Written exposure therapy for post-traumatic stress disorder in individuals with emergent psychosis: a case series

Background: Emerging psychosis (EP), encompassing both first episode psychosis (FEP) and clinical high-risk states, affects approximately 7–11% of individuals aged 15–30 years. Post-traumatic stress disorder (PTSD) is common in this population and may contribute to the risk of psychotic transition. However, limited data on the feasibility of trauma-focused psychotherapies are available in this underserved population.Objective: To assess the feasibility and preliminary efficacy of written exposure therapy (WET) for the treatment of PTSD among the first patients suffering from EP who underwent routine care.Method: A case series of six patients with EP and comorbid PTSD received WET. PTSD symptom severity (PTSD Checklist for DSM-5) and positive psychotic symptoms (Positive And Negative Syndrome Scale – positive subscale) were assessed pretreatment and at 1–4 weeks post-treatment. Medication was stable for at least 2 weeks prior to therapy.Results: Five of the six patients (83.3%) completed the full WET protocol. Among completers, PTSD symptoms decreased significantly [M (SD) = 63.6 (9.0) to 31.8 (16.0)]. Similar results were observed in the last observation carried forward analysis [M (SD) = 63.7 (8.1) vs 36.0 (17.6)]. No worsening of psychotic symptoms was observed; instead, a non-significant trend towards reduction was noted.Conclusions: Preliminary findings suggest that WET is a feasible, acceptable, and potentially effective intervention for PTSD in patients with EP, without exacerbating psychotic symptoms. These results support the need for larger-scale randomized controlled trials to further evaluate its efficacy and safety in this vulnerable population.