Distress, trauma, and recovery: Adjustment to first episode psychosis

Abstract

Objective. To understand the experiences that people with early psychosis are adjusting to and their perceived barriers to recovery. Method. Semi‐structured interviews were conducted with eight participants. Grounded Theory was applied to the design and analysis. Sampling and coding ceased when saturation of the data was reached. Respondent validation was sought from participants. Results. A theoretical model was developed using Strauss and Corbin's (1998) framework. A core category of distress was elicited, which was evident in all participants’ accounts of their recovery. Overall six main categories were identified and it was proposed that individuals were adjusting to the distress of past experiences, uncertainty, a challenged identity, being in a psychiatric system, the reaction of others and social disadvantage. Conclusions. Recovery from the distress and trauma of early psychosis does not simply involve adjustment to and recovery from a single experience or set of symptoms. The results are discussed in relation to trauma, developmental, and social inequality frameworks. Specific implications for clinical practice include incorporating the findings within formulations, developing interventions that focus on trauma, identity, and uncertainty as well as addressing the social and systemic issues identified. Practitioner Points Recovery from early psychosis is multi‐faceted. Psychological formulations should seek to consider individual, social, and systemic factors influencing an individual's distress to more fully conceptualize what an individual's adjustment to early psychosis may involve. Services and wider systems should consider iatrogenic processes, which may contribute to and maintain the distress experienced by those with early psychosis. Education programmes that look to contextualize psychosis within a meaningful framework may help to develop understanding within wider society where a lack of knowledge and understanding serves to reinforce an individual's sense of exclusion and difference.

Sources of Distress in First-Episode Psychosis: A Systematic Review and Qualitative Metasynthesis

“…I didn’t understand what was happening to me, I didn’t understand what I was seeing. (Tan et al, 2014, p. 87)…”

“…Recalling incidents such as the one described above continued to cause participants distress long after the event. For example, some participants attributed ongoing problems with depression and suicidal thoughts to traumatic incidents, or described engaging in substance use as a means of escaping from painful memories (Tan et al, 2014). Other participants described how they thought abusive experiences had adversely affected their development.…”

“…There is now a growing body of qualitative research that explores the lived experience of FEP. These studies give an insight into topics as diverse as adjustment after FEP (Tan, Gould, Combes, & Lehmann, 2014), cannabis use (Childs, McCarthy-Jones, Rowse, & Turpin, 2011), and pathways to care (Ferrari et al, 2015). Within these qualitative studies, there exist firsthand accounts of distress from people who have experienced psychosis.…”

Identity in Personal Recovery for Mothers With a Mental Illness

“…This was associated with socio-economics, parenting styles and difficulty infiltrating closed (well-established) social groups. Feeling disconnected, socially isolated and “different” is a common experience for mothers with mental illness [e.g., (42)] and is considered a barrier to both sustaining a positive social identity and to recovery (43) and wellbeing more generally (41).…”

“…Elevating the significance of identity and self may reveal areas of intervention that can support more flexible, nuanced and realistic expectations surrounding women's multiple roles and activities. Identity work, integrating past experiences that may challenge individual's assumptions regarding their identity (43) and reflecting on emotional and behavioral responses, is acknowledged as a core component of the recovery process (1, 48).…”