This study evaluated an online psychoeducational program for people with dissociative symptoms. Methods: A total of 101 Hong Kong Chinese adults with dissociative symptoms were randomly assigned to the intervention group (n = 51) or the waitlist control group (n = 50). Results: The attrition rate was 15.8% at post-intervention. Over 90% participants were satisfied with the program. Within-subjects analyses showed that the intervention group had significant improvements in active coping, cognitive reappraisal, self-efficacy, and dissociative symptoms from baseline to 2-month follow-up, while the control group did not have such changes. Between-subjects analyses further showed that the intervention group had greater improvements in cognitive reappraisal than the control group with a medium effect (ηp2 = .101). Conclusion: This study contributes to the limited literature on interventions for dissociation. It provides preliminary evidence for an easily-accessible educational intervention for people with dissociative symptoms. Trial Registration: ClinicalTrials.gov—NCT05519748.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text revision).
2.
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association. https://www.apa.org/ptsd-guideline/ptsd.pdf.
3.
BækkelundH.UlvenesP.Boon-LangelaanS.ArnevikE. A. (2022). Group treatment for complex dissociative disorders: A randomized clinical trial. BMC Psychiatry, 22(1), 1–13. https://doi.org/10.1186/s12888-022-03970-8
4.
BoßL.LehrD.ReisD.VisC.RiperH.BerkingM.EbertD. D. (2016). Reliability and validity of assessing user satisfaction with web-based health interventions. Journal of Medical Internet Research, 18(8), e234. https://doi.org/10.2196/jmir.5952
5.
BrandB. L.ClassenC. C.McNaryS. W.ZaveriP. (2009). A review of dissociative disorders treatment studies. The Journal of Nervous and Mental Disease, 197(9), 646–654. https://doi.org/10.1097/NMD.0b013e3181b3afaa
6.
BrandB. L.McNaryS. W.MyrickA. C.ClassenC. C.LaniusR.LoewensteinR. J.PainC.PutnamF. W. (2013). A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 301. https://doi.org/10.1037/a0016210153
7.
BrandB. L.MyrickA. C.LoewensteinR. J.ClassenC. C.LaniusR.McNaryS. W.PainC.PutnamF. W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 490–500. https://doi.org/10.1037/a0026487
8.
BrandB.SchielkeH. J.PutnamK.PierorazioN. A.NesterM. S.RobertsonJ.MyrickA. C.LoewensteinR.PutnamF.SteeleK.BoonS.LaniusR. (2025). A randomized controlled trial assists individuals with complex trauma and dissociation in Finding Solid Ground. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001871
9.
BrandB. L.SchielkeH. J.PutnamK. T.PutnamF. W.LoewensteinR. J.MyrickA.JepsenE. K.LangelandW.SteeleK.ClassenC. C. (2019). An online educational program for individuals with dissociative disorders and their clinicians: 1-year and 2-year follow-up. Journal of Traumatic Stress, 32(1), 156–166. https://doi.org/10.1002/jts.22370
10.
BriereJ.WeathersF. W.RuntzM. (2005). Is dissociation a multidimensional construct? Data from the Multiscale Dissociation Inventory. Journal of Traumatic Stress, 18(3), 221–231. https://doi.org/10.1002/jts.20024
11.
CarlsonE. B.PutnamF. W. (1993). An update on the dissociative experiences scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16–27.
12.
CarverC. S. (1997). You want to measure coping but your protocol’s too long: Consider the brief COPE. International Journal of Behavioral Medicine, 4(1), 92–100. https://doi.org/10.1207/s15327558ijbm0401_6
13.
CheungC. T. Y.ChengC. M.-H.LamS. K. K.LingH. W. H.LauK. L.HungS. L.FungH. W. (2022). Reliability and validity of a novel measure of nonviolent communication behaviors. Research on Social Work Practice, 33(7), 790–797. https://doi.org/10.1177/10497315221128595
14.
CloitreM.CohenL. R.OrtigoK. M.JacksonC.KoenenK. C. (2020). Treating survivors of childhood abuse and interpersonal trauma: STAIR Narrative Therapy (2nd ed.). The Guilford Press.
15.
CohenJ. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). (2 ed.). Lawrence Erlbaum Associates.
16.
CooperC.KatonaC.LivingstonG. (2008). Validity and reliability of the brief COPE in carers of people with dementia: The LASER-AD study. The Journal of Nervous and Mental Disease, 196(11), 838–843. https://doi.org/10.1097/NMD.0b013e31818b504c
17.
DellP. F. (2009). The phenomena of pathological dissociation. In DellP. F.O'NeilJ. A. (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 228–233). Routledge.
FooteB.SmolinY.NeftD. I.LipschitzD. (2008). Dissociative disorders and suicidality in psychiatric outpatients. The Journal of Nervous and Mental Disease, 196(1), 29–36. https://doi.org/10.1097/NMD.0b013e31815fa4e7
20.
FungH. W.ČernisE.ShumM. H. Y. (2023). Self-stigma predicts post-traumatic and depressive symptoms in traumatized individuals seeking interventions for dissociative symptoms: A preliminary investigation. European Journal of Psychotraumatology, 14(2), 2251778. https://doi.org/10.1080/20008066.2023.2251778
21.
FungH. W.ChanC.ChienW. T.ChongY. Y.RossC. A. (2022a). The acceptability and potential benefits of a web-based psychoeducation program for people with pathological dissociation: A pilot evaluation study. Journal of Trauma & Dissociation, 24(1), 95–110. https://doi.org/10.1080/15299732.2022.2119457
22.
FungH. W.ChanC.RossC. A. (2020a). A web-based psychoeducation program for people with pathological dissociation: Development and pilot testing. Journal of Evidence-Based Social Work, 17(4), 427–442. https://doi.org/10.1080/26408066.2020.1760990
23.
FungH. W.ChauA. K. C.HungS. L.LamS. K. K.ChienW. T.LeeV. W. P. (2023). Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive emotions: A one-year follow-up study. European Journal of Psychotraumatology, 14(2), 2263314. https://doi.org/10.1080/20008066.2023.2263314
24.
FungH. W.ChauA. K. C.YuanG. F.LiuC.LamS. K. K. (2023). The nonviolent communication behaviors scale: Cross-cultural validity and association with trauma and post-traumatic stress. Research on Social Work Practice, 35(1), 88–96. https://doi.org/10.1177/10497315231221969
25.
FungH. W.ChienW. T.ChanC.RossC. A. (2023). A cross-cultural investigation of the association between betrayal trauma and dissociative features. Journal of Interpersonal Violence, 38(1–2), 1630. https://doi.org/10.1177/08862605221090568
26.
FungH. W.ChoiT. M.ChanC.RossC. A. (2018). Psychometric properties of the pathological dissociation measures among Chinese research participants – A study using online methods. Journal of Evidence-Informed Social Work, 15(4), 371–384. https://doi.org/10.1080/23761407.2018.1456995
27.
FungH. W.GengF.YuanD.ZhanN.LeeV. W. P. (2023). Childhood experiences and dissociation among high school students in China: Theoretical reexamination and clinical implications. International Journal of Social Psychiatry, 69(8), 1949–1957. https://doi.org/10.1177/00207640231181528
28.
FungH. W.HoG. W. K.LamS. K. K.RossC. A.WangE. K. S.HuangC. H. O.CheungC. T. Y.LingH. W.-H.ChauA. K. C.WongJ. Y.-H. (2025). An updated psychometric evaluation of the Brief Betrayal Trauma Survey. General Hospital Psychiatry, 94, 142–144. https://doi.org/10.1016/j.genhosppsych.2025.03.006
29.
FungH. W.HungS. L.LingH. W. H.LeeV. W. P.LamS. K. K. (2023). A preliminary longitudinal analysis of symptom management, post-traumatic stress, and depressive symptoms in Chinese adults with dissociative symptoms. Journal of Trauma & Dissociation, 25(1), 129–143. https://doi.org/10.1080/15299732.2023.2231908
30.
FungH. W.LaoI. W. (2017). Complex dissociative disorders: Cross-cultural trauma disorders (in Chinese: 複雜解離症：跨文化的創傷心理障礙). Clinical Medicine (in Chinese: 臨床醫學), 79(1), 39–48.
31.
FungH. W.LingH. W. H.RossC. A.TseJ. W.-L.LiuR. K. W. (2020). Dissociative, schneiderian and borderline personality symptoms in a non-clinical sample in Hong Kong: A preliminary report. European Journal of Trauma & Dissociation, 4(1), 100076. https://doi.org/10.1016/j.ejtd.2018.07.004
32.
FungH. W.RossC. A. (2019). Be a teammate with yourself: Understanding trauma and dissociation. Manitou Communications.
33.
FungH. W.RossC. A. (2024). Social work service needs of persons with complex dissociative disorders. European Journal of Trauma & Dissociation, 8(1), 100379. https://doi.org/10.1016/j.ejtd.2024.100379
34.
FungH. W.RossC. A.LamS. K. K.HungS. L. (2022). Recent research on the interventions for people with dissociation. European Journal of Trauma & Dissociation, 6(4), 100299. https://doi.org/10.1016/j.ejtd.2022.100299
35.
FungH. W.RossC. A.LingH. W. H. (2019). Complex dissociative disorders in social work: Discovering the knowledge gaps. Social Work in Mental Health, 17(6), 682–702. https://doi.org/10.1080/15332985.2019.1658689
36.
FungH. W.WongE. N. M.LamS. K. K.ChienW. T.HungS. L.RossC. A. (2022). The prevalence of dissociative symptoms and disorders: Findings from a sample of community health service users in Hong Kong. Asian Journal of Psychiatry, 80, 103351. https://doi.org/10.1016/j.ajp.2022.103351
37.
GoldbergL. R.FreydJ. J. (2006). Self-reports of potentially traumatic experiences in an adult community sample: Gender differences and test-retest stabilities of the items in a brief betrayal-trauma survey. Journal of Trauma & Dissociation, 7(3), 39–63. https://doi.org/10.1300/J229v07n03_04
38.
Gonzalez VazquezA. I.Seijo AmeneirosN.Díaz del ValleJ. C.Lopez FernandezE.Santed GermánM. A. (2017). Revisiting the concept of severe mental illness: Severity indicators and healthcare spending in psychotic, depressive and dissociative disorders. Journal of Mental Health, 29(6), 1–7. https://doi.org/10.1080/09638237.2017.1340615
39.
GrossJ. J.JohnO. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348
40.
HertzogM. A. (2008). Considerations in determining sample size for pilot studies. Research in Nursing & Health, 31(2), 180–191. https://doi.org/10.1002/nur.20247
41.
HylandP.HamerR.FoxR.VallièresF.KaratziasT.ShevlinM.CloitreM. (2023). Is dissociation a fundamental component of ICD-11 complex posttraumatic stress disorder?Journal of Trauma & Dissociation, 25(1), 1–17. https://doi.org/10.1080/15299732.2023.2231928
42.
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults. Third Revision. Journal of Trauma & Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247
43.
JepsenE. K.LangelandW.SextonH.HeirT. (2014). Inpatient treatment for early sexually abused adults: A naturalistic 12-month follow-up study. Psychological Trauma: Theory, Research, Practice, and Policy, 6(2), 142–151. https://doi.org/10.1037/a0031646
44.
KateM.-A.HopwoodT.JamiesonG. (2020). The prevalence of dissociative disorders and dissociative experiences in college populations: A meta-analysis of 98 studies. Journal of Trauma & Dissociation, 21(1), 16–61. https://doi.org/10.1080/15299732.2019.1647915
45.
KumpulaM. J.OrcuttH. K.BardeenJ. R.VarkovitzkyR. L. (2011). Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms. Journal of Abnormal Psychology, 120(3), 102–110. https://doi.org/10.1002/jts.21781
46.
LiC.-H.WuJ.-J. (2020). Psychometric evaluation of the Chinese version of the Emotion Regulation Questionnaire in Taiwanese college students. Assessment, 27(6), 1300–1309. https://doi.org/10.1177/1073191118773875
47.
LincolnT. M.SchulzeL.RennebergB. (2022). The role of emotion regulation in the characterization, development and treatment of psychopathology. Nature Reviews Psychology, 1(5), 272–286. https://doi.org/10.1038/s44159-022-00040-4
LoewensteinR. (2022). Conceptual foundations for long-term psychotherapy of dissociative identity disorder. In DorahyM. J.GoldS. N.O'NeilJ. A. (Eds.), Dissociation and the dissociative disorders: Past, present, future ((2 ed, pp. 770–789). Routledge.
50.
LoewensteinR.Lewis-FernándezR.FrewenP. (2024). Dissociative disorders. In BolandR.VerduinM. (Eds.), Kaplan and Sadock's comprehensive textbook of psychiatry ((11 ed, pp. 1927–2026.
51.
LyssenkoL.SchmahlC.BockhackerL.VonderlinR.BohusM.KleindienstN. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the Dissociative Experiences Scale. American Journal of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025
52.
Meyerowitz-KatzG.RaviS.ArnoldaL.FengX.MaberlyG.Astell-BurtT. (2020). Rates of attrition and dropout in app-based interventions for chronic disease: Systematic review and meta-analysis. Journal of Medical Internet Research, 22(9), e20283. https://doi.org/10.2196/20283
53.
MonzaniD.StecaP.GrecoA.D'AddarioM.CappellettiE.PancaniL. (2015). The situational version of the Brief COPE: Dimensionality and relationships with goal-related variables. Europe's Journal of Psychology, 11(2), 295–310. https://doi.org/10.5964/ejop.v11i2.935
54.
MouH.LamS. K. K.ChienW. T. (2022). Effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: A pilot study. BMC Nursing, 21(1), 1–17. https://doi.org/10.1186/s12912-022-01145-0
55.
MuseuxA.-C.DumontS.CareauE.MilotÉ (2016). Improving interprofessional collaboration: The effect of training in nonviolent communication. Social Work in Health Care, 55(6), 427–439. https://doi.org/10.1080/00981389.2016.1164270
56.
NesterM. S.HawkinsS. L.BrandB. L. (2022). Barriers to accessing and continuing mental health treatment among individuals with dissociative symptoms. European Journal of Psychotraumatology, 13(1), 2031594. https://doi.org/10.1080/20008198.2022.2031594
57.
PreeceD. A.BecerraR.RobinsonK.GrossJ. J. (2019). The Emotion Regulation Questionnaire: Psychometric properties in general community samples. Journal of Personality Assessment, 102(3), 348–356. https://doi.org/10.1080/00223891.2018.1564319
58.
RosenbergM. B.ChopraD. (2015). Nonviolent communication: A language of life: Life-changing tools for healthy relationships (3rd ed.). PuddleDancer Press.
59.
RossC. A.DuffyC. M.EllasonJ. W. (2002). Prevalence, reliability and validity of dissociative disorders in an inpatient setting. Journal of Trauma & Dissociation, 3(1), 7–17. https://doi.org/10.1300/J229v03n01_02
60.
RossC. A.EllasonJ. W. (2005). Discriminating among diagnostic categories using the dissociative disorders interview schedule. Psychological Reports, 96(2), 445–453. https://doi.org/10.2466/pr0.96.2.445-453
61.
RossC. A.HeberS.NortonG. R.AndersonD.AndersonG.BarchetP. (1989). The dissociative disorders interview schedule: A structured interview. Dissociation, 2(3), 169–189. https://doi.org/10.1037/e609942012-089
62.
ŞarV. (2011). Epidemiology of dissociative disorders: An overview. Epidemiology Research International, 2011(1), 404538. https://doi.org/10.1155/2011/404538
63.
ŞarV.MiddletonW.DorahyM. (2013). Individual and societal oppression: Global perspectives on dissociative disorders. Journal of Trauma & Dissociation, 14(2), 121–126. https://doi.org/10.1080/15299732.2013.761032
64.
ScholzU.DoñaB. G.SudS.SchwarzerR. (2002). Is general self-efficacy a universal construct? Psychometric findings from 25 countries. European Journal of Psychological Assessment, 18(3), 242. https://doi.org/10.1027/1015-5759.18.3.242
65.
TangW. P. Y.ChanC. W.ChoiK. (2021). Factor structure of the Brief Coping Orientation to Problems Experienced Inventory in Chinese (Brief-COPE-C) in caregivers of children with chronic illnesses. Journal of Pediatric Nursing, 59, 63–69. https://doi.org/10.1016/j.pedn.2021.01.002
66.
Van der HartO.NijenhuisE. R.SteeleK. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. W.W. Norton.
67.
WallerN. G.RossC. A. (1997). The prevalence and biometric structure of pathological dissociation in the general population: Taxometric and behavior genetic findings. Journal of Abnormal Psychology, 106(4), 499–510. https://doi.org/10.1037/0021-843X.106.4.499
68.
WuZ. Y.FungH. W.ChienW. T.RossC. A.LamS. K. K. (2022). Trauma and dissociation among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan. European Journal of Psychotraumatology, 13(2), 2105576. https://doi.org/10.1080/20008066.2022.2105576
69.
XiaoZ.YanH.WangZ.ZouZ.XuY.ChenJ.ZhangH.RossC. A.KeyesB. B. (2006). Trauma and dissociation in China. American Journal of Psychiatry, 163(8), 1388–1391. https://doi.org/10.1176/ajp.2006.163.8.1388
70.
ZhangJ. X.SchwarzerR. (1995). Measuring optimistic self-beliefs: A Chinese adaptation of the General Self-Efficacy Scale. Psychologia: An International Journal of Psychology in the Orient, 38(3), 174–181.
