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


David van den Berg

Saturday 18 june 2016

11:00 - 11:15h at Kilimanjaro

Categories: Psychotic disorders, Research

Parallel session: Researchtrack - EMDR & psychosis: above and beyond - latest research and developments


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

David van den Berg1, Paul de Bont2, Berber van der Vleugel3, Carlijn de Roos4, Ad de Jongh5,6, Agnes van Minnen7,8, Mark van der Gaag1,9

 

1 Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, The Netherlands.

2 Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg,

3 Bilderbeekstraat 44, 5831 CX Boxmeer, The Netherlands. 3 Community Mental Health Service GGZ Noord-Holland Noord, Oude Hoeverweg 10, 1816 BT Alkmaar, The Netherlands.

4 MHO Rivierduinen, Sandifortdreef 19, 2333 ZZ, Leiden, The Netherlands. Dept of Behavioral Sciences. Academic Centre for Dentistry Amsterdam (ACTA)

5 University of Amsterdam and VU University Amsterdam. Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.

6 School of Health Sciences, Salford University, Manchester, United Kingdom

7 Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands. P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.

8 MHO Pro Persona, Centre for Anxiety Disorders Overwaal, Nijmegen, The Netherlands.

9 VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.

 

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.

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  • Location(s)
  • plattegrond Kilimanjaro