Efficacy and safety of prolonged exposure or EMDR-treatment for PTSD with patients with a vulnerability for psychosis. A multiple baserate N=10 single case design

Objectives: Untill now, only a small number of studies have investigated the safety and effects of psychological treatment for PTSD in psychotic patients. The main aim of this study was to explore the effects of two psychological, highly manualized, guideline PTSD treatments: EMDR and prolonged exposure. Another important aim was to determine if negative side effects would occur as a result of therapy. Among clinicians fear exists of harming vulnerable patients with confronting therapeutic procedures, thus risking psychotic exacerbation, suicidal behaviour or other adverse events. Methods: In a N=10 single case study design the effects of psychological PTSD treatment were studied in psychiatric patients who suffer from psychoses. Participants were randomly assigned to either EMDR or Prolonged Exposure. Weekly measurements of PTSD and psychotic symptoms prior to, during and after treatment, gave a strong impression of how symptoms respond to treatment. The treatment in both conditions consisted of 12 sessions of 90 minutes. Adverse events were monitored weekly. Before, directly after and 3 months after treatment all subjects were tested more extensively for the variables PTSD and psychosis, and for three secondary outcome measures cognitive style, social functioning and quality of life. Results: The results show that PTSD-treatment can be quite effective for both PTSD and even some of the psychotic symptoms. PTSD symptoms dropped considerably, in a number of cases below the point of still having a PTSD. In some cases treatment helped diminish the occurence of harming voices. Not one patient became psychotic as a result of therapy, not even patients that went through the guided reliving of traumatic psychotic events during Prolonged Exposure. No suicide attempts occured. Occasional minor adverse events with medication occurred, but results taken as a whole the treatments were obviously safe. Conclusion: This study shows that PTSD-treatment in psychotic patients is a serious option, next to medical treatment. It can be done safely, effectively and in a manualized fashion. No information can be derived from this study as to which of the two, Prolonged Exposure or EMDR, can be best applied in specific situations. Both seem to be equal in the limited number of cases.

Conference

English

Paul de Bont

de Bont, P. (2011, August-September). Efficacy and safety of prolonged exposure or EMDR-treatment for PTSD with patients with a vulnerability for psychosis. A multiple baserate N=10 single case design. In Treating PTSD in patients with psychotic disorders. Symposium conducted at the 41st EABCT annual congress, Reykjavk, Iceland