Trauma-Focused Treatment in PTSD Patients With Psychosis: Symptom Exacerbation, Adverse Events, and Revictimization

David P G van den Berg; Paul A J M de Bont; Berber M van der Vleugel; Carlijn de Roos; Ad de Jongh; Agnes van Minnen; Mark van der Gaag

doi:10.1093/schbul/sbv172

Trauma-Focused Treatment in PTSD Patients With Psychosis: Symptom Exacerbation, Adverse Events, and Revictimization

Schizophr Bull. 2016 May;42(3):693-702. doi: 10.1093/schbul/sbv172. Epub 2015 Nov 24.

Authors

David P G van den Berg¹, Paul A J M de Bont², Berber M van der Vleugel³, Carlijn de Roos⁴, Ad de Jongh⁵, Agnes van Minnen⁶, Mark van der Gaag⁷

Affiliations

¹ Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, The Netherlands; d.vandenberg@parnassia.nl.
² Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, The Netherlands;
³ Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands;
⁴ MHO Rivierduinen, Leiden, The Netherlands;
⁵ Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, UK;
⁶ Behavioural Science Institute, NijCare, Radboud University Nijmegen, Nijmegen, The Netherlands; MHO Pro Persona, Centre for Anxiety Disorders Overwaal, Nijmegen, The Netherlands;
⁷ Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, The Netherlands; Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.

Abstract

Objectives: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD).

Methods: Analyses were conducted on data from a single-blind randomized controlled trial comparing TF treatment (N = 108; 8 sessions prolonged exposure or eye movement desensitization) and waiting list (WL; N = 47) among patients with a lifetime psychotic disorder and current chronic PTSD. Symptom exacerbation, adverse events, and revictimization were assessed posttreatment and at 6-month follow-up. Also investigated were symptom exacerbation after initiation of TF treatment and the relationship between symptom exacerbation and dropout.

Results: Any symptom exacerbation (PTSD, paranoia, or depression) tended to occur more frequently in the WL condition. After the first TF treatment session, PTSD symptom exacerbation was uncommon. There was no increase of hallucinations, dissociation, or suicidality during the first 2 sessions. Paranoia decreased significantly during this period. Dropout was not associated with symptom exacerbation. Compared with the WL condition, fewer persons in the TF treatment condition reported an adverse event (OR = 0.48, P = .032). Surprisingly, participants receiving TF treatment were significantly less likely to be revictimized (OR = 0.40, P = .035).

Conclusions: In these participants, TF treatment did not result in symptom exacerbation or adverse events. Moreover, TF treatment was associated with significantly less exacerbation, less adverse events, and reduced revictimization compared with the WL condition. This suggests that conventional TF treatment protocols can be safely used in patients with psychosis without negative side effects.

Keywords: adversities; safety; schizophrenia; trauma.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Comorbidity
Eye Movement Desensitization Reprocessing / methods*
Female
Follow-Up Studies
Humans
Implosive Therapy / methods*
Male
Middle Aged
Outcome Assessment, Health Care*
Psychotic Disorders / epidemiology
Psychotic Disorders / physiopathology*
Single-Blind Method
Stress Disorders, Post-Traumatic / epidemiology
Stress Disorders, Post-Traumatic / therapy*