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Bloomfield MAP, Yusuf FNIB, Srinivasan R, Kelleher I, Bell V, Pitman A. Trauma-informed care for adult survivors of developmental trauma with psychotic and dissociative symptoms: a systematic review of intervention studies. Lancet Psychiatry 2020; 7:449-462. [PMID: 32004444 DOI: 10.1016/s2215-0366(20)30041-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 12/29/2022]
Abstract
Developmental trauma is associated with an increased risk of psychosis and predicts poor prognosis. Despite this association, little is known about which treatments work best for survivors of developmental trauma with psychosis. We sought to do the first review, to our knowledge, to investigate treatments for people with psychotic and dissociative symptoms who have a history of developmental trauma. We searched MEDLINE, PsychINFO, and Google Scholar for studies reporting psychological and pharmacological treatments of psychotic or dissociative symptoms in adult survivors of developmental trauma. We identified 24 studies, most of which investigated various modalities of psychotherapy with two case reports of pharmacological treatments. There is preliminary evidence in favour of third wave cognitive therapies. However, because of low methodological quality and reporting in most of the studies found, it remains unknown which treatments are most effective in this clinical group. Nonetheless, our findings of potential treatment targets, including emotion regulation, acceptance, interpersonal skills, trauma re-processing, and the integration of dissociated ego states, could guide future work in this area. Methodologically rigorous studies are needed to enable clinicians and patients to collaboratively form evidence-based treatment plans. Our Review is registered with PROSPERO, number CRD42018104533.
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Affiliation(s)
- Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, University College London, London, UK; Division of Psychiatry, University College London, Institute of Mental Health, and Clinical Psychopharmacology Unit, Research Department of Clinical and Health Psychology, Division of Psychology, University College London, London, UK; The Traumatic Stress Clinic, Camden and Islington NHS Foundation Trust, London, UK; St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK; National Hospital for Neurology and Neurosurgery, London, UK.
| | - Fatin N I B Yusuf
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, University College London, London, UK
| | - Ramya Srinivasan
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, University College London, London, UK
| | - Ian Kelleher
- Royal College of Surgeons in Ireland, Department of Psychiatry, Dublin, Ireland
| | - Vaughan Bell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- Epidemiology and Applied Clinical Research Department, University College London, London, UK; The Huntley Centre, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College Hospital, London, UK
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