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The following is a summary of “Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial,” published in the October 2024 issue of Psychiatry by Patterson et al. 

Adversity-focused treatment trials have improved post-traumatic stress disorder (PTSD) and psychotic symptoms in individuals with psychotic disorders, but their effects on substance use in early phase psychosis remain unexplored. 

Researchers conducted a prospective study to evaluate the effects of adversity-focused treatment on substance use and psychotic symptoms in individuals with early phase psychosis. 

They assessed the outcomes of an adapted prolonged exposure protocol (PE+) using a multiple-baseline design with 19 adults from an early psychosis program who had a psychotic disorder, substance misuse, and a history of adversity. Participants were randomized to different treatment start times and completed a 15-session PE+ therapy course, with 10 assessments focused on primary outcomes (i.e., adversity sequelae, negative psychotic symptoms, substance misuse) and secondary outcomes (i.e., functioning, hopelessness, experiential avoidance). The Reliable Change Index (RCI) was used to identify clinically significant changes. 

The results showed that half or more of treatment completers experienced clinically significant changes in most domains of adversity sequelae, while no participants saw improvements in negative psychotic symptoms, and substance misuse increased for several. For secondary outcomes, functioning and experiential avoidance improved for some participants, whereas hopelessness decreased for only 1 participant. Participants reported high satisfaction with the PE+ treatment, citing exposure and coping skills as the most helpful elements. 

The study concluded that while PE+ treatment reduced adversity sequelae in individuals with early psychosis, integrating strategies for psychotic symptoms and substance use is essential for effective treatment. Future research should focus on incorporating substance use strategies into adversity treatment trials for this population. 

Source: bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06050-1