Trauma Within Psychosis: Using a CBT Model for PTSD in Psychosis

Abstract

Trauma within psychosis is often undiagnosed or untreated. There is a wide body of literature on the efficacy of cognitive behaviour therapy (CBT) for post-traumatic stress disorder (PTSD), but there has been no report of combining CBT for psychosis and CBT for PTSD in modular form. The authors discuss a combined treatment for two patients with psychosis and a history of trauma. The clinical features, process of therapy, and outcome are all described in relation to cognitive therapy models developed for use in PTSD. The implications for therapy, service development, and training are discussed.

Making Sense of Voices: An Exploration of Meaningfulness in Auditory Hallucinations in Schizophrenia

“…However, for the most part, the treatment of schizophrenia precludes the influence of psychological and/ or emotional trauma as being critical in the development of schizophrenia. As Callcott, Standart, and Turkington (2004) have documented, "trauma within psychosis is often missed, and even when it is noted, individuals are not offered specific psychological interventions to treat the trauma memory" (p. 244). This implies that apart from employing the medical model, the treatment of schizophrenia should also consider and establish ways in which the possible role of trauma can be assessed to develop more effective treatment models.…”

Post‐traumatic stress disorder in a person with a diagnosis of schizophrenia: Examining the efficacy of psychological intervention using single N methodology

“…In particular, psychological intervention in this case was adapted for a person who was not in the acute phase of psychosis, and the traumatic event was not identified as a possible precipitant of the onset of psychosis. This contrasts markedly with cases of 'traumatic-psychosis' (Callcott & Turkington, 2002;Kingdon & Turkington, 1991), where the interaction between trauma exposure and subsequent psychosis has important implications for integrating psychosocial interventions in psychosis and psychological interventions for PTSD (Callcott et al, 2004). For patients with an ongoing psychosis, preparatory work based around stress-inoculation models may be necessary and concurrent assessment of symptoms of psychosis would be indicated.…”

“…There are single case presentations attesting to the efficacy of cognitivebehavioural intervention and eclectic treatment approaches in patients with SMHP, PTSD, and a history of sexual and physical abuse (Harris, 1996;Mueser & Taylor, 1997) and stress inoculation, cognitive restructuring (CR) and exposure techniques in PTSD with co-morbid major depression using single case methodology (Nishith, Hearst, Mueser, & Foa, 1995). More recently, Callcott, Standart, and Turkington (2004) have presented case studies of psychological interventions in 'traumatic psychosis' informed by psychological approaches to understanding PTSD and associated interventions. There are, however, different 'routes' to PTSD in persons with a history of psychosis (e.g., childhood trauma-induced psychosis versus adult victimization post-dating the onset of psychosis); hence, the examination of psychological intervention in different populations is of pertinence.…”

“…As exemplified in the work of Callcott et al (2004), there is a wide literature regarding PTSD in the general population on which to draw upon when formulating the onset, development and maintenance of PTSD in persons with SMHP and planning intervention. The efficacy of cognitivebehavioural interventions for PTSD in the general population has been validated, comprising variations on psycho-education, in-vivo and imaginal exposure, stress-inoculation and anxiety management techniques and CR (Harvey, Bryant, & Tarrier, 2003).…”

Clinical and psychosocial significance of trauma history in schizophrenia spectrum disorders

“…Reduction in general subjective distress, as well as depression and PTSD, symptoms are reported. Callcott and Turkington have similarly reported on the successful modification and applications of cognitive-behavioral therapy in two cases of individuals with psychosis who also suffered from PTSD [43]. Finally, Lysaker and Gumley have reported another case study of an adult with schizophrenia and a history of severe sexual and physical trauma [44].…”