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Changes in posttraumatic cognitions mediate the effects of trauma-focused therapy on paranoia

van der Vleugel, B.M., Libedinsky, I., de Bont, P.A.J.M., de Roos, C., van Minnen, A., de Jongh, Ad, van der Gaag, M. and van den Berg, D. (2020) Changes in posttraumatic cognitions mediate the effects of trauma-focused therapy on paranoia. Schizophrenia Bulletin Open, 1 (1). sgaa036. ISSN 2632-7899

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Abstract

Abstract Background Evidence suggests that in individuals with psychosis, paranoia is reduced after trauma-focused therapy (TFT) aimed at co-morbid posttraumatic stress disorder (PTSD). Objective To identify mediators of the effect of TFT on paranoia. Method In a multicenter single-blind randomized controlled trial 155 outpatients in treatment for psychosis were allocated to 8 sessions Prolonged Exposure (PE; n=53), 8 sessions Eye Movement Desensitization and Reprocessing (EMDR) therapy (n=55), or a waiting-list condition (WL; n=47) for treatment of co-morbid PTSD. Measures were performed on (1) paranoia (GPTS); (2) DSM-IV-TR PTSD symptom clusters (CAPS-IV; i.e., intrusions, avoidance, and hyperarousal); (3) negative posttraumatic cognitions (PTCI; i.e., negative self posttraumatic cognitions, negative world posttraumatic cognitions and self-blame); (4) depression (BDI-II); and (5) cognitive biases (i.e., jumping to conclusion, attention to threat, belief inflexibility and external attribution), cognitive limitations (i.e., social cognition problems and subjective cognitive problems), and safety behaviors (DACOBS). Outcome in terms of symptoms of paranoia (1) and potential mediators (2-5) were evaluated at post-treatment, controlling for baseline scores. Results The effects of TFT on paranoia were primarily mediated by negative self and negative world posttraumatic cognitions, representing almost 70% of the total indirect effect. Safety behaviors and social cognition problems were involved in the second step mediational pathway models. Conclusions Targeting the cognitive dimension of PTSD in TFT in psychosis could be an effective way to influence paranoia, whereas addressing safety behaviors and social cognition problems might enhance the impact of TFT on paranoia.

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© The Author(s) 2020. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

© The Author(s) 2020. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Uncontrolled Discrete Keywords: PTSD, psychosis, mechanism of change, prolonged exposure, EMDR therapy
Divisions: College of Business, Psychology and Sport > School of Psychology
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Copyright Info: Open access article
SWORD Depositor: Prof. Pub Router
Depositing User: Karen Veitch
Date Deposited: 14 Aug 2020 10:59
Last Modified: 09 Sep 2020 13:03
URI: https://eprints.worc.ac.uk/id/eprint/9627

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