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

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).

Das Weddinger Modell

“…Besondere Relevanz erlangt die Vermeidung von Zwangsmaßnahmen gerade im Hinblick auf die hohen Prävalenzen für Gewalterfahrungen in Kindheit und Jugend bei Menschen mit Psychosen [10,13]. Zwangsmaßnahmen stellen immer einen wesentlichen Eingriff in die Freiheitsrechte einer Person dar und ihre traumatisierende Wirkung ist vielfach belegt.…”

“…Bei Personen mit bestehender (traumatisierender) Gewalterfahrung bergen sie darüber hinaus ein enormes Retraumatisierungsrisiko. Auch wird die Psychose zunehmend als mögliche Reaktion auf traumatische Erfahrungen verstanden [10,14,15]. Die psychiatrische Behandlung muss vor diesem Hintergrund nicht nur im Hinblick auf ihre Wirksamkeit, sondern insbesondere auch hinsichtlich ihrer Schädigungsfreiheit betrachtet werden [16].…”

“…Gemessen mit der deutschen Version der Impact of Events Scale (IES-R) [17] zeigen sich signifikant weniger Intrusion und Hyperarousal bei standardisierter Nachbesprechung im Vergleich zur nicht standardisierten üblichen Art der Nachbesprechung. Dabei unterschieden sich Interventions-und Kontrollgruppe nicht im Hinblick auf den durch die Zwangsmaßnahme ausgelösten peritraumatischen Stress [10]. Diese Ergebnisse weisen darauf hin, dass insbesondere bei Menschen mit psychotischen Erkrankungen die spezielle Form der gemeinsamen Reflexion stattgefundener Zwangsmaßnahmen das Risiko reduziert, eine PTBS zu entwickeln, auch wenn die Zwangsmaßnahme zunächst als sehr belastend und potenziell traumatisierend erlebt wurde.…”

Building up resilience in an uncertain world: mental health challenges in the aftermath of the first modern pandemic

“…In this vein, the study by Wullschleger et al [ 9 ] in this issue examines the impact of standardized post-coercion review sessions as an easy-to-implement preventative interventions directed at mitigating the experience of distress and post-traumatic symptoms in individuals with psychosis who underwent coercive measures (e.g., mechanical restraint or isolation) in an inpatient setting, using a randomized controlled trial design. Coercion in psychiatric care is a potentially traumatic experience leading to the development of pervasive and invalidating post-traumatic symptoms.…”

“…Coercion in psychiatric care is a potentially traumatic experience leading to the development of pervasive and invalidating post-traumatic symptoms. A total of 70% of participants in the Wullschleger et al [ 9 ] study presented post-traumatic reactions to coercion with 20% having a high probability of post-traumatic stress disorder (PTSD), highlighting the importance of careful management of these experiences and related PTSD. These authors demonstrated that post-coercion review sessions can be an effective way to overcome distress and prevent the development of PTSD symptoms in individuals with psychosis in comparison with the control group.…”