The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis

Panayi, Peter; Berry, Katherine; Sellwood, William; Campodonico, Carolina; Bentall, Richard P.; Varese, Filippo

doi:10.3389/fpsyg.2022.791996

Cited by 6 publications

(3 citation statements)

References 89 publications

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“…Complex trauma can also result from multiple exposures to different traumas, which is especially relevant for the CHR population given the role of multiple trauma exposures in increased risk for developing a psychotic disorder. In fact, compared to PTSD, a diagnosis of cPTSD was found to be four times more common in a sample of individuals with psychosis ( 54 ). From a treatment perspective, this emphasizes the need for considerations beyond traditional PTSD symptoms.…”

Section: Unique Considerations In Trauma Treatments In Those With a C...mentioning

confidence: 99%

History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis

2023

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People meeting criteria for a clinical high-risk (CHR) for psychosis syndrome frequently represent a heterogeneous, help-seeking, and dynamic population. Among the numerous symptoms and risk factors for psychosis, exposure to trauma stands out as both highly prevalent and poorly understood. Indeed, while up to 80% of individuals meeting criteria for a CHR syndrome report trauma histories, there is currently limited research dedicated to this specific area. This is particularly problematic as trauma is tied to risk for conversion, leads to a range of clinical issues, and contributes to disability and poor quality of life. Fortunately, recent research in the general population has led to a significant evolution in the way trauma is assessed and understood, and further, some studies have indicated that targeted trauma interventions in formal psychotic disorders are highly effective. However, direct adoption is challenging as the CHR syndrome holds a number of unique concerns (e.g., clinical heterogeneity, developmental trauma), and characteristically, involves a developing pediatric or young adult population that also comes with specific considerations (e.g., living with caregivers, transitionary period in roles). In this “perspective” we frame the issues around understanding trauma in CHR individuals, discuss viable treatments and unique considerations, and provide suggestions for future steps in developing and incorporating trauma-focused interventions in this population.

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Section: Unique Considerations In Trauma Treatments In Those With a C...mentioning

confidence: 99%

History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis

2023

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“…These lead to a range of safety‐seeking responses (cognitive, behavioural and interpersonal) that, while understandable, may paradoxically maintain a sense of threat. It is of note that these models can, therefore, support understanding of the role of both PTSD and complex PTSD mechanisms in psychosis, given the defining characteristic of the latter (i.e ‘disturbances of self‐organisation’) consists of negative beliefs about the self, interpersonal problems and emotional regulation difficulties (Panayi et al, 2022; ICD 11, WHO, 2021). Indeed, EASE (a UK feasibility RCT of EMDRp) is the first trial of a trauma‐focused therapy for psychosis to have incorporated a standardised assessment of complex PTSD and, while not powered to detect effects, found encouraging indications of efficacy (Varese et al, 2023).…”

Section: Research and Clinical Issues In Trauma Therapies For Psychosismentioning

confidence: 99%

Trauma therapies for psychosis: A state‐of‐the‐art review

Hardy,

Keen,

van den Berg

et al. 2023

Psychol Psychother

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BackgroundTraumatic events, particularly childhood interpersonal victimisation, have been found to play a causal role in the occurrence of psychosis and shape the phenomenology of psychotic experiences. Higher rates of post‐traumatic stress disorder (PTSD) and other trauma‐related mental health problems are also found in people with psychosis diagnoses compared to the general population. It is, therefore, imperative that therapists are willing and able to address trauma and its consequences when supporting recovery from distressing psychosis.MethodThis paper will support this need by providing a state‐of‐the‐art overview of the safety, acceptability and effects of trauma therapies for psychosis.ResultsWe will first introduce how seminal cognitive‐behavioural models of psychosis shed light on the mechanisms by which trauma may give rise to psychotic experiences, including a putative role for trauma‐related emotions, beliefs and episodic memories. The initial application of prolonged exposure and eye movement and desensitation and reprocessing therapy (EMDR) for treating PTSD in psychosis will be described, followed by consideration of integrative approaches. These integrative approaches aim to address the impact of trauma on both post‐traumatic stress symptoms and trauma‐related psychosis. Integrative approaches include EMDR for psychosis (EMDRp) and trauma‐focused Cognitive‐Behavioural Therapy for psychosis (tf‐CBTp). Finally, emerging dialogic approaches for targeting trauma‐related voice‐hearing will be considered, demonstrating the potential value of adopting co‐produced (Talking with Voices) and digitally augmented (AVATAR) therapies.ConclusionWe will conclude by reflecting on current issues in the area, and implications for research and clinical practice.

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“…past research (e.g. Panayi et al, 2022;Rodrigues & Anderson, 2017). Future evaluations of trauma therapies in patients with psychosis may benefit from using similarly broad inclusion criteria.…”

Section: Psychological Medicinementioning

confidence: 99%

Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings

Varese,

Sellwood,

Pulford

et al. 2023

Psychol. Med.

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Background Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. Methods A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the ‘promise of efficacy’ of EMDRp on relevant clinical outcomes. Results Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. Conclusions The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.

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The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis

Cited by 6 publications

References 89 publications

History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis

History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis

Trauma therapies for psychosis: A state‐of‐the‐art review

Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings

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