Rates of Exposure to Traumatic Events and
Development of PTSD among PSMD in Treatment 

Principal Investigators: Mary Jane Alexander, Ph.D., Kristina Muenzenmaier, M.D., Lew Opler, M.D., Ph.D.

GOALS

Project goals include:

• Examination of the relationship of trauma exposure to the clinical profiles of persons with severe mental disorder (PSMD),
• Examination of their contacts with health, welfare and criminal justice systems in the five years prior to admission,
• Adaptation of existing measures of psychosis to include elements of complex post traumatic stress disorder (PTSD) that co-occur with psychosis,
• Development of an intervention to assist PSMD in coping with the dissociative symptoms of PTSD.

RESEARCH ACTIVITIES AND RESULTS .  

             Methods: In this project's earlier phase, two advisory meetings were held with consumer-survivor advocates who had dissociative histories, in order to understand the phenomenology of the flashback/numbing/dissociative continuum that appears to characterize PTSD co-occuring with psychosis. In addition, four focus groups were conducted with state hospital inpatients who had histories of childhood sexual abuse and current severe dissociative symptoms.  Issues of clinical support for the fragile study population were raised by the IRBs and were addressed by making clinical support available during and between groups. This was important for some participants who became dissociative or upset during group discussions

Results: Researchers used the results of Year 8 focus groups and the healing dimensions identified in a related Center project to adapt a group therapy intervention for inpatients with schizophrenia or schizoaffective disorders, and to address their trauma related PTSD and complex PTSD symptoms. The group intervention uses cognitive behavioral, psycho-education and skills training approaches to address schizophrenia symptoms. Seven women with these diagnoses plus a history of childhood sexual abuse attended 12 group sessions adapted for trauma survivors. Each group targeted one of the symptoms of PTSD or complex PTSD (e.g. Nightmares, Flashbacks, Dissociation, Hyperarousal, Numbing, Self-Injury) and provided a coping skill to deal with the symptom (e.g. Grounding, Behavior Scripts, Identifying Feelings, Relaxation Techniques, Anger Management, Assertiveness Training, Rescripting Nightmares.) Five of the participants reported that the groups were “very helpful”. Symptoms improved, as measured by the PTSD Checklist (PCL) and the Disorders of Extreme Stress –Pathological Items (DES-P) interview, and participants’ knowledge, use, and perceived helpfulness of coping skills increased.

POLICY IMPLICATIONS

PSMD with trauma histories appear to be more severely ill than those without trauma experiences. Results of this study indicate that dissociative aspects of PTSD that are experienced by inpatient PSMDs with histories of childhood abuse respond favorably to a cognitive behavioral model. These symptoms should be systematically incorporated into standardized measures of improvement and outcome for this population.

PLANS

We will develop and disseminate a manual for the cognitive behavioral intervention. Items reflecting the symptoms reported by patients in this study will be incorporated into a widely used symptom measure, the Positive and Negative Symptoms of Schizophrenia (PANSS) (Kay and Opler, 1980). The new items will be pilot tested in ongoing studies of PSMD in public sector inpatient and outpatient settings.