Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Jan 24;1(1):CD011464.
doi: 10.1002/14651858.CD011464.pub2.

Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness

Jacqueline Sin  1 , Debbie Spain  2 , Marie Furuta  3 , Trevor Murrells  4 , Ian Norman  4
Affiliations
Meta-Analysis

Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness

Jacqueline Sin et al. Cochrane Database Syst Rev. .

Abstract

Background: Increasing evidence indicates that individuals who develop severe mental illness (SMI) are also vulnerable to developing post-traumatic stress disorder (PTSD), due to increased risk of exposure to traumatic events and social adversity. The effectiveness of trauma-focused psychological interventions (TFPIs) for PTSD in the general population is well-established. TFPIs involve identifying and changing unhelpful beliefs about traumatic experiences, processing of traumatic memories, and developing new ways of responding to cues associated with trauma. Little is known about the potential feasibility, acceptability and effectiveness of TFPIs for individuals who have a SMI and PTSD.

Objectives: To evaluate the effectiveness of psychological interventions for PTSD symptoms or other symptoms of psychological distress arising from trauma in people with SMI.

Search methods: We searched the Cochrane Schizophrenia Group's Trials Study-Based Register (up until March 10, 2016), screened reference lists of relevant reports and reviews, and contacted trial authors for unpublished and/or specific outcome data.

Selection criteria: We included all relevant randomised controlled trials (RCTs) which investigated TFPIs for people with SMI and PTSD, and reported useable data.

Data collection and analysis: Three review authors (DS, MF, IN) independently screened the titles and abstracts of all references identified, and read short-listed full text papers. We assessed risk of bias in each case. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes, and the mean difference (MD) and 95% CI for continuous data, on an intention-to-treat basis. We assessed quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and created 'Summary of findings' tables.

Main results: Four trials involving a total of 300 adults with SMI and PTSD are included. These trials evaluated three active intervention therapies: trauma-focused cognitive behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing (EMDR), and brief psychoeducation for PTSD, all delivered via individual sessions. Our main outcomes of interest were PTSD symptoms, quality of life/well-being, symptoms of co-morbid psychosis, anxiety symptoms, depressive symptoms, adverse events and health economic outcomes. 1. TF-CBT versus usual care/waiting list Three trials provided data for this comparison, however, continuous outcome data available were more often found to be skewed than unskewed, leading to the necessity of conducting analyses separately for the two types of continuous data. Using the unskewed data only, results showed no significant differences between TF-CBT and usual care in reducing clinician-rated PTSD symptoms at short term (1 RCT, n =13, MD 13.15, 95% CI -4.09 to 30.39,low-quality evidence). Limited unskewed data showed equivocal results between groups in terms of general quality of life (1 RCT, n = 39, MD -0.60, 95% CI -4.47 to 3.27, low-quality evidence), symptoms of psychosis (1 RCT, n = 9, MD -6.93, 95% CI -34.17 to 20.31, low-quality evidence), and anxiety (1 RCT, n = 9, MD 12.57, 95% CI -5.54 to 30.68, very low-quality evidence), at medium term. The only available data on depression symptoms were skewed and were equivocal across groups at medium term (2 RCTs, n = 48, MD 3.26, 95% CI -3.66 to 10.18, very low-quality evidence). TF-CBT was not associated with more adverse events (1 RCT, n = 100, RR 0.44, 95% CI 0.09 to 2.31, low-quality evidence) at medium term. No data were available for health economic outcomes. Very limited data for PTSD and other symptoms were available over the long term. 2. EMDR versus waiting listOne trial provided data for this comparison. Favourable effects were found for EMDR in terms of PTSD symptom severity at medium term but data were skewed (1 RCT, n = 83, MD -12.31, 95% CI -22.72 to -1.90, very low-quality evidence). EMDR was not associated with more adverse events (1 RCT, n = 102, RR 0.21, 95% CI 0.02 to 1.85, low-quality evidence). No data were available for quality of life, symptoms of co-morbid psychosis, depression, anxiety and health economics.3. TF-CBT versus EMDROne trial compared TF-CBT with EMDR. PTSD symptom severity, based on skewed data (1 RCT, n = 88, MD -1.69, 95% CI -12.63 to 9.23, very low-quality evidence) was similar between treatment groups. No data were available for the other main outcomes.4. TF-CBT versus psychoeducationOne trial compared TF-CBT with psychoeducation. Results were equivocal for PTSD symptom severity (1 RCT, n = 52, MD 0.23, 95% CI -14.66 to 15.12, low-quality evidence) and general quality of life (1 RCT, n = 49, MD 0.11, 95% CI -0.74 to 0.95, low-quality evidence) by medium term. No data were available for the other outcomes of interest.

Authors' conclusions: Very few trials have investigated TFPIs for individuals with SMI and PTSD. Results from trials of TF-CBT are limited and inconclusive regarding its effectiveness on PTSD, or on psychotic symptoms or other symptoms of psychological distress. Only one trial evaluated EMDR and provided limited preliminary evidence favouring EMDR compared to waiting list. Comparing TF-CBT head-to-head with EMDR and brief psychoeducation respectively, showed no clear effect for either therapy. Both TF-CBT and EMDR do not appear to cause more (or less) adverse effects, compared to waiting list or usual care; these findings however, are mostly based on low to very low-quality evidence. Further larger scale trials are now needed to provide high-quality evidence to confirm or refute these preliminary findings, and to establish which intervention modalities and techniques are associated with improved outcomes, especially in the long term.

PubMed Disclaimer

Conflict of interest statement

JS was involved in the Cognitive Behaviour Therapy for Post‐traumatic stress disorder and Schizophrenia (C‐PAS) study (ISRCTN67096137) in the capacity of a trial therapist from 2009 to 2012. JS is also based, in part, at the Berkshire Traumatic Stress Service (2004 onwards). JS is now supported by the National Institute for Health Research (NIHR) Post Doctoral Research Fellowship (Reference: PDF‐2015‐08‐035, 2016 ‐ 2020) and also in part by the NIHR Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London (2015 ‐ 2017). DS is funded by a NIHR Clinical Doctoral Research Fellowship (Reference: CDRF‐03‐059, 2013 ‐ 2016). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

DS: no known conflict of interest.

MF: no known conflict of interest.

TM: no known conflict of interest.

IN: no known conflict of interest.

Figures

1
1
Study flow diagram.
2
2
,Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 1 PTSD symptom severity: 1. Clinician‐rated severity ‐ average endpoint CAPS total score (high = poor).
1.2
1.2. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 2 PTSD symptom severity: 1a. Clinician‐rated severity ‐ average endpoint CAPS total score (high = poor) ‐ skewed data.
1.3
1.3. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 3 PTSD symptom severity: 2. Self‐reported trauma‐related cognition ‐ average endpoint PTCI total score (high = poor).
1.4
1.4. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 4 PTSD symptom severity: 3. Self‐reported frequency of PTSD symptoms ‐ average endpoint PSS‐SR total score (high = poor) ‐ skewed data.
1.5
1.5. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 5 PTSD symptom severity: 4. Remission from PTSD: Symptoms below diagnostic threshold ‐ CAPS total score < 40.
1.6
1.6. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 6 PTSD symptom severity: 5. Recovery from PTSD: Asymptomatic or few symptoms ‐ CAPS total score < 20.
1.7
1.7. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 7 Quality of life: 1. General quality of life ‐ average endpoint QLS total score (high = good).
1.8
1.8. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 8 Quality of life: 2. Overall functioning ‐ average endpoint GAF total score (high = good).
1.9
1.9. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 9 Quality of life: 3. Mental health functioning ‐ average endpoint SF‐12 mental component total score (high = good).
1.10
1.10. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 10 Quality of life: 4. Physical functioning ‐ average endpoint SF‐12 physical component total score (high = good).
1.11
1.11. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 11 Symptoms of co‐morbid psychosis: 1. Overall mental state ‐ average endpoint BPRS total score (high = poor).
1.12
1.12. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 12 Symptoms of co‐morbid psychosis: 2. Positive symptoms ‐ average endpoint PANSS positive subscale total score (high = poor).
1.13
1.13. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 13 Symptoms of co‐morbid psychosis: 4. Negative symptoms ‐ average endpoint PANSS negative subscale total score (high = poor).
1.14
1.14. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 14 Symptoms of co‐morbid psychosis: 3. Hallucinations ‐ average endpoint PSYRATS‐hallucinations subscale total score (high = poor) ‐ skewed data.
1.15
1.15. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 15 Symptoms of co‐morbid psychosis: 5. Delusions ‐ average endpoint PSYRATS‐delusions subscale total score (high = poor) ‐ skewed data.
1.16
1.16. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 16 Anxiety symptoms: 1a. average endpoint BAI total score (high = poor).
1.17
1.17. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 17 Anxiety symptoms: 1b. average endpoint BAI total score (high = poor) ‐ skewed data.
1.18
1.18. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 18 Depressive symptoms: 1. average endpoint BDI‐II total (high = poor) ‐ skewed data.
1.19
1.19. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 19 Adverse events ‐ incidents of unspecified severe adverse events.
1.20
1.20. Analysis
Comparison 1 TF‐CBT versus WAITING LIST/TAU, Outcome 20 Leaving the study early.
2.1
2.1. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 1 PTSD symptom severity: 1. Clinician‐rated severity ‐ average endpoint CAPS total score (high = poor) ‐ skewed data.
2.2
2.2. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 2 PTSD symptom severity: 2. Self‐reported trauma‐related cognition ‐ average endpoint PTCI total score (high = poor).
2.3
2.3. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 3 PTSD symptom severity: 3. Self‐reported frequency of PTSD symptoms ‐ average endpoint PSS‐SR total score (high = poor) ‐ skewed data.
2.4
2.4. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 4 PTSD symptom severity: 4. Remission from PTSD: Symptoms below diagnostic threshold ‐ CAPS total score < 40.
2.5
2.5. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 5 PTSD symptom severity: 5. Recovery from PTSD: Asymptomatic or few symptoms ‐ CAPS total score < 20.
2.6
2.6. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 6 Adverse events ‐ incidents of unspecified severe adverse events.
2.7
2.7. Analysis
Comparison 2 EMDR versus WAITING LIST, Outcome 7 Leaving the study early.
3.1
3.1. Analysis
Comparison 3 TF‐CBT versus EMDR, Outcome 1 PTSD symptom severity: 1. Clinician‐rated severity ‐ average endpoint CAPS total score (high = poor) ‐ skewed data.
3.2
3.2. Analysis
Comparison 3 TF‐CBT versus EMDR, Outcome 2 PTSD symptom severity: 2. Self‐reported trauma‐related cognition ‐ average endpoint PTCI total score (high = poor).
3.3
3.3. Analysis
Comparison 3 TF‐CBT versus EMDR, Outcome 3 PTSD symptom severity: 3. Self‐reported frequency of PTSD symptoms ‐ average endpoint PSS‐SR total score (high = poor) ‐ skewed data.
3.4
3.4. Analysis
Comparison 3 TF‐CBT versus EMDR, Outcome 4 PTSD symptom severity: 4. Remission from PTSD: Symptoms below diagnostic threshold ‐ CAPS total score < 40.
3.5
3.5. Analysis
Comparison 3 TF‐CBT versus EMDR, Outcome 5 PTSD symptom severity: 5. Recovery from PTSD: Asymptomatic or few symptoms ‐ CAPS total score < 20.
4.1
4.1. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 1 PTSD symptom severity: 1a. Clinician‐rated severity ‐ average endpoint CAPS total score (high = poor).
4.2
4.2. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 2 PTSD symptom severity: 1b. Clinician‐rated severity ‐ average endpoint CAPS total score (high = poor) ‐ skewed data.
4.3
4.3. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 3 PTSD symptom severity: 2. Self‐reported trauma‐related cognition ‐ average endpoint PTCI total score (high = poor).
4.4
4.4. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 4 PTSD symptom severity: 4. Remission from PTSD: Symptoms below diagnostic threshold ‐ CAPS total score < 40.
4.5
4.5. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 5 PTSD symptom severity: 5. Remission from severe PTSD: Loss of severe PTSD diagnosis ‐ CAPS total score < 65.
4.6
4.6. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 6 Quality of life: 1. General quality of life ‐ average endpoint QoLI total score (high = good).
4.7
4.7. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 7 Quality of life: 2. Overall functioning ‐ average endpoint GAF total score (high = good).
4.8
4.8. Analysis
Comparison 4 Individual TF‐CBT versus brief PTSD psychoeducation, Outcome 8 Quality of life: 3. Social functioning ‐ average endpoint CAPS social functioning subscale total score (high = poor) ‐ skewed data.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Mueser 2008 {published and unpublished data}
    1. Mueser KT, Rosenberg SD, Xie H, Jankowski MK, Bolton EE, Lu W, et al. A randomized controlled trial of cognitive‐behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology 2008;76(2):259‐71. [MEDLINE: ] - PMC - PubMed
    1. NCT00053690. Cognitive‐behavioral treatment of PTSD in SMI clients. clinicaltrials.gov/ct2/show/NCT00053690 (first received 4 February 2003).
Mueser 2015 {published and unpublished data}
    1. Mueser KT, Gottlieb JD, Xie H, Lu W, Yanos PT, Rosenberg SD, et al. Evaluation of cognitive restructuring for post‐traumatic stress disorder in people with severe mental illness. British Journal of Psychiatry 2015;206:501‐8. - PMC - PubMed
    1. NCT00494650. Cognitive behavioral treatment for post‐traumatic stress disorder in people with additional serious mental illnesses. clinicaltrials.gov/ct2/show/NCT00494650?term=NCT00494650&rank=1 (first accessed 28 June 2007).
Steel 2010 {published and unpublished data}
    1. ISRCTN67096137. The acceptability and effectiveness of cognitive behavioural therapy for the treatment of post‐traumatic stress disorder within schizophrenia. isrctn.com/ISRCTN67096137 (first received 23 April 2010).
van den Berg 2015 {published data only}
    1. ISRCTN79584912. Treating Trauma in Psychosis. isrctn.com/ISRCTN79584912 (first received 22 December 2011).
    1. Bont PA, Berg DP, Vleugel BM, Roos C, Mulder CL, Becker ES, et al. A multi‐site single blind clinical study to compare the effects of prolonged exposure, eye movement desensitization and reprocessing and waiting list on patients with a current diagnosis of psychosis and co morbid post traumatic stress disorder: Study protocol for the randomized controlled trial Treating Trauma in Psychosis. Trials 2013;14:151. - PMC - PubMed
    1. Berg DP, Bont PA, Vleugel BM, Roos C, Jongh A, Minnen A. Prolonged exposure vs Eye Movement Desensitization and Reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder ‐ a randomised clinical trial. JAMA Psychiatry 2015;72(3):259‐67. [DOI: 10.1001/jamapsychiatry.2014.2637] - DOI - PubMed

References to studies excluded from this review

de Bont 2013 {published data only}
    1. Bont PA, Minnen A, Jongh A. Treating PTSD in patients with psychosis: a within‐group controlled feasibility study examining the efficacy and safety of evidence‐based PE and EMDR protocols. Behavior Therapy 2013;44(4):717‐30. - PubMed
ISRCTN43816889 {published data only}
    1. ISRCTN43816889. Trauma therapy for psychosis: Eye Movement Desensitisation and Reprocessing (EMDR) for people with a psychotic illness. isrctn.com/ISRCTN43816889 (first received 10 July 2014).
Jackson 2006 {published data only}
    1. ISRCTN43585723. Promoting personal recovery from psychosis: a randomised controlled trial in first episode schizophrenia. isrctn.com/ISRCTN43585723 (first received 23 January 2004).
    1. Jackson C. Promoting personal recovery from psychosis: a randomised control trial in first episode schizophrenia. National Research Register 2003.
    1. Jackson C. Promoting personal recovery from psychosis: a randomised controlled trial in first episode schizophrenia. National Research Register 2001.
    1. Jackson C, Smith J, Birchwood M, Trower P, Reid I, Townend M, et al. Preventing the traumatic sequelae of first episode psychosis: a randomised controlled trial. Schizophrenia Research 2004;70(1):45‐6.
    1. Jackson C, Trower P, Reid I, Smith J, Birchwood M, Hall M, et al. Improving psychological adjustment following a first episode of psychosis: a randomised controlled trial of cognitive therapy to reduce post‐psychotic trauma symptoms. Schizophrenia Research 2006;86(Suppl 1):S39. - PubMed
NCT00307216 {published data only}
    1. NCT00307216. Graduated recovery intervention program for enhancing treatment for first‐episode psychosis. clinicaltrials.gov/ct2/show/NCT00307216 (first received 23 March 2006).

Additional references

ACPMH 2013
    1. Australian Centre for Posttraumatic Mental Health. The Australian Guidelines for the Treatment for Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne: ACPMH, 2013.
Altman 1996
    1. Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313(7066):1200. - PMC - PubMed
APA 2013
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th edition). Arlington, VA: American Psychiatric Publishing, 2013.
APA, 2000
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edition, text rev.). Washington DC: APA, 2000.
Bebbington 2004
    1. Bebbington PE, Bhugra D, Brugha T, Singleton N, Farrell M, Jenkins R, et al. Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. British Journal of Psychiatry 2004;185:220‐6. - PubMed
Bebbington 2011
    1. Bebbington P, Jonas S, Kuipers E, King M, Cooper C, Brugha T, et al. Childhood sexual abuse and psychosis: data from a cross‐sectional national psychiatric survey in England. British Journal of Psychiatry 2011;199:19‐37. - PubMed
Beck 1990
    1. Beck AT, Steer RA. Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation, 1990.
Beck 1996
    1. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory ‐ II. San Antonio, TX: Psychological Corporation, 1996.
Bisson 2013
    1. Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post‐traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews 2013, Issue 12. [DOI: 10.1002/14651858.CD003388.pub4] - DOI - PMC - PubMed
Blake 1995
    1. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a clinician administered PTSD scale. Journal of Traumatic Stress 1995;8(1):75‐90. - PubMed
Bland 1997
    1. Bland JM. Statistics notes. Trials randomised in clusters. BMJ 1997;315:600. - PMC - PubMed
Boissel 1999
    1. Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, et al. The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use [Apercu sur la problematique des indices d'efficacite therapeutique, 3: comparaison des indices et utilisation. Groupe d'Etude des Indices D'efficacite]. Therapie 1999;54(4):405‐11. [PUBMED: 10667106] - PubMed
Borenstein 2011
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta‐Analysis. Available from eu.wiley.com/WileyCDA/WileyTitle/productCd‐EHEP002313.html. Wiley, 2011.
Bradley 2005
    1. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta‐analysis of psychotherapy for PTSD. American Journal of Psychiatry 2005;162(2):214‐27. - PubMed
Brunet 2012
    1. Brunet K, Birchwood M, Upthegrove R, Michail M, Ross K. A prospective study of PTSD following recovery from first‐episode psychosis: the threat from persecutors, voices, and patienthood. British Journal of Clinical Psychology 2012;51:418‐33. - PubMed
Bryant 2003
    1. Bryant RA, Moulds ML, Guthrie RM, Dang ST, Nixon RDV. Imaginal exposure alone and imaginal exposure with cognitive structuring in the treatment of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 2003;71:706‐12. - PubMed
Callcott 2004
    1. Callcott P, Standart S, Turkington D. Trauma within psychosis: using a CBT model for PTSD in psychosis. Behavioural and Cognitive Psychotherapy 2004;32(2):239‐44.
Calvert 2008
    1. Calvert C, Larkin W, Jellicoe‐Jones L. An exploration of the links between trauma and delusional ideation in secure services. Behavioural and Cognitive Psychotherapy 2008;36(5):589‐604.
Creamer 2004
    1. Creamer M, Forbes D, Phelps A, Humphreys L. TreatingTraumatic Stress: Conducting Imaginal Exposure. Phoenix: Australian Centre for Posttraumatic Mental Health, 2004.
Darves‐Bornoz 2008
    1. Darves‐Bornoz JM, Alonzo J, Girolamo G, Graaf R, Haro JM, Kovess‐Masfety V, et al. Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey. Journal of Traumatic Stress 2008;21(5):455‐62. - PubMed
de Jongh 2003
    1. Jongh A, Broeke E. Handbook of EMDR: A Standardised Treatent for the Consequences of Psychotrauma. Amsterdam, the Netherlands: Harcourt, 2003.
Deeks 2000
    1. Deeks J. Issues in the selection for meta‐analyses of binary data. 8th International Cochrane Colloquium; 2000 Oct 25‐28; Cape Town. Cape Town: The Cochrane Collaboration, 2000.
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta‐analyses. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.. Available from hanbook.cochrane.org.
Divine 1992
    1. Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7(6):623‐9. - PubMed
Donner 2002
    1. Donner A, Klar N. Issues in the meta‐analysis of cluster randomized trials. Statistics in Medicine 2002;21:2971‐80. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315:629‐34. - PMC - PubMed
Ehlers 2005
    1. Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M. Cognitive therapy for post‐traumatic stress disorder: development and evaluation. Behaviour Research andTherapy 2005;43(4):413‐31. - PubMed
Ehlers 2010
    1. Ehlers A, Bisson J, Clark DM, Creamer M, Pilling S, Richards D, et al. Do all psychological treatments really work the same in posttraumatic stress disorder?. Clinical Psychology Review 2010;30:269‐76. - PMC - PubMed
Elbourne 2002
    1. Elbourne D, Altman DG, Higgins JPT, Curtina F, Worthingtond HV, Vaile A. Meta‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9. - PubMed
First 1996
    1. First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamin L. Structured clinical interview for DSM‐IV Axis‐I disorders ‐ patient edition (SCID‐I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute, 1996.
Fisher 2013
    1. Fisher HL, Caspi A, Poulton R, Meier MH, Houts R, Harrington H, et al. Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychological Medicine 2013;43:2077‐86. - PMC - PubMed
Foa 1993
    1. Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post‐traumatic stress disorder. Journal of Traumatic Stress 1993;6:459‐73.
Foa 1995
    1. Foa EB. Posttraumatic Stress Diagnostic Scale Manual. Minneapolis: National Computer Systems Inc., 1995.
Foa 1999
    1. Foa EB, Ehlers A, Clark DM, Tolin DF, Orsillo SM. The Posttraumatic Cognitions Inventory (PTCI): development and validation. Psychological Assessment 1999;11:303‐14.
Foa 2007
    1. Foa EB, Hembree EA, Rothbaum BO. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences ‐ Therapist Guide. Oxford, England: Oxford University Press, 2007.
Furukawa 2006
    1. Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta‐analyses can provide accurate results. Journal of Clinical Epidemiology 2006;59(7):7‐10. - PubMed
Gairns 2015
    1. Gairns S, Alvarez‐Jimenez M, Hulbert C, McGorry P, Bendall S. Perceptions of clinicians treating young people with first‐episode psychosis for post‐traumatic stress disorder. Early Intervention in Psychiatry 2015;9:12‐20. - PubMed
Gearon 2004
    1. Gearon JS, Bellack AS, Tenhula WN. Preliminary reliability and validity of the Clinician‐Administered PTSD Scale for schizophrenia. Journal of Consulting and Clinical Psychology 2004;72:121‐5. - PubMed
Gulliford 1999
    1. Gulliford MC. Components of variance and intraclass correlations for the design of community‐based surveys and intervention studies: data from the Health Survey for England 1994. American Journal of Epidemiology 1999;149:876‐83. - PubMed
Haddock 1999
    1. Haddock G, McCarron J, Tarrier N, Faraghan EB. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine 1999;29(4):879‐89. - PubMed
Heinrichs 1984
    1. Heinrichs DW, Hanlon TE, Carpenter WT. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 1984;10(3):388‐98. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins, JP, Green, S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Horowitz 1979
    1. Horowitz MJ, Wilner NR, Alvarez W. Impact of event scale ‐ a measure of subjective stress. Psychosomatic Medicine 1979;41:209‐18. - PubMed
Horvath 1989
    1. Horvath AO, Greenberg LS. Development and validation of the Working Alliance Inventory. Journal of Counselling Psychology 1989;36:223‐33.
Hutton 2009
    1. Hutton JL. Number needed to treat and number needed to harm are not the best way to report and assess the results of randomised clinical trials. British Journal of Haematology 2009;146(1):27‐30. - PubMed
Jackson 2009
    1. Jackson C, Trower P, Reid I, Smith J, Hall M, Townend M, et al. Improving psychological adjustment following a first episode of psychosis: a randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms. Behaviour Research and Therapy 2009;47:454‐62. - PubMed
Jones 1995
    1. Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale‐reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry 1995;266:654‐9. - PubMed
Jones 2014
    1. Jones V, Steel C. Examining vulnerability to involuntary memories in schizophrenia comorbid with post‐traumatic stress disorder. Schizophrenia Research 2014;152(2):487‐9. - PubMed
Kay 1986
    1. Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale (PANSS) Manual. North Tonawanda, NY: Multi‐Health Systems, 1986.
Kessler 1995
    1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 1995;52(12):1048‐60. - PubMed
Kilcommons 2005
    1. Kilcommons AM, Morrison AP. Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatrica Scandinavica 2005;112:351‐9. - PubMed
Kontopantelis 2013
    1. Kontopantelis E, Springate DA, Reeves D. A re‐analysis of the Cochrane Library data: the dangers of unobserved heterogeneity in meta‐analyses. PLoS ONE 2013;8(7):e69930. - PMC - PubMed
Lehman 1995
    1. Lehman A, Kernan E, Postrado L. Toolkit for Evaluating Quality of Life for Persons with Severe Mental Illness. New York, USA: The Evaluation Center at HSRI, 1995.
Leon 2006
    1. Leon AC, Mallinckrodt CH, Chuang‐Stein C, Archibald DG, Archer GE, Chartier K. Attrition in randomized controlled clinical trials: methodological issues in psychopharmacology. Biological Psychiatry 2006;59(11):1001‐5. [PUBMED: 16905632] - PubMed
Leucht 2005a
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean?. Schizophrenia Research 2005;79(2‐3):231‐8. [PUBMED: 15982856] - PubMed
Leucht 2005b
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of brief psychiatric rating scale scores. British Journal of Psychiatry 2005;187:366‐71. [PUBMED: 16199797] - PubMed
Leucht 2007
    1. Leucht S, Engel RR, Bauml J, Davis JM. Is the superior efficacy of new generation antipsychotics an artefact of LOCF?. Schizophrenia Bulletin 2007;33(1):183‐91. - PMC - PubMed
Lukoff 1986
    1. Lukoff D, Nuechterlein KH, Ventura J. Manual for the expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin 1986;12:594‐602.
Marks 1998
    1. Marks IM, Lovell K, Noshirvani H, Livanou M, Thrasher S. Treatment of postraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Archives of General Psychiatry 1998;55:317‐25. - PubMed
Marshall 2000
    1. Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249‐52. - PubMed
Meichenbaum 1988
    1. Meichenbaum D, Deffenbacher JL. Stress inoculation training. Counseling Psychologist 1988;16:69‐90.
Moore 2010
    1. Moore RA, Eccleston C, Derry S, Wiffen P, Bell BF, Straube S, et al. "Evidence" in chronic pain ‐ establishing best practice in the reporting of systematic reviews. Pain 2010;150:386‐9. - PubMed
Morrison 2003
    1. Morrison AP, Frame L, Larkin W. Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychology 2003;42:331‐53. - PubMed
Mueser 2009
    1. Mueser KM, Rosenberg SD, Rosenberg HJ. Treatment of Posttraumatic Stress Disorder in Special Populations: A Cognitive Restructuring Program. New York: American Psychological Association, 2009.
Mueser 2010
    1. Mueser KT, Lu W, Rosenberg SD, Wolfe R. The trauma of psychosis: posttraumatic stress disorder and recent onset psychosis. Schizophrenia Research 2010;116:217‐27. - PubMed
NICE 2005
    1. National Institute for Clinical Excellence. Post‐Traumatic Stress Disorder (PTSD) ‐ The Management of PTSD in Adults and Children in Primary and Secondary Care. London: National Collaborating Centre for Mental Health, 2005.
NICE 2011
    1. National Institute for Health and Care Excellence. Stepped Care for People with Common Mental Health Disorders Commissioning Guide. www.swscn.org.uk/wp/wp‐content/uploads/2015/03/non‐guidance‐commissionin.... London: NICE, (accessed 2011).
NICE 2013
    1. National Institute for Health and Care Excellence. Post‐Traumatic Stress Disorder (PTSD) ‐ Evidence Update December 2013 (Evidence Update 49). file:///C:/Users/mszter/Downloads/PTSD+Evidence+Update+December+2013.pdf. London: NICE, (accessed 2013).
NICE 2014
    1. National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Adults ‐ Treatment and Management (Clinical Guideline 136). www.nice.org.uk/guidance/cg178/evidence/full‐guideline‐490503565. London: National Collaborating Centre for Mental Health, (accessed 2014).
Overall 1962
    1. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychological Reports 1962;10:799‐812.
Pratt 2005
    1. Pratt SI, Rosenberg SD, Mueser KT, Brancato J, Salyers MP, Jankowski MK, et al. Evaluation of a PTSD psychoeducational program for psychiatric inpatients. Journal of Mental Health 2005;14:121‐7.
Read 2008
    1. Read J, Fink PJ, Rudegeair T, Felitti V, Whitfield CL. Child maltreatment and psychosis: a return to a genuinely integrated bio‐psycho‐social model. Clinical Schizophrenia & Related Psychoses 2008;2(3):235‐54.
Resick 2003
    1. Resick PA, Nishith P, Griffin MG. How well does cognitive behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial. CNS Spectrums 2003;8(5):340‐55. - PMC - PubMed
Rogers 1961
    1. Roger C. On Becoming a Person: A Therapist's View of Psychotherapy. London: Constable, 1961.
Rosenberg 2004
    1. Rosenberg SD, Mueser KT, Jankowski MK, Salyers MP, Acker K. Cognitive‐behavioural treatment of posttraumatic stress disorder in severe mental illness: results of a pilot study. American Journal of Psychiatric Rehabilitation 2004;7:171‐86.
Roth 2005
    1. Roth A, Fonagy P. What Works for Whom? A Critical Review of Psychotherapy Research. 2nd Edition. New York: Guilford Press, 2005.
Ruggeri 2000
    1. Ruggeri M, Leese M, Thornicroft G, Bisofti G, Tansella M. Definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry 2000;177:149‐55. - PubMed
Saha 2005
    1. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Medicine 2005;2(5):e141. - PMC - PubMed
Schnyder 2015
    1. Schnyder U, Ehlers A, Elbert T, Foa EB, Gersons BPR, Resick PA, et al. Psychotherapies for PTSD: what do they have in common?. European Journal of Psychotramatology 2015;6:28186. - PMC - PubMed
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Shapiro 1989
    1. Shapiro F. Eye‐movement desensitization ‐ a new treatment for post‐traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry 1989;20(3):211‐7. - PubMed
Shapiro 2001
    1. Shapiro F. Eye Movement Desensitization and Reprocessing, Basic Principles, Protocols and Procesures. 2nd Edition. New York: The Guilford Press, 2001.
Sheehan 1997
    1. Sheehan DV, Lecrubier Y, Harnett Sheehan K, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID‐P and its reliability. European Psychiatry 1997;12(5):232‐41.
Sheehan 1998
    1. Sheehan DV, Lecrubier Y, Harnett Sheehan K, Amorim P, Janavs J, Weiller, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM‐IV and ICD‐10. Journal of Clinical Psychiatry 1998;59(Suppl 20):22‐33. - PubMed
Spielberger 1973
    1. Spielberger CD, Gorsuch RL, Lushene R. Manual for the State‐Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press, 1973.
Sterne 2011
    1. Sterne JAC, Egger M, Moher D. Chapter 10: Addressing reporting biases. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
The Schizophrenia Commission 2012
    1. The Schizophrenia Commission. The Abandoned Illness: A Report from the Schizophrenia Commission. London: Rethink Mental Illness, 2012.
Ukoumunne 1999
    1. Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area‐wide and organisation‐based intervention in health and health care: a systematic review. Health Technology Assessment 1999;3(5):1‐75. - PubMed
Varese 2012
    1. Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, et al. Childhood adversities increase the risk of psychosis: a meta‐analysis of patient‐control, prospective‐ and cross‐sectional cohort studies. Schizophrenia Bulletin 2012;38(4):661‐71. - PMC - PubMed
Waraich 2004
    1. Waraich P, Goldner EM, Somers JM, Hsu L. Prevalence and incidence studies of mood disorders: a systematic review of the literature. Canadian Journal of Psychiatry 2004;49(2):124‐38. - PubMed
Ware 1994
    1. Ware JE, Kosinski M, Keller SD. SF‐36 Physical and Mental Health Summary Scales: A User's Manual. Boston, USA: Health Assessment Lab, 1994.
Weathers 2001
    1. Weathers FW, Keane TM, Davidson JR. Clinician‐Administered PTSD Scale: a review of the first ten years of research. Depression and Anxiety 2001;13(3):132‐56. - PubMed
WHO 1992
    1. World Health Organization. International Statistical Classification of Diseases and Related Health problems. ICD 10. Geneva: WHO, 1992.
Xia 2009
    1. Xia J, Adams CE, Bhagat N, Bhagat V, Bhoopathi P, El‐Sayeh H, et al. Loss to outcomes stakeholder survey: the LOSS study. Psychiatric Bulletin 2009;33(7):254‐7.

References to other published versions of this review

Sin 2015
    1. Sin J, Spain D, Furuta M, Murrells T, Norman I. Psychological interventions for post‐traumatic stress disorder (PTSD) in people with severe mental illness. Cochrane Database of Systematic Reviews 2015, Issue 1. [DOI: 10.1002/14651858.CD011464] - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources