Safety and predictors of outcome in trauma-focused treatment in psychosis

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 treatment in patients with psychosis and post traumatic stress disorder (PTSD). Methods: Analyses were conducted on data from a single-blind randomized controlled trial comparing Trauma-Focused treatment (N=108; 8 sessions Prolonged Exposure or Eye Movement Desensitization) and Waiting List (N=47) among patients with a lifetime psychotic disorder and current chronic PTSD. Symptom exacerbation, adverse events and revictimization were assessed post-treatment and at 6-month follow-up. Also investigated were symptom exacerbation after initiation of trauma-focused treatment, and the relationship between symptom exacerbation and dropout. Moreover, potential predictors that are characteristic of this population were tested. Results: Any symptom exacerbation (PTSD, paranoia, or depression) tended to occur more frequently in the Waiting List condition. After the first trauma-focused treatment session PTSD symptom exacerbation was uncommon. There was no increase of hallucinations, dissociation, or suicidality during the first two sessions. Paranoia decreased significantly during this period. Dropout was not associated with symptom exacerbation. Compared to the Waiting List condition, fewer persons in the Trauma-Focused treatment condition reported an adverse event (OR=0.48, p=0.032). Surprisingly, participants receiving Trauma-Focused treatment were significantly less likely to be revictimized (OR=0.40, p=0.035). The psychosis-specific baseline factors did not appear to influence outcome. Conclusions: In these participants, trauma-focused treatment did not result in symptom exacerbation or adverse events. Moreover, trauma-focused treatment was associated with significantly less exacerbation, fewer adverse events, and reduced revictimization compared to the Waiting List condition. This suggests that conventional trauma-focused treatment protocols can be safely used in patients with psychosis without negative side-effects.

English

David van den Berg

van den Berg, D. (2016, June). Safety and predictors of outcome in trauma-focused treatment in psychosis. In Researchtrack - EMDR & psychosis: above and beyond - latest research and developments (Antonio Onofri and Tineke van der Linden, Chairs). Presentation at the at the 17th EMDR Europe Association Conference, The Hague