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Varese F, Sellwood W, Pulford D, Awenat Y, Bird L, Bhutani G, Carter LA, Davies L, Aseem S, Davis C, Hefferman-Clarke R, Hilton C, Horne G, Keane D, Logie R, Malkin D, Potter F, van den Berg D, Zia S, Bentall RP. Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings. Psychol Med 2024; 54:874-885. [PMID: 37882058 DOI: 10.1017/s0033291723002532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
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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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Daniel Pulford
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Leanne Bird
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Gita Bhutani
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Lesley-Anne Carter
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Saadia Aseem
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Claire Davis
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | | | - Claire Hilton
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Georgia Horne
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - David Keane
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Robin Logie
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Debra Malkin
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Fiona Potter
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | | | - Shameem Zia
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Richard P Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Hardy A, Keen N, van den Berg D, Varese F, Longden E, Ward T, Brand RM. Trauma therapies for psychosis: A state-of-the-art review. Psychol Psychother 2024; 97:74-90. [PMID: 37795877 DOI: 10.1111/papt.12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/11/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Traumatic 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. METHOD This paper will support this need by providing a state-of-the-art overview of the safety, acceptability and effects of trauma therapies for psychosis. RESULTS We 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. CONCLUSION We will conclude by reflecting on current issues in the area, and implications for research and clinical practice.
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Affiliation(s)
- Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nadine Keen
- South London and Maudsley NHS Foundation Trust, London, UK
| | - David van den Berg
- Mark van der Gaag Research Centre, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Vrije University, Amsterdam, The Netherlands
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Eleanor Longden
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Thomas Ward
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel M Brand
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Grady S, Twomey C, Cullen C, Gaynor K. Does affect mediate the relationship between interpersonal trauma and psychosis? A systematic review and meta-analysis. Schizophr Res 2024; 264:435-447. [PMID: 38245930 DOI: 10.1016/j.schres.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The relationship between interpersonal trauma and psychosis is well established, and research is now focused on identifying mechanisms that may explain this relationship. Models of trauma and psychosis increasingly emphasize a broad range of affective processes, yet the overall effect of these affective processes is not well understood. AIM This review systematically examined the effect of any form of long-term affective dysfunction on the relationship between interpersonal trauma and psychosis. Where possible, it used meta-analytic techniques to quantify the overall magnitude of this effect. METHOD Searches were conducted using PsychINFO, MEDLINE and CINAHL databases, and eligible studies were appraised for methodological quality. Narrative synthesis and meta-analytic methods were used to evaluate evidence. RESULTS Twenty-nine studies met criteria for inclusion. Five affective mediators were found; depression, anxiety, affective dysregulation, loneliness and attachment. Findings from both the narrative synthesis (n = 29) and meta-analysis (n = 8) indicated that, overall, affect is a small but significant mediator of the relationship between interpersonal trauma and psychosis (pooled Cohen's d = 0.178; pooled 95 % CI: 0.022-0.334). CONCLUSIONS Overall, findings support affective pathways to psychosis, though highlight the need for further research on broader affective mediators (loneliness, shame). The small effect size found in the meta-analysis also points to the potential importance of non-affective mediators. Clinically, these findings highlight the value of treatment modalities that attend to multiple mechanisms in the relationship between interpersonal trauma and psychosis. Future research should focus on the interplay and causal sequence between these mechanisms to further understand pathways between interpersonal trauma and psychosis.
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Affiliation(s)
- Shelley Grady
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland.
| | - Conal Twomey
- Dept. of Psychology, St Patrick's University Hospital, Dublin, Ireland
| | - Clare Cullen
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Keith Gaynor
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland; DETECT, Early Intervention in Psychosis Service, Blackrock, Dublin, Ireland
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Zarubin VC, Gupta T, Mittal VA. History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis. Front Psychiatry 2023; 13:1102464. [PMID: 36683986 PMCID: PMC9846262 DOI: 10.3389/fpsyt.2022.1102464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
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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Affiliation(s)
- Vanessa C. Zarubin
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Chicago, IL, United States
| | - Tina Gupta
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Chicago, IL, United States
- Department of Psychiatry, Northwestern University, Chicago, IL, United States
- Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL, United States
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