Objective Increasing evidence suggests experiences of childhood trauma may be causally related to the development of hallucinations. Cognitive theories of psychosis suggest post‐traumatic intrusions to be a primary mechanism in this relationship. These theories predict that the content of hallucinations will be related to traumatic experiences; however, few studies have investigated this. This study examined the relationship between childhood trauma, the content of hallucinations, and the content of post‐traumatic intrusions in a sample with first‐episode psychosis. Methods Sixty‐six young people aged 15–25 experiencing a first episode of psychosis were recruited from an early intervention service. Participants completed assessments of traumatic experiences, hallucination content, and post‐traumatic intrusion content using a systematic coding frame. The coding frame assessed for three types of relationships between traumatic experiences, the content of hallucinations, and the content of post‐traumatic intrusions: direct relationships (hallucination content exactly matching the trauma/intrusion), thematic relationships (hallucinations with the same themes as the trauma/intrusion), and no relationship (hallucination and trauma/intrusion content unrelated). Results Of those people who reported trauma and hallucinations (n = 36), 22 of these (61%) experienced post‐traumatic intrusions, and of these, 16 (73%) experienced hallucinations that were directly or thematically related to their post‐traumatic intrusions. Twelve people experienced hallucination content directly related to their trauma, six of whom (50%) also had intrusions relating to the same traumatic event as their hallucinations. Conclusions The finding that some people experience hallucinations and post‐traumatic intrusions relating to the same traumatic event supports theories proposing a continuum of memory intrusion fragmentation. These results indicate that early intervention services for young people with psychosis should provide assessment and intervention for trauma and PTSD and should consider the impact of past traumatic events on the content of current hallucinatory experience. Practitioner points Trauma and post‐traumatic stress disorder should be assessed in those experiencing a first episode of psychosis. Interventions for trauma should be offered in early intervention for psychosis services. In a notable proportion of people, hallucination content is related to traumatic experiences. Clinical assessment and formulation of hallucinations requires consideration of how past traumatic events may be contributing to hallucinatory experience. It is important for clinicians to have an understanding of the phenomenological differences between hallucinations and post‐traumatic intrusions when conducting clinical assessments with people with comorbid psychosis and PTSD.

Objective There is increasing evidence that childhood trauma may play a role in the aetiology of psychosis. Cognitive models implicate trauma‐related symptoms, specifically post‐traumatic intrusions and trauma‐related beliefs as primary mechanisms, but these models have not been extensively tested. This study investigated relationships between childhood trauma, psychotic symptoms (hallucinations and delusions), post‐traumatic intrusions, and trauma‐related beliefs while accounting for comorbid symptoms. Methods Sixty‐six people with first episode psychosis aged between 15 and 24 years were assessed for hallucinations, delusions, childhood trauma, post‐traumatic intrusions, post‐traumatic avoidance, and trauma‐related beliefs. Results Fifty‐three per cent of the sample had experienced childhood trauma, and 27% met diagnostic criteria for post‐traumatic stress disorder. Both post‐traumatic intrusions and trauma‐related beliefs mediated the relationships between childhood trauma and hallucinations, and childhood trauma and delusions. Multiple regression analyses revealed that post‐traumatic intrusions (but not childhood trauma, post‐traumatic avoidance, or trauma‐related beliefs) were independently associated with hallucination severity (β = .53, p = .01). Post‐traumatic intrusions and trauma‐related beliefs (but not childhood trauma or post‐traumatic avoidance) were independently associated with delusion severity (β = .67, p < .01 and β = .34, p < .01, respectively). Conclusions These findings support cognitive models that implicate post‐traumatic intrusions in hallucination aetiology, and post‐traumatic intrusions and trauma‐related beliefs in delusion aetiology. The results suggest that trauma and post‐traumatic stress disorder, including trauma‐related beliefs, should be addressed in the assessment and treatment of people with early psychosis. Practitioner points Trauma and post‐traumatic stress disorder, including trauma‐related beliefs, should be addressed in the assessment and treatment of people with early psychosis. Routine assessment of childhood trauma and PTSD in clinical services dealing with young people with first episode psychosis is needed. These findings support cognitive models of trauma and hallucinations and delusions.

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Aim Increasing evidence suggests that childhood trauma and dissociation are associated with psychotic symptoms and disorders. Significant rates of dissociative disorders and clinical levels of dissociative symptoms are found in chronic schizophrenia. To date, no studies have examined the prevalence of these in a first episode psychosis (FEP) group. This study aimed to investigate the prevalence of dissociative disorders and symptoms in a FEP sample as well as the prevalence of severe dissociative symptoms in those with or without experiences of childhood trauma. Methods Sixty‐six young people with FEP completed a research interview which included the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) Axis I Disorders, Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM‐IV Dissociative Disorders‐Revised. Results Dissociative symptoms at clinical levels were found in 36.4% of the sample. Furthermore, 13.6% of the sample met diagnostic criteria for a lifetime dissociative disorder. Significant differences in the frequency of clinical dissociative symptoms between those with or without childhood trauma were also found. Conclusions Dissociative symptoms should be routinely assessed for in early intervention settings, especially in cases where childhood trauma is disclosed or suspected. Where present, dissociative symptoms should also be incorporated into subsequent case formulation and treatment planning.

IntroductionPost-traumatic stress disorder (PTSD) and substance use disorder frequently co-occur and tend to have their onset during adolescence. Although research has highlighted the importance of treating these disorders in an integrated fashion, there is a dearth of empirically validated integrated treatment options for adolescents with this comorbidity. This paper describes the study protocol for a randomised controlled trial (RCT) examining the efficacy of an integrated trauma-focused cognitive–behavioural treatment for traumatic stress and substance use among adolescents (Concurrent Treatment of PTSD and Substance Use Using Prolonged Exposure - Adolescent (COPE-A)), relative to a supportive counselling control condition (Person-Centred Therapy (PCT)).Methods and analysisA two-arm, parallel, single-blind RCT with blinded follow-up at 4 and 12 months poststudy entry will be conducted in Sydney, Australia. Participants (n~100 adolescents aged 12–18 years) and their caregivers (caregiver participation is optional) will be allocated to undergo either COPE-A or PCT (allocation ratio 1:1) using minimisation. Both therapies will be delivered individually by project psychologists over a maximum of 16 sessions of 60–90 min duration and will include provision of up to four 30 min optional caregiver sessions. The primary outcome will be between-group differences in change in the severity of PTSD symptoms from baseline to 4-month follow-up, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents for DSM-5.Ethics and disseminationEthical approval has been obtained from the human research ethics committees of the Sydney Children’s Hospital Network (HREC/17/SCHN/306) and the University of Sydney (HREC 2018/863). Findings will be published in peer-reviewed journals and presented at scientific conferences.Trial registration numberACTRN12618000785202; Pre-reults.Protocol versionVersion 1, 31 July 2017.

Traditional interpretations of the bias have suggested that anxious people are hypervigilant to threat; that is, their attention orients more quickly towards threatening stimuli. Recent research has questioned the validity of this interpretation, suggesting that difficulty disengaging attention from threat might play a role in the attentional bias. A limited number of experimental paradigms have differentiated between hypervigilance and difficulty disengaging. In this study, 169 undergraduate students completed an emotional Stroop task to investigate the presence of an attentional bias to threat, and a lexical decision task to differentiate between hypervigilance and difficulty disengaging. Hypotheses regarding the emotional Stroop task were partially supported; Stroop effects were found in some, but not all, of the threat-types investigated. Lexical decision task results lent support for the hypervigilance hypothesis. Anxiety levels did not predict the extent of the attentional bias. Results are discussed in relation to future directions for attentional bias research.

Purpose Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur (PTSD+SUD). The onset of these disorders often occurs during adolescence. There is limited understanding of the perspectives of service providers working with this population. The purpose of this paper is to identify the practices, attitudes, experiences and training needs of Australian service providers treating adolescents with PTSD+SUD. Design/methodology/approach Service providers in Australia were invited to complete an anonymous online survey regarding their experiences working with adolescents who have PTSD+SUD. Ninety participants completed the 48-item survey that comprised multiple choice and open-ended questions. Findings Service providers estimated that up to 60 per cent of their adolescent clients with PTSD also have SUD. They identified case management, engaging with caregivers and difficult client emotions as specific challenges associated with working with this population. Despite this, providers rated treating PTSD+SUD as highly gratifying for reasons such as teaching new coping skills, developing expertise and assisting clients to achieve their goals. There were mixed perspectives on how to best treat adolescents with PTSD+SUD, and all participants identified a need for evidence-based resources specific to this population. Originality/value This is the first survey of Australian service providers working with adolescents who experience PTSD+SUD. The findings improve our understanding of the challenges and rewards associated with working with this population, and provide valuable information that can enhance clinical training and guide the development of new treatment approaches for this common and debilitating comorbidity.

Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) occur frequently as comorbid diagnoses among adolescents. Historically, these conditions have been treated using a sequential model; however, emerging evidence suggests that an integrated treatment model may be most effective. This article presents two de-identified clinical case studies from an ongoing randomised controlled trial examining the efficacy of an integrated, exposure-based, cognitive-behavioral psychotherapy (CBT) for PTSD and SUD among adolescents (COPE-A), relative to a supportive counselling control condition (person-centred therapy). In both case studies, participants were randomised to receive the COPE-A integrated treatment, which incorporates prolonged exposure (PE) including imaginal and in vivo exposure as a core treatment component alongside CBT for PTSD and SUD. The clinical profile and treatment response of each participant is discussed. Promising results were found in both cases, with substantially reduced traumatic stress symptoms and decreased or stable levels of substance use by the end of treatment. Clinical implications of these early findings are discussed.