Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
Department of Psychosis research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands.
J Trauma Stress. 2023 Apr;36(2):299-309. doi: 10.1002/jts.22907. Epub 2023 Jan 31.
Concern for symptom exacerbation and treatment drop-out is an important barrier to the implementation of trauma-focused therapy (TFT), especially in people with a psychotic disorder. This study, which was part of a multicenter randomized controlled trial, investigated posttraumatic stress disorder (PTSD) symptom exacerbation during eye movement desensitization reprocessing (EMDR) therapy and prolonged exposure (PE) in a sample of 99 participants with PTSD and psychosis. Symptom exacerbations during the first four sessions (early exacerbation) and between-session exacerbations over the course of therapy were monitored using the PTSD Symptom Scale-Self Report. Analyses of covariance and chi-square tests were conducted to investigate exacerbation rates and their associations with treatment response and drop-out. Both early exacerbation and between-session exacerbation were relatively common (32.3% and 46.5%, respectively) but were unrelated to poor treatment response or an increased likelihood of treatment drop-out. Both clinicians and patients need to be aware that symptom exacerbation during TFT is common and not related to poor outcomes. Symptom exacerbation can be part of the therapeutic process, should be acknowledged and guided, and should not be a barrier to the implementation of TFT in people with psychosis.
对症状恶化和治疗脱落的担忧是实施创伤焦点治疗 (TFT) 的一个重要障碍，特别是在患有精神病障碍的人群中。这项研究是一项多中心随机对照试验的一部分，调查了 PTSD 和精神病患者 99 名参与者在 EMDR 治疗和延长暴露 (PE) 期间 PTSD 症状恶化的情况。使用 PTSD 症状量表自我报告监测前四节治疗期间的症状恶化（早期恶化）和治疗过程中的节间恶化。进行协方差分析和卡方检验，以调查恶化率及其与治疗反应和脱落的关系。早期恶化和节间恶化都很常见（分别为 32.3%和 46.5%），但与治疗反应差或治疗脱落的可能性增加无关。临床医生和患者都需要意识到 TFT 期间的症状恶化很常见，与不良结果无关。症状恶化可能是治疗过程的一部分，应该得到承认和指导，不应该成为在精神病患者中实施 TFT 的障碍。
