Effect of standardized post-coercion review session on symptoms of PTSD: results from a randomized controlled trial

Alexandre Wullschleger, Angelika Vandamme, Juliane Mielau, Lara Renner, Felix Bermpohl, Andreas Heinz, Christiane Montag, Lieselotte Mahler, Alexandre Wullschleger, Angelika Vandamme, Juliane Mielau, Lara Renner, Felix Bermpohl, Andreas Heinz, Christiane Montag, Lieselotte Mahler

Abstract

Objective: Post-coercion review is increasingly regarded as a mean to reduce the negative consequences of coercive interventions, including the development of posttraumatic symptoms. However, the efficacy of this intervention in preventing posttraumatic symptoms or PTSD has not been sufficiently studied. The objective of this study is to examine the influence of a single, standardized post-coercion review session on the development or exacerbation of PTSD symptoms in patients with psychotic disorders.

Methods: In a multi-center, two-armed, randomized controlled trial, patients who experienced coercive interventions during current hospitalization were either randomized to standard treatment or an intervention group receiving a guideline-based, standardized reflecting review session. Factorial MANCOVA and subsequent ANCOVAs investigated the effects of the post-coercion reflecting review session on post-traumatic symptoms as measured by the subscales of the Impact of Events Scale-Revised (IES-R). Similarly, the effect of the intervention on the intensity of the peritraumatic reactions measured by the Peritraumatic Distress Inventory (PDI) was analyzed by conducting a factorial ANCOVA.

Results: N = 82 patients were included in an intention-to-treat analysis. MANCOVA and post hoc ANCOVAs revealed a significant main effect of the intervention for the IES-R subscales intrusion and hyperarousal, when controlling for levels of peritraumatic distress, whereby intervention group participants presented lower respective mean scores. There was no significant difference regarding the intensity of the peritraumatic reaction.

Conclusion: Standardized post-coercion review contributes to a reduction of the burden of PTSD symptoms in patients with psychotic disorders experiencing coercive interventions in acute settings and shall be recommended as a measure of trauma-informed care. The trial was registered at ClinicalTrials.gov (ID NCT03512925) on 01/30/2018 (retrospectively registered).

Keywords: Coercion; PTSD; Post coercion review; Psychosis; Trauma.

Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

© 2020. The Author(s).

Figures

Fig. 1
Fig. 1
Study flowchart (adapted from the CONSORT diagram)

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