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Trauma-Focused Treatment in PTSD Patients With Psychosis: Symptom Exacerbation, Adverse Events, and Revictimization
Open accessAbstract
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.
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“Although previous adversity-focused trials among people with chronic psychosis similarly observed few psychotic symptom exacerbations [20]”
From Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial (2024) · cites this paper as [20]
In the citing paper
“Preliminary evidence suggests that PE treatment reduces symptoms of psychosis and PTSD, and does not lead to symptom exacerbation [15, 20].”
From Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial (2024) · cites this paper as [20]
In the citing paper
“However, the evidence has thus far focused almost exclusively on people with chronic psychosis rather than early phase psychosis (EPP; i.e., first 5 years of a psychotic disorder), and SM outcomes have rarely been considered. [20].”
From Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial (2024) · cites this paper as [20]
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Metadata
- 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.
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-11-24
- Volume
- 42
- Issue
- 3
- Pages
- 693-702
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC4838096
- OpenAlex
- W2179855908
- Cited by
- 153
- References
- 47
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 10 · 2023: 10 · 2022: 15 · 2021: 20 · 2020: 17 · 2019: 32 · 2018: 12 · 2017: 13 · 2016: 7
- FWCI
- 13.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Schizophrenia Bulletin (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- VU Research Portal (publishedVersion)
- HighWire Press Open Archive (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 › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- trauma-focused psychotherapy, post-traumatic stress disorder
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Implosive Therapy, Male, Middle Aged, Psychotic Disorders, Stress Disorders, Post-Traumatic, Comorbidity, Single-Blind Method, Outcome Assessment, Health Care, Eye Movement Desensitization Reprocessing
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