PDF(Sci-hub)
Abstract：
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% (n = 7) of whom 86% (n = 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.
摘要：
尽管有精神病症状的人的创伤发生率很高，创伤后应激症状在临床实践中经常被忽视。在再处理创伤的治疗程序加剧精神病症状的情况下，也不愿治疗创伤后症状。最近的证据表明，在该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治疗创伤后症状，而不是精神病性症状。当前案例系列的目的是评估可接受性，可行性,以及将创伤后应激和精神病症状的认知行为方法整合到单一方案中的初步有效性。9名报告令人痛苦的精神病和创伤后症状的参与者从精神病的专业心理治疗服务中招募。在五个时间点对客户进行评估(基线，pre,mid,治疗结束,并在6个月以上的随访中）由独立评估者对当前精神病症状的测量，创伤后应激,情绪问题,和幸福。治疗是基于配方和个性化的，取决于症状和创伤类型。它由五个广泛的，灵活的阶段，并包括想象的再处理策略（重述和/或重新编写脚本）。干预得到了好评，具有积极的治疗后反馈和满意度评分。对于这个人群来说，不同寻常的是，没有人退出治疗.治疗后,与治疗前相比，除一名患者（88%的参与者）在至少一项结果指标上实现了可靠的改善：创伤后症状（63%），声音（25%），妄想（50%），抑郁症（50%），焦虑（36%），幸福（40%）。78％（n=7）完成了后续评估，其中86％（n=6）保持至少一个可靠的改善。治疗后的改善率（治疗后措施的平均值为44％；随访时为32％）是等待列表期间发现的两倍（19％）。没有参与者在治疗期间或治疗后出现任何症状的可靠恶化。研究表明，对于这个小样本，结合后处理策略的综合疗法是一种可接受且可行的干预措施，有希望的有效性。有必要进行随机对照试验以测试干预对该人群的疗效。
