Psychological Interventions for Working with Trauma and Distressing Voices: The Future Is in the Past.

Abstract

The relationship between stressful or traumatic life events and the content of experiences associated with a diagnosis of schizophrenia is clinically intriguing but lacks developed theoretical understanding. The high prevalence of traumatic events in this group indicates the need to develop psychosocial interventions. However, antipsychotic medication remains the frontline treatment within most mental health services, frequently prescribed by a doctor implicitly (or explicitly) imposing a simplistic disease model, along with the associated lack of hope for those who do not respond well. The essence of this model being that the distressing experiences associated with the diagnosis, typically paranoia and/or hearing voices, are abnormal and symptoms of a disease. Staying within a diagnostic approach, it is worth noting that recent studies suggest that ~15% of people diagnosed with schizophrenia will also present with experiences consistent with a diagnosis of posttraumatic stress disorder (PTSD; Achim et al., 2011). To date the clinical trials aimed at treating PTSD within this group suggest that exposure and eye movement desensitization and reprocessing (EMDR) are effective (Van den Berg et al., 2015) whilst cognitive restructuring alone may not be (Steel et al., 2017). It is likely that psychological interventions for this group will evolve alongside developments in evidence-based interventions for PTSD. Whilst 85% of people diagnosed with schizophrenia do not fulfill the diagnostic criteria for PTSD, the majority have suffered stressful and traumatic life events (Grubaugh et al., 2011). For many of these people, there appears to be a relationship between their life events and the content of their “psychotic” experiences. For example, Hardy et al. (2005) showed that whilst 12.5% of a sample heard distressing voices which were a direct repetition of a past traumatic event, 45% reported a broader emotional link, e.g., hearing a voice content which made them feel humiliated, replicating the emotional state they experienced during the trauma. There is a need to develop trauma informed approaches for this group, especially when considering the negative relationship between adverse life events and antipsychotic treatment outcome (Hassan and De Luca, 2015).