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Cited by 343Posttraumatic Stress Disorder ResearchPsychotherapy Techniques and ApplicationsPsychoanalysis and Psychopathology Research

Prolonged Exposure vs Eye Movement Desensitization and Reprocessing vs Waiting List for Posttraumatic Stress Disorder in Patients With a Psychotic Disorder: A Randomized Clinical Trial

van den Berg, David P. G., de Bont, Paul A. J. M., van der Vleugel, Berber M., de Roos, Carlijn, de Jongh, Ad, Van Minnen, Agnes, van der Gaag, Mark·2015·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2014.2637
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Abstract

IMPORTANCE: The efficacy of posttraumatic stress disorder (PTSD) treatments in psychosis has not been examined in a randomized clinical trial to our knowledge. Psychosis is an exclusion criterion in most PTSD trials. OBJECTIVE: To examine the efficacy and safety of prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) therapy in patients with psychotic disorders and comorbid PTSD. DESIGN, SETTING, AND PARTICIPANTS: A single-blind randomized clinical trial with 3 arms (N = 155), including PE therapy, EMDR therapy, and waiting list (WL) of 13 outpatient mental health services among patients with a lifetime psychotic disorder and current chronic PTSD. Baseline, posttreatment, and 6-month follow-up assessments were made. INTERVENTIONS: Participants were randomized to receive 8 weekly 90-minute sessions of PE (n = 53), EMDR (n = 55), or WL (n = 47). Standard protocols were used, and treatment was not preceded by stabilizing psychotherapeutic interventions. MAIN OUTCOMES AND MEASURES: Clinician-rated severity of PTSD symptoms, PTSD diagnosis, and full remission (on the Clinician-Administered PTSD Scale) were primary outcomes. Self-reported PTSD symptoms and posttraumatic cognitions were secondary outcomes. RESULTS: Data were analyzed as intent to treat with linear mixed models and generalized estimating equations. Participants in the PE and EMDR conditions showed a greater reduction of PTSD symptoms than those in the WL condition. Between-group effect sizes were 0.78 (P < .001) in PE and 0.65 (P = .001) in EMDR. Participants in the PE condition (56.6%; odds ratio [OR], 3.41; P = .006) or the EMDR condition (60.0%; OR, 3.92; P < .001) were significantly more likely to achieve loss of diagnosis during treatment than those in the WL condition (27.7%). Participants in the PE condition (28.3%; OR, 5.79; P = .01), but not those in the EMDR condition (16.4%; OR, 2.87; P = .10), were more likely to gain full remission than those in the WL condition (6.4%). Treatment effects were maintained at the 6-month follow-up in PE and EMDR. Similar results were obtained regarding secondary outcomes. There were no differences in severe adverse events between conditions (2 in PE, 1 in EMDR, and 4 in WL). The PE therapy and EMDR therapy showed no difference in any of the outcomes and no difference in participant dropout (24.5% in PE and 20.0% in EMDR, P = .57). CONCLUSIONS AND RELEVANCE: Standard PE and EMDR protocols are effective, safe, and feasible in patients with PTSD and severe psychotic disorders, including current symptoms. A priori exclusion of individuals with psychosis from evidence-based PTSD treatments may not be justifiable. TRIAL REGISTRATION: isrctn.com Identifier: ISRCTN79584912.

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Authors
van den Berg, D. P. G., de Bont, P. A. J. M., van der Vleugel, B. M., de Roos, C., de Jongh, A., Van Minnen, A., & van der Gaag, M.
Affiliations
  • Parnassia Psychiatric Institute, Den Haag, the Netherlands
  • Mental Health Organization Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, the Netherlands
  • Mental Health Organization Noord-Holland Noord, Alkmaar, the Netherlands
  • Mental Health Organization Rivierduinen, Leiden, the Netherlands
  • Department of Behavioral Sciences, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands6School of Health Sciences, Salford University, Manchester, England
  • Radboud University Nijmegen, Behavioral Science Institute, NijCare, the Netherlands, Nijmegen8Mental Health Organization “Pro Persona,” Center for Anxiety Disorders Overwaal, Nijmegen, the Netherlands
  • Parnassia Psychiatric Institute, Den Haag, the Netherlands9Department of Clinical Psychology, VU University Amsterdam and EMGO+ Institute for Health and Care Research, Amsterdam, the Netherlands
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2015-03-01
Volume
72
Issue
3
Pages
259
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2014.2637
OpenAlex
W2120574168
Cited by
341
References
50
Citations by year
2026: 18 · 2025: 20 · 2024: 24 · 2023: 28 · 2022: 31 · 2021: 34 · 2020: 26 · 2019: 38 · 2018: 29 · 2017: 42 · 2016: 35 · 2015: 14
FWCI
49.60
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (publishedVersion)
  • VU Research Portal (publishedVersion)
  • UvA-DARE (University of Amsterdam) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords
post-traumatic stress disorder, psychosis, prolonged exposure therapy, EMDR, PTSD comorbidity, PTSD symptom severity, PTSD remission, treatment efficacy, treatment safety, posttraumatic cognitions, outpatient mental health services, waitlist control, treatment discontinuation, treatment acceptability
MeSH terms
Adult, Desensitization, Psychologic, Eye Movements, Female, Humans, Implosive Therapy, Male, Psychotic Disorders, Severity of Illness Index, Stress Disorders, Post-Traumatic, Waiting Lists, Comorbidity, Single-Blind Method, Treatment Outcome, Young Adult

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