Prolonged exposure, eye movement desensitization and reprocessing therapy, and cognitive restructuring versus waiting-list for individuals with PTSD and psychosis (RE.PROCESS): A multicenter, four-arm, assessor-masked, superiority randomized controlled trial.
Simone R Burger, Inez Verdaasdonk, Catherine van Zelst et al.
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In 30 seconds
The multicenter, assessor-masked RE.PROCESS randomized controlled trial compared Prolonged Exposure (PE), eye movement desensitization and reprocessing (EMDR), and Cognitive Restructuring (CR), each alongside usual care, with waiting-list plus usual care in 162 people with PTSD and a lifetime schizophrenia-spectrum psychotic disorder. Participants were followed for six months. All three therapies reduced researcher-rated PTSD severity relative to waiting-list; at six months, adjusted CAPS-5 differences were -9.76 for PE, -11.74 for EMDR, and -12.72 for CR. Secondary PTSD-related outcomes also improved, while psychosis outcomes did not show significant therapy effects.
Key findings
- At six months, PE reduced CAPS-5 severity versus waiting-list by an adjusted difference of -9.76 (95% CI -16.13,-3.38; p = 0.0029).
- EMDR reduced CAPS-5 severity versus waiting-list by -11.74 (95% CI -18.04,-5.44; p = 0.0003); CR reduced it by -12.72 (95% CI -18.89,-6.55; p = 0.0001).
- Therapy effects were significant for secondary PTSD-related outcomes, but not for psychosis.
Why it matters
PTSD treatment in people with psychosis can raise concerns about whether trauma-focused approaches are effective in this population. This trial found improvements in PTSD symptoms with three distinct therapies compared with waiting-list, extending evidence relevant to an underserved group. The absence of significant effects on psychosis also distinguishes the observed PTSD benefit from improvement in psychotic symptoms.
What to keep in mind
The authors state that replication in larger samples is needed.