Exposing therapists to trauma-focused treatment in psychosis: effects on credibility, expected burden, and harm expectancies

BACKGROUND: Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment. OBJECTIVE: This feasibility study explores the impact of specialized training on therapists’ beliefs about trauma-focused treatment within a randomized controlled trial. METHOD: Therapist-rated (n=16) credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed. RESULTS: Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists’ expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD) in patients with psychotic disorders (n=79), pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists. CONCLUSIONS: These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists’ credibility, burden, and harm beliefs concerning trauma-focused treatment. HIGHLIGHTS OF THE ARTICLE: Specialized training improved therapists’ credibility, burden, and harm beliefs. Patients’ symptom severity and treatment outcome did not affect these beliefs. Replication of our findings in larger cohorts with a control group is warranted.