First Trial of PTSD Treatment in Psychosis

MedicalResearch.com Interview with:
David P.G. van den Berg PhD studen
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Clinical Psychologist Cognitive behavioural therapist
Parnassia Psychiatric Institute
Early Detection and Intervention Team (EDIT)
Zoutkeetsingel, The Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: The last decade it has become clear that many people with psychotic disorders suffered severe childhood trauma. These experiences enhance chances of developing psychosis, but also result in comorbid posttraumatic stress disorder (PTSD). PTSD is highly prevalent in patients with psychotic disorders and negatively influences prognosis and wellbeing. Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective treatments and recommended as first choice treatments in PTSD guidelines worldwide. Although there is no evidence to support this, patients with psychosis are excluded from PTSD treatment due to fear of destabilization or psychotic decompensation. Moreover, psychosis is the most used exclusion criterion in PTSD trials. This is the first randomized clinical trial (RCT) of the efficacy of PTSD treatment in psychosis.

In this RCT 155 patients with a psychotic disorder and comorbid PTSD were randomly assigned to PE, EMDR or Waiting List (WL). In the treatment conditions participants received 8 sessions of 90-minutes therapy. Standard protocols were used. Treatment was not preceded by stabilizing psychotherapeutic interventions or skills training. The first session comprised psycho-education about PTSD and target selection. In sessions 2 to 8 traumas were treated, starting with the most distressing experience. Baseline, post-treatment and 6-month follow-up assessments were made. Participants in both PE and EMDR showed greater reduction of PTSD symptoms than those in WL. Between group effect sizes were large. About sixty percent of the participants in the treatment groups achieved loss of diagnosis. Treatment effects were maintained at six-month follow-up for both PE and EMDR. Treatments did not result in serious adversities.

Medical Research: What should clinicians and patients take away from your report?

Response: Trauma is an important factor in psychosis. Both trauma history and PTSD symptoms should be assessed in patients with psychotic disorders. In case of a comorbid PTSD, standard evidence based protocols can be used effectively and safely. Both treatment effects and dropout rates are similar to those in PTSD samples without psychosis. At least one in eight patients with psychotic disorder has posttraumatic stress disorder. There is no need to exclude these people from effective trauma treatments.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Another research group should replicate these finding. We especially advocate the use of ‘evidence based’ treatments in this patient group. Future trials may want to extend the number of sessions, since for many participants eight sessions were too little (most participants suffered severe and multiple childhood trauma). Lastly, future studies may want to include a supportive condition to differentiate between the specific therapeutic effects of the target treatments and factors such as hope and attention.

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