For individuals with severe psychotic disorders and post-traumatic stress disorder (PTSD), trauma-focused treatments, such as prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy, create long-term improvements in PTSD symptoms, psychosis, and depression, according to a recent study published in The British Journal of Psychiatry.
This single-blind, randomized, controlled trial sought to investigate the long-term outcomes of trauma-focused treatments on symptoms of PTSD, psychosis, and depression at 6 and 12 months post-treatment. All 155 participants in the study met the criteria for both PTSD and a lifetime psychotic disorder (29% schizoaffective disorder and 61.3% schizophrenia). All participants received treatment as usual for psychotic disorders — half were given trauma-focused treatments (8 sessions of EMDR therapy or prolonged exposure) and the other half were put on a waiting list, and then received trauma-focused treatment after the 6-month follow-up.
The study found that the positive effects of EMDR therapy and prolonged exposure remain at 6- and 12-month follow-ups, with no differences in PTSD (clinician-rated and self-rated), depression, voice hearing, delusion, paranoid-referential thinking, or remissions from schizophrenia found between the 6- and 12-month follow-up points. A significant decrease in social functioning was found between 6 months and 12 months, however. As social functioning tends to improve alongside improvements in PTSD symptoms, a more fine-tuned examination of other factors that can influence social functioning and the effect of trauma-focused treatments on social functioning is needed.
Study investigators conclude that the study findings show “there seems to be no reason to exclude individuals with psychosis from [trauma-focused treatments]. Although replication of these findings and more research on the long-term effects on social functioning is required, these findings provide further support for the notion that the current guidelines for PTSD also apply to individuals with psychosis.”
This study was funded by the Dutch Support Foundation.
van den Berg D, de Bont PAJM, van der Vleugel BM, et al. Long-term outcomes of trauma-focused treatment in psychosis. Br J Psychiatry. 2018; 212(3):180-182.