New research: Improving access to trauma-focused therapy for people with psychosis | News and Events

By Amy Hardy and Eleanor Longden

Sadly, traumatic events are common in society, but some groups, including people with psychosis, are more likely to experience them.^[1] The result is that people with psychosis are five times more likely to have diagnosed Post-Traumatic Stress Disorder (PTSD) than the general population.^[2] 

What’s more, these figures do not include people who have symptoms of PTSD but no formal diagnosis, or other trauma-related symptoms. Despite this, people with psychosis often cannot access trauma-focused therapies.^[3]

This lack of treatment options is partly due to concerns from clinicians about people with psychosis being able to tolerate the emotional burden associated with processing traumatic memories. There is also a lack of evidence-based clinical guidelines and pathways for trauma-focused therapy for people with psychosis. Building on previous research which suggests that trauma-focused therapies are safe and suitable for treating PTSD symptoms in people with psychosis,^[4] our recent study examined how trauma-focused Cognitive Behavioural Therapy (CBT) can be implemented in routine care.

The results were positive. After treatment, there was a reduction in PTSD symptoms in 68.8 percent of participants, with 37.5 percent no longer meeting the threshold for clinically significant PTSD. Interviews with participants found that while the process was often emotionally challenging, there was a desire and commitment to persevere with the treatment, especially when there was a supportive therapeutic relationship.

We hope this study will help overcome clinician’s concerns about the use of trauma-focused therapy for people with psychosis, and encourage them to implement these therapies in their local services, ultimately widening access to treatments for this group.

 

If you’d like to find out more about these topics, we recommend the following further reading:

Hardy A. Pathways from trauma to psychotic experiences: a theoretically informed model of posttraumatic stress in psychosis. Front Psychol. (2017) 8:679. doi: 10.3389/fpsyg.2017.00697

Swan S, Keen N, Reynolds N, Onwumere J. Psychological interventions for post-traumatic stress symptoms in psychosis: a systematic review of outcomes. Front Psychol. (2017) 2017:8. doi: 10.3389/fpsyg.2017.00341

van den Berg D, van de Giessen I, Hardy A. Trauma therapies in psychosis. A Clinical Introduction To Psychosis. In: Badcock J, Paulik-White G editors. Academic Press (2020). p. 447–63.

 

^{[1] Grubaugh AL, Zinzow HM, Paul L, Egede LE, Frueh BC. Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clin Psychol Rev. (2011) 31:883–99.}

^{[2] de Bont PA, van den Berg DPG, van der Vleugel BM, de Roos C, de Jongh A, van der Gaag M, et al. Predictive validity of the trauma screening questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. Br J Psychiatry. (2015) 206:408–16. doi: 10.1192/bjp.bp.114.148486}

^{[3] Meyer JM, Farrell NR, Kemp JJ, Blakey SM, Deacon BJ. Why do clinicians exclude anxious clients from exposure therapy? Behav Res Ther. (2014) 54:49–53. doi: 10.1016/j.brat.2014.01.004}

^{[4] Swan S, Keen N, Reynolds N, Onwumere J. Psychological interventions for post-traumatic stress symptoms in psychosis: a systematic review of outcomes. Front Psychol. (2017) 2017:8. doi: 10.3389/fpsyg.2017.00341}