MedWire News: Exposure-based cognitive behavioral therapy (CBT) may be effective for treating post-traumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder, results of a pilot study suggest.
Writing in the Journal of Anxiety Disorders, B Christopher Frueh (Baylor College of Medicine, Houston, Texas, USA) and team say that “both trauma and PTSD occur at higher rates in adults with serious mental illness than in the general population.”
However, they add, “despite increased recognition of PTSD in the general population, it is largely ignored among the severely mentally ill.”
They add that this can have unfortunate consequences as “leaving PTSD unaddressed in the severely mentally ill almost certainly exacerbates patients’ illness severity and hinders their care.”
The team therefore conducted a pilot study to investigate whether exposure-based cognitive behavioral therapy can benefit mental health patients with PTSD.
The researchers enrolled 20 adult patients with PTSD and either schizophrenia or schizoaffective disorder from a public sector community mental health center who were assigned to an 11-week CBT intervention. None of the patients met DSM-IV criteria for current alcohol or drug dependence or had a history of psychiatric hospitalization or suicide attempt in the previous 2 months
The intervention consisted of psycho-education, anxiety management therapy, social skills training, and exposure therapy. Participants engaged in 22 sessions of group and individually administered CBT within the context of their usual care.
In total, 13 patients completed the treatment program, with no significant differences between completers and non-completers, except for gender – completers were more likely to be female than male, at 92.3% versus 7.7%.
The researchers found that 12 of the 13 completers showed significant improvements in PTSD symptoms, as indicated by significant reductions in PTSD Checklist scores, and these improvements were maintained at 3-month follow-up. Indeed, 10 patients no longer met criteria for PTSD at 3-month follow-up.
Clinical outcomes for other targeted domains, such as anger and general mental health, also improved and were maintained at 3-month follow-up, and participant satisfaction with the treatment was high.
However, the intervention was not associated with improvements in depression levels, general anxiety, or physical health status among the participants.
Frueh and team conclude: “Results of this open trial of manualized exposure-based CBT offer preliminary optimism for the effective treatment of PTSD among adults with schizophrenia or schizoaffective disorder, high psychiatric comorbidity, and meeting criteria for severe mental illness.”
However, they add: “While preliminary findings are extremely promising, additional research is needed. Future studies should include larger samples, with other diagnoses associated with severe mental illness (eg, bipolar disorder), and hypotheses-driven randomized methodology, including efficacy and effectiveness designs.”
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