Do trauma-focussed psychological interventions have an effect on psychotic symptoms? A systematic review and meta-analysis

Brand, Rachel; McEnery, Carla; Rossell, Susan L.; Bendall, Sarah; Thomas, Neil

doi:10.1016/j.schres.2017.08.037

Cited by 80 publications

(65 citation statements)

References 44 publications

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“…However, van den report that both prolonged exposure and eye movement desensitization and reprocessing (EMDR) were both effective in the treatment of PTSD in this group. However, subsequent analyses indicated that there was no effect on hearing voices (de Bont et al, 2016), an outcome supported when reviewing the outcomes of both of these trials together (Brand et al, 2018).…”

Section: Introductionmentioning

confidence: 88%

Imagery rescripting for the treatment of trauma in voice hearers: a case series

Paulik

Steel

Arntz

2019

Behav. Cogn. Psychother.

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Background: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent meta-analysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas.Aims: The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms, and (2) voice frequency and distress in voice hearers.Method: We used a single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered in sessions 1–8, post-intervention, and at 3-month follow-up) and longer measures (administered pre-, mid- and post-intervention) were administered. Mixed regression analysis was used to analyse the results.Results: There was one treatment drop-out. Results of the weekly measure showed significant linear reductions over time in all three primary variables – voice distress, voice frequency, and trauma intrusions – all with large effect sizes. These effects were maintained (and continued to improve for trauma intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress.Conclusions: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices.

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Section: Introductionmentioning

confidence: 88%

Imagery rescripting for the treatment of trauma in voice hearers: a case series

Paulik

Steel

Arntz

2019

Behav. Cogn. Psychother.

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“…Recent systematic reviews evaluating a range of trauma-focussed therapies (TFTs) in people with psychosis provide preliminary support for the usefulness and safety of TFTs for the treatment of traumaassociated symptoms of psychosis, and promising effects for the positive symptoms of psychosis (Brand & McEnery, 2018;Swan, Keen, Reynolds, & Onwumere, 2017;Sin & Spain, 2017;Valiente-Gomez et al, 2017). Current literature also suggests that adding TFTs to treatment for people with a psychotic disorder and comorbid PTSD can generate better quality of life, and reduce costs from shorter hospital admissions than the current standard treatment for psychosis (de Bont et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of psychosis: a systematic review

Adams

Ohlsen

Wood

2020

European Journal of Psychotraumatology

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Background: Psychosis is a public health concern. There is increasing evidence suggesting trauma can play a pivotal role in the development and maintenance of psychosis. Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for trauma and could be a vital addition to the treatment of psychosis. Objective: To explore the evidence for EMDR as a treatment for psychosis, focussing on the safety, effectiveness and acceptability of this intervention for this population. Methods: Four databases (Cochrane, EMBASE, MEDLINE PsychINFO), and the Francine Shapiro Library were systematically searched, along with grey literature and reference lists of relevant papers. No date limits were applied as this is an area of emerging evidence. Studies were screened for eligibility based on inclusion and exclusion criteria. The included studies were quality assessed and data was extracted from the individual studies, and synthesized using a narrative synthesis approach. Results: Six studies met the inclusion criteria (1 RCT, 2 Pilot studies, 2 Case series and 1 Case report). Across the studies EMDR was associated with reductions in delusional and negative symptoms, mental health service and medication use. Evidence for reductions in auditory hallucinations and paranoid thinking was mixed. No adverse events were reported, although initial increases in psychotic symptoms were observed in two studies. Average dropout rates across the studies were comparable to other trauma-focused treatments for PTSD. The acceptability of EMDR was not adequately measured or reported. Conclusion: EMDR appears a safe and feasible intervention for people with psychosis. The evidence is currently insufficient to determine the effectiveness and acceptability of the intervention for this population. Larger confirmative trials are required to form more robust conclusions.

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“…Interestingly, few changes were seen in secondary measures of psychotic experience, raising questions about the role of intrusions in the maintenance of psychosis. A recent review of the impact of trauma interventions on psychosis found small effects on positive symptoms that were not maintained at follow-up, and small effects on trauma symptoms that were only significant at follow-up (Brand et al, 2018). A case series of imagery rehearsal for nightmares in people with psychosis also found reductions in nightmare-related distress but not psychosis (Sheaves et al, 2015), and a clinical case series of imaginal reprocessing based on individualized formulation of people's trauma and psychosis showed promising results, although more conclusively in measures of trauma than psychosis (Keen et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes

Newman‐Taylor

McSherry

Stopa

2019

Behav. Cogn. Psychother.

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Background:Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base.Aims:This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions – memory characteristics and self-representations – and level of paranoia.Method:We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data.Results:As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up.Conclusions:While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

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Do trauma-focussed psychological interventions have an effect on psychotic symptoms? A systematic review and meta-analysis

Cited by 80 publications

References 44 publications

Imagery rescripting for the treatment of trauma in voice hearers: a case series

Imagery rescripting for the treatment of trauma in voice hearers: a case series

Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of psychosis: a systematic review

Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes

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