Academic journal article European Journal of Psychotraumatology

Exposing Therapists to Trauma-Focused Treatment in Psychosis: Effects on Credibility, Expected Burden, and Harm Expectancies

Academic journal article European Journal of Psychotraumatology

Exposing Therapists to Trauma-Focused Treatment in Psychosis: Effects on Credibility, Expected Burden, and Harm Expectancies

Article excerpt

Because there is strong empirical support for the efficacy of trauma-focused treatments such as prolonged exposure therapy (PE), eye movement desensitization and reprocessing therapy (EMDR), and cognitive therapy (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013; Bradley, Greene, Russ, Dutra, & Westen, 2005), these treatments are recommended worldwide in treatment guidelines for posttraumatic stress disorder (PTSD; Forbes et al., 2010; World Health Organization, 2013). In addition, most patients with PTSD seem to have a positive attitude toward evidence-based trauma-focused treatments such as PE (Becker, Darius, & Schaumberg, 2007) and prefer this to medication (Feeny, Zoellner, Mavissakalian, & Roy-Byrne, 2009; Polusny, Erbes, & Gerould, 2014; Reger et al., 2013). PTSD is highly prevalent in patients diagnosed with a psychotic disorder (Achim et al., 2011; De Bont et al., 2015), and several trauma-focused treatments are known to be effective and safe in patients with psychosis and other severe mental illnesses (De Bont, Van Minnen, & De Jongh, 2013; Frueh et al., 2009; Mueser et al., 2015, 2008; Van den Berg et al., 2015; Van den Berg & Van der Gaag, 2012).

Nevertheless, dissemination of evidence-based traumafocused treatments remains highly problematic (Deacon & Farrell, 2013; Foa, Gillihan, & Bryant, 2013). For example, a study using clinical data of six specialized PTSD outpatient veteran units in the USA (n = 1,924) found that only 6.3% of the patients received at least one session of evidence-based trauma-focused treatment during the first six months of their treatment (Shiner et al., 2013). In the presence of a comorbid psychotic disorder, the situation may be even more problematic, since most therapists are reluctant to use trauma-focused treatments in patients with psychosis (Becker, Zayfert, & Anderson, 2004; Frueh, Cusack, Grubaugh, Sauvageot, & Wells, 2006; Meyer, Farrell, Kemp, Blakey, & Deacon, 2014; Salyers, Evans, Bond, & Meyer, 2004).

Together with contextual factors (e.g., insufficient time) and patient factors (e.g., poor engagement), therapist characteristics and, more specifically, therapists' beliefs about trauma-focused treatments appear to be an important cause of underutilization of evidence-based interventions for PTSD (Becker et al., 2007; Harned, Dimeff, Woodcock, & Contreras, 2013; Meyer et al., 2014). Some therapists hold negative beliefs about the tolerability, safety, and utility of evidence-based trauma-focused treatments (Farrell, Deacon, Dixon, & Lickel, 2013; Foa et al., 2013). Based on the literature, we distinguished three types of therapist beliefs related to trauma-focused treatment that may influence therapists' behavior in clinical practice: credibility, expected burden, and harm expectancies of trauma-focused treatment.

Credibility refers to therapists' beliefs about the efficacy and utility of that particular treatment. Some therapists consider that findings on the efficacy of evidence-based treatments (mainly cognitive behavior therapy) are of little value to their clinical practice (e.g., Barlow, Levitt, & Bufka, 1999; Foa et al., 2013; Shafran et al., 2009). This is supported by a survey of 2,607 USA and Canadian psychotherapists in which significant mentors, books, training received in graduate school and informal discussions with colleagues were the most highly endorsed factors influencing clinical behavior (Cook, Schnurr, Biyanova, & Coyne, 2009). Not surprisingly, the credibility of a certain trauma-focused treatment was found to be associated with a preference for using it (Van Minnen, Hendriks, & Olff, 2010).

Burden expectancy concerns therapists' beliefs that a certain treatment is burdensome for patients and therapists. Conducting trauma-focused treatments can be burdensome for both patient and therapist, albeit patients generally consider it to be tolerable, are inclined to undergo treatment again, and tend to recommend it to a friend with similar problems (Devilly & Spence, 1999). …

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