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JAMA Psychiatry. 2015 Mar;72(3):259-67. doi: 10.1001/jamapsychiatry.2014.2637.

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.

Author information

1
Parnassia Psychiatric Institute, Den Haag, the Netherlands.
2
Mental Health Organization Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, the Netherlands.
3
Mental Health Organization Noord-Holland Noord, Alkmaar, the Netherlands.
4
Mental Health Organization Rivierduinen, Leiden, the Netherlands.
5
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.
6
Radboud University Nijmegen, Behavioral Science Institute, NijCare, the Netherlands, Nijmegen8Mental Health Organization "Pro Persona," Center for Anxiety Disorders Overwaal, Nijmegen, the Netherlands.
7
Parnassia Psychiatric Institute, Den Haag, the Netherlands9Department of Clinical Psychology, VU University Amsterdam and EMGO+ Institute for Health and Care Research, Amsterdam, the Netherlands.

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.

[Indexed for MEDLINE]

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