, coping strategies, and dissociation on the treatment response of this group of patients. METHODS: Pharmacoresistant patients, who underwent a 6-week psychotherapeutic program, were enrolled in the study. All patients completed the Clinical Global Impression (CGI) - both objective and subjective forms, Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI)-II at baseline and after 6 weeks. The COPE Inventory, the Adult Dispositional Hope Scale (ADHS), and the Dissociative Experiences Scale (DES) were completed at the start of the treatment. RESULTS: Seventy-six patients completed the study. The mean scores for all scales measuring the severity of the disorders (BAI, BDI-II, subjective and objective CGI) significantly decreased during the treatment. Several subscores of the COPE Inventory, the overall score of ADHS, and the overall score of DES significantly correlated with the treatment outcome. Multiple regression was used to find out which factors were the most significant predictors of the therapeutic outcomes. The most important predictors of the treatment response were the overall levels of hope and dissociation. CONCLUSION: According to our results, a group of patients with a primary neurotic disorder, who prefer the use of maladaptive coping strategies, feel hopelessness, and have tendencies to dissociate, showed poor response to treatment.

Department of Psychiatry Faculty of Medicine and Dentistry Palacky University Olomouc University Hospital Olomouc Olomouc Czech Republic

Department of Psychology Faculty of Arts Palacky University Olomouc University Hospital Olomouc Olomouc Czech Republic ; Department of Psychiatry Faculty of Medicine and Dentistry Palacky University Olomouc University Hospital Olomouc Olomouc Czech Republic

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World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992. [Accessed April 29, 2015]. Available from: http://apps.who.int/iris/handle/10665/37958/

American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM-5. Arlington: American Psychiatric Association; 2013.

Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survery. Arch Gen Psychiatry. 1994;51:8–19. PubMed

Pohl RB, Feltner DE, Fieve RR, Pande AC. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing. J Clin Psychopharmacol. 2005;25(2):151–158. PubMed

Hooke GR, Page AC. Predicting outcomes of group cognitive behavior therapy for patients with affective and neurotic disorders. Behav Modif. 2002;26(5):648–659. PubMed

Heldt E, Gus Manfro G, Kipper L, Blaya C, Isolan L, Otto MW. One-year follow-up of pharmacotherapy-resistant patients with panic disorder treated with cognitive-behavior therapy: outcome and predictors of remission. Behav Res Ther. 2006;44(5):657–665. PubMed

Tyrer P, Seivewright H, Johnson T. The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder. Psychol Med. 2004;34:1385–1394. PubMed

Schat A, van Noorden MS, Noom MJ, et al. Predictors of outcome in outpatients with anxiety disorders: the Leiden routine outcome monitoring study. J Psychiatr Res. 2013;47(12):1876–1885. PubMed

Praško J, Raszka M, Adamcova K, et al. Predicting the therapeutic response to cognitive behavioral therapy in patients with pharmacoresistant obsessive-compulsive disorder. Neuro Endocrinol Lett. 2009;30(5):615–623. PubMed

Dell PF, O’Neil JA, editors. Dissociation and the Dissociative Disorders: DSM-V and Beyond. New York, NY: Routledge; 2009.

Ross CA. Borderline personality disorder and dissociation. J Trauma Dissociation. 2007;8:71–80. PubMed

Watson S, Chilton R, Fairchild H, Whewell P. Association between childhood trauma and dissociation among patients with borderline personality disorder. Aust NZJ Psychiatry. 2006;40:478–481. PubMed

Bob P. Disociativní projevy a jejich měření. [Dissociative symptoms and their measurement] Ceska Slov Psychiatr. 2000;6:301–309. Czech.

Zlotnick C, Shea MT, Pearlstein T, Simpson E, Costello E, Begin A. The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation. Compr Psychiatry. 1996;37:12–16. PubMed

van Heugten-van der Kloet D, Merckelbach H, Giesbrecht T, Broers N. Night-time experiences and daytime dissociation: a path analysis modeling study. Psychiatry Res. 2014;216(2):236–241. PubMed

Csikszentmihalyi M. Flow: The Psychology of Optimal Experience. New York: Harper Perennial Modern Classics; 2008.

Sar V, Akyuz G, Kugu N, Ozturk E, Ertem-Vehid H. Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma. J Clin Psychiatry. 2006;67:1583–1590. PubMed

Gulsun M, Doruk A, Uzun O, Turkbay T, Ozsahin A. Effect of dissociative experiences on drug treatment of panic disorder. Clin Drug Investig. 2007;27:583–590. PubMed

Pastucha P, Prasko J, Grambal A, et al. Panic disorder and dissociation – comparison with healthy controls. Neuro Endocrinol Lett. 2009;30(6):774–778. PubMed

Prasko J, Raszka M, Diveky T, et al. Obsessive compulsive disorder and dissociation – comparison with healthy controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010;154(2):179–183. PubMed

Rufer M, Held D, Cremer J, et al. Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder. Psychother Psychosom. 2006;75:40–46. PubMed

Sar V, Tutkun H, Alyanak B, Bakim B, Baral I. Frequency of dissociative disorders among psychiatric outpatients in Turkey. Compr Psychiatry. 2000;41(3):216–222. PubMed

Pastucha P, Prasko J, Diveky T, et al. Borderline personality disorder and dissociation – comparison with healthy controls. Activitas Nervosa Superior Rediviva. 2009;51(3–4):146–149.

Pastucha P, Prasko J, Grambal A, Latalova K, Sigmundova Z, Tichackova A. Dissociative disorder and dissociation – comparison with healthy controls. Neuro Endocrinol Lett. 2009;30(6):769–773. PubMed

Sar V, Ross C. Dissociative disorders as a confounding factor in psychiatric research. Psychiatr Clin North Am. 2006;29:129–144. PubMed

Ball S, Robinson A, Shekhar A, Walsh K. Dissociative symptoms in panic disorder. J Nerv Ment Dis. 1997;185:755–760. PubMed

Seguí J, Márquez M, García L, Canet J, Salvador-Carulla L, Ortiz M. Depersonalization in panic disorder: a clinical study. Compr Psychiatry. 2000;41:172–178. PubMed

Hagenaars MA, van Minnen A, Hoogduin KA. The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD. Behav Res Ther. 2010;48(1):19–27. PubMed

Simeon D, Greenberg J, Nelson D, Schmeidler J, Hollander E. Dissociation and posttraumatic stress 1 year after the World Trade Center disaster: follow-up of a longitudinal survey. J Clin Psychiatry. 2005;66(2):231–237. PubMed

Vásquez DA, de Arellano MA, Reid-Quiñones K, et al. Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino youth: results from the Hispanic family study. J Trauma Dissociation. 2012;13(5):509–525. PubMed PMC

Najavits LM, Walsh M. Dissociation, PTSD, and substance abuse: an empirical study. J Trauma Dissociation. 2012;13(1):115–126. PubMed PMC

Briere J, Weathers FW, Runtz M. Is dissociation a multidimensional construct? Data from the Multiscale Dissociation Inventory. J Trauma Stress. 2005;18(3):221–231. PubMed

LeDoux JE, Gorman JM. A call to action: overcoming anxiety through active coping. Am J Psychiatry. 2001;158(12):1953–1955. PubMed

Roemer L, Litz BT, Orsillo SM, Wagner AW. A preliminary investigation of the role of strategic withholding of emotions in PTSD. J Trauma Stress. 2001;14:149–156.

Feldner MT, Zvolensky MJ, Eifert GH, Spira AP. Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge. Behav Res Ther. 2003;41:403–411. PubMed

Frank JD. The faith that heals. Johns Hopkins Med J. 1975;137:127–131. PubMed

Snyder CR, Harris C, Anderson JR, et al. The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol. 1991;60:570–585. PubMed

Kwon P. Hope and dysphoria: the moderating role of defense mechanisms. J Pers. 2000;68(2):199–223. PubMed

Snyder CR, editor. Handbook of Hope: Theory, Measures, and Applications. San Diego, CA: Academic Press; 2000.

Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249–275.

Snyder CR. The Psychology of Hope: You Can Get There From Here. New York: The Free Press; 1994.

Wolverson Radbourne EL, Clarke C, Moniz-Cook E. Remaining hopeful in early-stage dementia: a qualitative study. Aging Ment Health. 2010;14(4):450–460. PubMed

Perry BM, Taylor D, Shaw SK. “You’ve got to have a positive state of mind”: an interpretative phenomenological analysis of hope and first episode psychosis. J Ment Health. 2007;16(6):781–793.

Guy W. ECDEU Assessment Manual for Psychopharmacology. Rockville: U.S. Department of Health, Education, and Welfare; 1976.

Zaider TI, Heimberg RG, Fresco DM, Schneier FR, Liebowitz MR. Evaluation of the clinical global impression scale among individuals with social anxiety disorder. Psychol Med. 2003;33:611–622. PubMed

Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897. PubMed

Steer RA. Amount of general factor saturation in the Beck Anxiety Inventory response of outpatients with anxiety disorders. J Psychopathol Behav Assess. 2009;31(2):112–118.

Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–597. PubMed

Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depress Anxiety. 2004;19(3):187–189. PubMed

Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56(2):267–283. PubMed

Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis. 1986;174(12):727–735. PubMed

Waller NG, Ross CA. The prevalence and biometric structure of pathological dissociation in the general population: taxometric and behavior genetic findings. J Abnorm Psychol. 1997;106(4):499–510. PubMed

Ptacek R, Bob P, Paclt I, et al. Psychobiology of dissociation and its clinical assessment. Neuro Endocrinol Lett. 2007;28(2):191–198. PubMed

Seifertova D, Prasko J, Hoschl C, Horacek J, editors. Postupy v lecbe psychickych poruch. [Guidelines for the treatment of mental disorders] Praha: Amepra, Medical Tribune; 2008. Czech.

Raboch J, Uhlikova P, Hellerova P, Anders M, Susta P, editors. Psychiatrie: Doporucene postupy psychiatricke pece IV. [Psychiatry: Recommended guidelines for psychiatric treatment IV] Praha: Psychiatricka Spolecnost, o.s.; 2013. Czech.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–191. PubMed

Guideline for Good Clinical Practice. EMEA. 2002. [Accessed April 29, 2015]. Available from: http://www.edctp.org/fileadmin/documents/EMEA_ICH-GCP_Guidelines_July_2002.pdf.

Ellis PD. The Essential Guide to Effect Sizes: Statistical Power, Meta-Analysis, and the Interpretation of Research Results. Cambridge: Cambridge University Press; 2010.

Grimm LG, Yarnold PR, editors. Reading and Understanding Multivariate Statistics. Washington, DC: American Psychological Association; 1995.

Halvorsen JØ, Stenmark H, Neuner F, Nordahl HM. Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial. Behav Res Ther. 2014;57:21–28. PubMed

Telch MJ, Kamphuis JH, Schmidt NB. The effects of comorbid personality disorders on cognitive behavioral treatment for panic disorder. J Psychiatr Res. 2011;45(4):469–474. PubMed

Thiel N, Hertenstein E, Nissen C, Herbst N, Külz AK, Voderholzer U. The effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders. J Pers Disord. 2013;27(6):697–715. PubMed

Steketee G, Siev J, Fama JM, Keshaviah A, Chosak A, Wilhelm S. Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder. Depress Anxiety. 2011;28(4):333–341. PubMed PMC

Overbeek T, Schruers K, Vermetten E, Griez E. Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. J Clin Psychiatry. 2002;63(12):1106–1112. PubMed

Self-stigma and schizophrenia: a cross-sectional study