Integrated Trauma-Focused Cognitive-Behavioural Therapy for Post-traumatic Stress and Psychotic Symptoms: A Case-Series Study Using Imaginal Reprocessing Strategies
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Despite high rates of trauma in individuals with psychotic symptoms, post-traumatic stress symptoms are frequently overlooked in clinical practice. There is also reluctance to treat post-traumatic symptoms, in case the therapeutic procedure of reprocessing the trauma exacerbates psychotic symptoms. Recent evidence demonstrates that it is safe to use reprocessing strategies in this population. However, most published studies have been based on treating post-traumatic symptoms in isolation from psychotic symptoms. The aims of the current case series were to assess the acceptability, feasibility and preliminary effectiveness of integrating cognitive-behavioural approaches for post-traumatic stress and psychotic symptoms into a single protocol. Nine participants reporting distressing psychotic and post-traumatic symptoms were recruited from a specialist psychological therapies service for psychosis. Clients were assessed at five time points (baseline, pre-, mid, end of therapy and at 6+ months follow-up) by an independent assessor on measures of current symptoms of psychosis, post-traumatic stress, emotional problems and well-being. Therapy was formulation-based and individualised, depending on presenting symptoms and trauma type. It consisted of five broad, flexible phases, and included imaginal reprocessing strategies (reliving and/or rescripting). The intervention was well received, with positive post-therapy feedback and satisfaction ratings. Unusually for this population, no-one dropped out of therapy. Post-therapy, all but one (88% of participants) achieved a reliable improvement compared to pre-therapy on at least one outcome measure: post-traumatic symptoms (63%), voices (25%), delusions (50%), depression (50%), anxiety (36%) and well-being (40%). Follow-up assessments were completed by 78% (n=7), 86% (n=6) of whom maintained at least one reliable improvement. Rates of improvements following therapy (average of 44% across measures post-therapy; 32% at follow-up) were over twice those found during the waiting list period (19%). No participant indicated a reliable worsening of any symptoms during or after therapy. The study shows that an integrative therapy incorporating reprocessing strategies was an acceptable and feasible intervention for this small sample, with promising effectiveness. A randomised controlled trial is warranted to test the efficacy of the intervention for this population.
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Keen et al. reported that 63% of participants with psychotic symptoms achieved clinically significant change to adversity sequelae during a longer protocol.
“Keen and colleagues [42] reported that 63% of their participants with psychotic symptoms achieved CSC to AE sequelae during their longer protocol (median number of sessions = 41)”
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 [42]
The Results (Changes during Therapy; page unavailable) report that 63% (5 of 8) of participants completing post-therapy assessments showed reliable improvement in post-traumatic symptoms. The Results (Therapy and Assessment Attrition; page unavailable) give a median of 41 sessions. The paper measures statistically reliable change, not clinically significant change, and the 63% figure concerns post-traumatic symptoms specifically rather than adversity sequelae generally. (LLM, conf=0.88)
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“Keen and colleagues [42] reported that 63% of their participants with psychotic symptoms achieved CSC to AE sequelae during their longer protocol (median number of sessions = 41), while van den Berg and colleagues [15] found that more than 56% of their participants with chronic psychosis no longer…”
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Correctional social work with Canada's Indigenous people.
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Self-citation
- Authors
- Keen, N., Hunter, E. C. M., & Peters, E.
- Affiliations
- King's College London (GB)
- Corresponding author
- Keen, Nadine
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2017-06-01
- Volume
- 8
- Pages
- 92-92
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC5451497
- OpenAlex
- W2617228160
- Cited by
- 53
- References
- 85
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 7 · 2023: 6 · 2022: 8 · 2021: 1 · 2020: 11 · 2019: 6 · 2018: 1
- FWCI
- 6.09
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- King's College London
- Menzies Centre for Australian Studies, King's College London, University of London
- 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 cognitive behavioral therapy, post-traumatic stress, psychotic symptoms, reliving, rescripting, psychosis, treatment acceptability, treatment feasibility, treatment effectiveness, voice, delusions, depression, anxiety, well-being
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