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Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders

Published online by Cambridge University Press:  14 June 2016

P. A. J. M. de Bont*
Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer, The Netherlands Radboud University Nijmegen, Behavioural Science Institute, NijCare, HE Nijmegen, The Netherlands
D. P. G. van den Berg
Parnassia Psychiatric Institute, Den Haag, The Netherlands
B. M. van der Vleugel
Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands
C. de Roos
MHO Rivierduinen, Leiden, The Netherlands
A. de Jongh
Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands School of Health Sciences, Salford University, Manchester, UK
M. van der Gaag
Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health and Care Research, Van der Boechorststraat 1, BT Amsterdam, The Netherlands Parnassia Psychiatric Institute, Zoutkeetsingel 40, HN Den Haag, The Netherlands
A. M. van Minnen
Radboud University Nijmegen, Behavioural Science Institute, NijCare, HE Nijmegen, The Netherlands MHO ‘Pro Persona’, Centre for Anxiety Disorders Overwaal, Nijmegen, The Netherlands
*Address for correspondence: P. A. J. M. de Bont, MSc, Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg, Bilderbeekstraat 44, 5831 CX Boxmeer, The Netherlands; Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands. (Email:



In patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknown


In a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE; n = 53) or eye movement desensitization and reprocessing (EMDR) (n = 55), or a waiting-list condition (WL, n = 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points.


Both PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged.


In patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.

Original Articles
Copyright © Cambridge University Press 2016 

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