A Cognitive-Behavioral Treatment Program for Posttraumatic Stress Disorder in Persons with Severe Mental Illness

Clients with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have high rates of exposure to trauma over their lives, and are at sharply increased risk for the development of posttraumatic stress disorder (PTSD). However, at present there are no validated treatments of PTSD in the SMI population. In this article we describe a new cognitive-behavioral treatment program for PTSD in clients with SMI. We begin with a brief review of the research on trauma and PTSD in clients with SMI. Next, we summarize findings on the treatment of PTSD in the general population, followed by considerations in the development of a treatment program for clients with SMI. We then describe our program, which is based primarily on the principles of cognitive restructuring and involves treatment closely integrated with the ongoing provision of comprehensive services for the SMI. We conclude with a description of how common challenges of working with clients with SMI are handled in the treatment program, including substance abuse, cognitive impairment, and psychosis. Two companion articles to this one provide clinical examples of clients treated in this program (Hamblen, et al., in press) and summarize the results of a pilot study of the program that establish its feasibility and clinical promise (Rosenberg, Mueser, Jankowski, Salyers, & Acker, 2004).