Cognitive-Behavioral Treatmenzt of PTSD in Severe Mental Illness: Results of a Pilot Study

Abstract

There is a documented need for standardized treatments of posttraumatic stress disorder (PTSD) in people with severe mental illness (SMI), but no interventions have been shown to be effective for this population. To address this need we developed a 12- to 16-week individual cognitive-behavioral treatment (CBT) program for PTSD. The program includes psychoeducation, breathing retraining, and cognitive restructuring, with treatment closely coordinated with clients' community support treatment teams. A pilot study was conducted and included clients with PTSD and SMI (such as schizophrenia or bipolar disorder) to evaluate the safety, feasibility, and preliminary clinical effectiveness of the program. Retention rate in the treatment was 86% with no serious adverse clinical events reported. Clinical outcomes were good, with reductions in PTSD diagnoses, based on the Clinician Administered PTSD Scale (CAPS), from 100% at baseline to 64% at post-treatment and 50% at three-month follow-up. Clients also experienced significant reductions in the affect subscale (depression and anxiety) of the Brief Psychiatric Rating Scale (BPRS) from baseline to the three-month follow-up. The results support the feasibility and potential clinical effectiveness of the CBT program for PTSD in the SMI, and suggest the intervention should be evaluated in a randomized clinical trial.