Keen Nadine, Hunter Elaine C M, Peters Emmanuelle
South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, United Kingdom.
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
Front Psychiatry. 2017 Jun 1;8:92. doi: 10.3389/fpsyt.2017.00092. eCollection 2017.
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 of 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% ( = 7) of whom 86% ( = 6) 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.
尽管有精神病性症状的个体遭受创伤的比例很高，但创伤后应激症状在临床实践中却常常被忽视。此外，由于担心对创伤进行再处理的治疗程序会加重精神病性症状，所以人们也不愿意治疗创伤后症状。最近的证据表明，在这一人群中使用再处理策略是安全的。然而，大多数已发表的研究都是基于将创伤后症状与精神病性症状分开治疗。本病例系列的目的是评估将创伤后应激和精神病性症状的认知行为方法整合到一个单一方案中的可接受性、可行性和初步有效性。从一家专门的精神病心理治疗服务机构招募了9名报告有痛苦的精神病性和创伤后症状的参与者。由一名独立评估者在五个时间点（基线、治疗前、治疗中期、治疗结束时以及随访6个月以上）对客户进行评估，评估内容包括精神病性症状、创伤后应激、情绪问题和幸福感的当前症状。治疗基于症状表现和创伤类型进行制定并个体化。它包括五个广泛、灵活的阶段，并包括想象再处理策略（重温及/或重新编写）。该干预措施受到好评，治疗后的反馈和满意度评分均为积极。对于这一人群来说不同寻常的是，没有人退出治疗。治疗后，除一人外（88%的参与者），与治疗前相比，至少在一项结果指标上实现了可靠的改善：创伤后症状（63%）、幻听（2%）、妄想（50%）、抑郁（50%）、焦虑（36%）和幸福感（40%）。78%（n = 7）的参与者完成了随访评估，其中86%（n = 6）至少保持了一项可靠的改善。治疗后的改善率（治疗后各项指标的平均改善率为44%；随访时为32%）是等待期（19%）的两倍多。没有参与者表示在治疗期间或治疗后任何症状有可靠的恶化。该研究表明，对于这个小样本来说，一种包含再处理策略的综合疗法是一种可接受且可行的干预措施，效果很有前景。有必要进行一项随机对照试验来检验该干预措施对这一人群的疗效。
