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Cognitive–behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial

Published online by Cambridge University Press:  21 September 2016

C. Steel ,
A. Hardy ,
B. Smith ,
T. Wykes ,
S. Rose ,
S. Enright ,
M. Hardcastle ,
S. Landau ,
M. F. Baksh  and
J. D. Gottlieb
...Show all authors
C. Steel*
Affiliation:
School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
A. Hardy
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
B. Smith
Affiliation:
North East London NHS Foundation Trust, UK
T. Wykes
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
S. Rose
Affiliation:
Berkshire Healthcare NHS Foundation Trust, UK
S. Enright
Affiliation:
Berkshire Healthcare NHS Foundation Trust, UK
M. Hardcastle
Affiliation:
Berkshire Healthcare NHS Foundation Trust, UK
S. Landau
Affiliation:
Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
M. F. Baksh
Affiliation:
Department of Mathematics and Statistics, University of Reading, Reading, UK
J. D. Gottlieb
Affiliation:
Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
D. Rose
Affiliation:
Health Services Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
K. T. Mueser
Affiliation:
Department of Mathematics and Statistics, University of Reading, Reading, UK
*
*Address for correspondence: C. Steel, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. (Email: [email protected])
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Abstract

Background

There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia.

Method

A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive–behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale.

Results

Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes.

Conclusions

The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.

Keywords

Cognitive–behavioural therapycognitive restructuringpost-traumatic stressrandomized controlled trialsschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 43 - 51
Copyright
Copyright © Cambridge University Press 2016 

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