Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes

Abstract

Individuals with severe mental health problems, such as psychosis, are consistently shown to have experienced high levels of past traumatic events. They are also at an increased risk of further traumatisation through victimization events such as crime and assault. The experience of psychosis itself and psychiatric hospitalization have also been recognized to be sufficiently traumatic to lead to the development of post-traumatic stress (PTS) symptoms. Rates of post-traumatic stress disorder (PTSD) are elevated in people with psychosis compared to the general population. The current guidance for the treatment of PTSD is informed by an evidence base predominately limited to populations without co-morbid psychiatric disorders. The systematic review therefore sought to present the current available literature on the use of psychological treatments targeting PTS symptoms in a population with a primary diagnosis of a psychotic disorder. The review aimed to investigate the effect of these interventions on PTS symptoms and also the effect on secondary domains such as psychotic symptoms, affect and functioning. Fifteen studies were identified reporting on cognitive behavior therapy, prolonged exposure, eye movement desensitisation and reprocessing and written emotional disclosure. The review provides preliminary support for the safe use of trauma-focused psychological interventions in groups of people with severe mental health problems. Overall, the interventions were found to be effective in reducing PTS symptoms. Results were mixed with regard to secondary effects on additional domains. Further research including studies employing sufficiently powered methodologically rigorous designs is indicated.

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

“…This systematic review adds to the growing body of evidence that supports the use of trauma-focused interventions for individuals experiencing psychosis (Swan et al, 2017;Sin & Spain, 2017;Valiente-Gomez et al, 2017). Despite exciting results highlighting the potential benefits of EMDR for the treatment of psychosis, the lack of definitive, high-powered RCTs found, limits any conclusions on the overall effectiveness.…”

“…There is increasing evidence to suggest that psychosis often occurs in people with a significant history of traumas. Although there is still limited research into the use of EMDR for people with psychosis, early indications suggest that it has potential to be a safe and beneficial intervention for this population (Swan et al, 2017;Sin & Spain, 2017;Valiente-Gomez et al, 2017).…”

“…Similar to Swan et al's (2017) systematic review of psychological interventions for post-traumatic stress symptoms in psychosis, a strength of this review is the broad search strategy facilitating the inclusion of a variety of study designs. A broad search strategy ensured that no potentially relevant studies were missed, and an inclusive review was produced incorporating all relevant findings within the current literature irrespective of study design.…”

“…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).…”

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

“…In outpatient and community mental health settings, treatments addressing the effects of trauma in those with psychosis have focused on trauma-specific approaches, which have been shown to be effective in reducing PTSD symptoms (Brand, McEnery, Rossell, Bendall, & Thomas, 2017;Swan, Keen, Reynolds, & Onwumere, 2017). These treatments have in common the main mechanism of targeting trauma memories to evoke and promote emotional processing (Schnyder et al, 2015).…”