Effect of Multiple Behavioural Therapy on Dissociative Symptoms Among Patients with Dissociative Disorder: A Preliminary Study

Dissociative disorders are characterized by disruptions in the normal integration of consciousness, memory, identity, emotion, and perception. Dissociation is often conceptualized as a maladaptive psychological response to overwhelming stress, functioning as an avoidance based coping mechanism that temporarily reduces emotional distress. However, when dissociative responses become repetitive and automatic, they interfere with emotional regulation, behavioural control, and overall psychological functioning. From a behavioural perspective, dissociation can be understood as a learned response that is reinforced over time through relief from distress. Repeated pairing of emotional stressors with dissociative reactions strengthens maladaptive behavioural patterns, making dissociation a conditioned response. Therefore, effective treatment requires not only insight but also systematic disruption of these maladaptive behavioural patterns through behavioural conditioning and relearning. Multiple behavioural Therapy (MBT) is grounded in behavioural learning principles and focuses on modifying maladaptive behavioural responses through conditioning, reinforcement, and controlled therapeutic suggestion. Rather than relying primarily on cognitive rehearsal, MBT emphasizes experiential learning, behavioural conditioning, and the strategic use of expectancy and placebo-related mechanisms to facilitate symptom reduction. Placebo effects, understood as psychobiological responses mediated by expectancy, therapeutic context, and suggestion, play a significant role in symptom modulation and emotional regulation. Individuals with dissociative disorders are often highly suggestible due to heightened dissociative capacity, emotional vulnerability, and altered states of consciousness. In such patients, therapeutic suggestion and expectancy can be effectively utilized to reduce symptom severity and interrupt maladaptive dissociative responses. MBT capitalizes on this suggestibility by employing structured therapeutic procedures that promote relaxation, behavioural inhibition of dissociation, and reconditioning of adaptive responses. By repeatedly pairing relaxation, grounding, and controlled behavioural responses with previously triggering situations, MBT aims to extinguish maladaptive dissociative patterns and replace them with more adaptive coping behaviours. Conditioning-based techniques help weaken the learned association between stress and dissociation, while supportive therapeutic suggestion enhances patient engagement and treatment responsiveness. Thus, MBT provides a comprehensive behavioural framework for addressing dissociative symptoms, particularly in patients who demonstrate high suggestibility and responsiveness to conditioning-based interventions. The present study seeks to examine the effectiveness of Multiple behavioural Therapy in reducing dissociative symptoms among women diagnosed with Dissociative Disorder.

METHODOLOGY

Objectives

1. To assess the severity of dissociative symptoms before and after Multiple behavioural Therapy (MBT) intervention.
2. To examine the effectiveness of Multiple behavioural Therapy in reducing dissociative symptoms among women with dissociative disorder.
3. To evaluate changes in emotional regulation following Multiple behavioural Therapy intervention.
4. To examine the role of conditioning-based behavioural techniques in reducing maladaptive dissociative responses.
5. To assess the effectiveness of Multiple behavioural Therapy among highly suggestible patients with dissociative disorder.

Hypotheses of the Study

1. Dissociative symptoms will significantly reduce following Multiple behavioural Therapy intervention.
2. Multiple behavioural Therapy will have a positive effect on emotional regulation in women with dissociative disorder.
3. Conditioning-based behavioural techniques used in MBT will significantly reduce maladaptive dissociative behavioural patterns.
4. Highly suggestible patients will show greater reduction in dissociative symptoms following MBT intervention.
5. Multiple behavioural Therapy will lead to overall improvement in adaptive coping and behavioural control among women with dissociative disorder

RESEARCH DESIGN

A single-group pre–post experimental research design was used to assess changes in dissociative symptoms following Multiple behavioural Therapy.

Sample

The sample consisted of 10 women aged 20–45 years, diagnosed with Dissociative Disorder based on ICD-11 criteria. Participants were selected using purposive sampling from clinical settings.

Inclusion Criteria

• Females aged 20–45 years
• Diagnosed with Dissociative Disorder for a minimum duration of 3 years.
• Willingness to participate with informed consent

Exclusion Criteria

• Substance dependence
• Women with chronic illnesses or neurological conditions
• Pregnant or postpartum women

Procedure

After obtaining informed consent, baseline assessment was conducted using the Dissociative Experiences Scale-II (DES-II). Participants then underwent a six-month Multiple behavioural Therapy program. Post-assessment was conducted immediately after completion of the intervention. Ethical guidelines were strictly followed.

TOOLS USED

Dissociative Experiences Scale-II (DES-II)

The DES-II is a 28-item self-report scale assessing the frequency of dissociative experiences. Higher scores indicate greater severity of dissociation.

Multiple Behavioural Therapy (MBT) Multiple behavioural Therapy apparatus Model MBT-498

Description of Tools

1. Dissociative Experiences Scale – II (DES-II)

The Dissociative Experiences Scale–II (DES-II), developed by Bernstein and Putnam (1986), is a widely used self-report instrument designed to assess the frequency and severity of dissociative experiences in clinical and non-clinical populations. The scale consists of 28 items measuring a range of dissociative phenomena, including dissociative amnesia, depersonalization, derealization, absorption, and identity disturbance. Each item is rated on a continuum from 0% to 100%, indicating the percentage of time the respondent experiences a particular symptom. The total score is calculated by averaging responses across all items, with higher scores reflecting greater dissociative severity. Scores above 30 are generally considered indicative of clinically significant dissociation. The DES-II has demonstrated strong psychometric properties, including high internal consistency, test–retest reliability, and construct validity. Due to its sensitivity in detecting dissociative symptom severity and treatment-related change, the DES-II was used in the present study to assess dissociative symptoms before and after the Multiple behavioural Therapy intervention.

2. Multiple behavioural Therapy (MBT)

The Multiple behavioural Therapy apparatus (Model MBT-498) is a multi-unit therapeutic device designed to support behavioural and psychological interventions as part of a structured Multiple behavioural Therapy (MBT) program. The apparatus integrates multiple therapeutic components within a single system, including electrosleep stimulation, brain polarization, aversion-based behavioural intervention, and supportive sex therapy components. Although the apparatus operates on a single alternating current (AC) power input, it provides multiple independently regulated output channels, each clearly designated for a specific therapeutic function.

The electrosleep unit delivers low-intensity, modulated electrical stimulation through forehead electrodes to facilitate relaxation and reduce psychomotor arousal. Patients typically experience a mild tapping sensation, which is generally well tolerated. This component is used to promote relaxation and emotional stabilization within the therapeutic setting.

The brain polarization unit involves the application of low-intensity electrical stimulation through strategically positioned electrodes to support behavioural activation and mood regulation. This component is used as an adjunctive measure to enhance therapeutic engagement.

The aversion-based behavioural unit is grounded in behavioural conditioning principles and is used selectively to reduce maladaptive habits by pairing controlled, non-injurious sensory stimulation with maladaptive behavioural cues. All applications are conducted ethically, within safe limits, and under professional supervision.

In addition, the apparatus includes supportive components related to sex therapy, aimed at addressing behavioural and psychological aspects of sexual functioning as part of a broader therapeutic framework.

Statistical Analysis:

Data were analyzed using SPSS. Mean scores and standard deviations were calculated, and paired-sample t-test was applied to assess pre–post differences in dissociative symptoms

RESULTS:

Paired-sample t-test analysis revealed a statistically significant reduction in dissociative symptoms following Multiple behavioural Therapy.

Table: Pre- and Post-Intervention DES-II Scores (N = 10)