Finding Solid Ground: An Online Program for Dissociative Disorders Produces d = 1.32 in the First RCT of Its Kind
- Finding Solid Ground (FSG) — adjunctive online psychoeducational program — significantly improved emotion regulation, PTSD symptoms, self-compassion, and adaptive functioning in 291 outpatients with trauma-related dissociation (TRD), including DID, dissociative PTSD, and complex PTSD
- Large effect sizes at 12 months: |g| = 0.95–1.32 for emotion regulation, PTSD symptoms, self-compassion, and adaptive capacities — among the largest effects reported for this severely impaired population
- The trial did NOT exclude for suicidality, NSSI, hospitalization, or substance abuse — this is the real-world dissociative population, not a cherry-picked sample
- The Waitlist group showed comparable improvements after accessing FSG for 6 months — replicating the effect in the same trial
Dissociative disorders — DID, dissociative PTSD, complex PTSD with dissociative features — are among the most treatment-resistant presentations in psychotherapy. Patients are complex, suicidal, frequently hospitalized, and underserved by a field that has been slow to produce RCT evidence for their treatment. This trial from Brand, Loewenstein, Lanius, and colleagues is the first RCT for a dissociative population this severe, and the effects are not merely statistically significant — they are clinically transformative.
What Finding Solid Ground is
FSG is not a replacement for individual therapy. It is an adjunctive, online, psychoeducational program based on the phase-oriented treatment model for dissociative disorders. Participants continued their regular outpatient psychotherapy throughout the trial. FSG provided structured content on emotion regulation, grounding, understanding dissociative symptoms, self-compassion, and building adaptive functioning — the skills that phase-one treatment aims to develop.
The online delivery is significant: dissociative patients frequently cannot attend regular appointments consistently due to crisis episodes, switching, amnesia, and the practical disruption that severe dissociation causes. An on-demand online program meets them where they are.
The inclusive sample
The trial's most important methodological decision: they did not exclude participants for active suicidality, NSSI, recent hospitalization, or substance abuse. Most psychotherapy RCTs exclude exactly these patients, producing clean results that do not apply to the actual clinical population. By including the most severe cases, this trial demonstrates that FSG helps the people who need it most — not just the subset who are stable enough to participate in a tightly controlled study.
The effect sizes
|g| = 0.95–1.32 at 12 months is exceptional for this population. For context: most PTSD treatments produce effects of d = 0.6–1.0. These patients are more impaired than standard PTSD samples, yet the effects are larger. The most plausible explanation: the dissociative population is so underserved that even structured psychoeducation — applied systematically — addresses unmet needs that produce outsized improvement.
For your practice
If you treat dissociative patients: FSG is an evidence-based adjunct you can add now. It does not replace your individual therapy — it scaffolds it. The program addresses the skills gap that slows phase-one work: emotion regulation, grounding, self-compassion. For patients who are not yet in specialist therapy: FSG provides structured stabilization that may prepare them for deeper work. For treatment planners: this RCT makes the case that online psychoeducation for dissociative disorders is both effective and scalable.
The most severe dissociative patients — suicidal, self-harming, frequently hospitalized — improved with d = 1.32. This is what happens when you stop excluding the people who need treatment most.
Non-blinded design (waitlist control). The international sample means variable quality of concurrent therapy. Online self-paced format limits standardization. The sample predominantly includes women — generalizability to men with TRD is limited.