Abstract
Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework, and childhood trauma is one environmental factor that can lead to psychotic symptoms and the development of psychotic disorders. Higher rates of trauma are associated with higher psychosis risk and greater symptom frequency and severity, resulting in increased hospitalization rates and demand on outpatient primary care and mental health services. Despite an estimated 70% of individuals in the early stages of psychosis reporting a history of experiencing traumatic events, trauma effects (post-traumatic anxiety or depressive symptoms) are often overlooked in psychosis treatment and current interventions typically do not target commonly comorbid post-traumatic stress symptoms. We presented a protocol for Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-CBTp), an approach to treating post-traumatic stress symptoms in the context of early psychosis care. We provided a brief summary of TI-CBTp as implemented in the context of Coordinated Specialty Care and presented preliminary data supporting the use of TI-CBTp in early psychosis care. The preliminary results suggest that individuals with comorbid psychosis and post-traumatic stress symptoms can be appropriately and safely treated using TI-CBTp within Coordinated Specialty Care.
Highlights
Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework whereby “vulnerability” comprises neurobiological abnormalities originating from genetic factors, abnormalities in fetal brain development and neuromaturational processes during adolescence and “stress” comprises environmental factors increasing risk for, or triggering the manifestation of, psychosis [1]
To address this critical gap, we developed an integrated protocol for treating post-traumatic stress and psychosis symptoms in early psychosis (EP)
Between July 2014 and August 2018, 22 individuals (19 ROP; 3 clinical high risk for psychosis (CHR)) were identified as having co-morbid psychosis and post-traumatic stress symptoms at baseline. All these individuals started within Stage 1 of Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-cognitive-behavioral therapy for psychosis (CBTp)) (Figure 1)
Summary
Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework whereby “vulnerability” comprises neurobiological abnormalities originating from genetic factors, abnormalities in fetal brain development and neuromaturational processes during adolescence and “stress” comprises environmental factors increasing risk for, or triggering the manifestation of, psychosis [1]. Exposure to traumatic events is one environmental factor that can lead to psychosis [2,3]. Risk increases in a dose-related fashion; greater childhood trauma exposure is associated with higher psychosis risk [4] and symptom frequency and severity [5,6]. Research regarding the relationship between experiencing trauma during adulthood and psychotic symptoms is limited and mixed, though generally supports a positive association between adult traumatic experiences and severity of psychosis symptoms [7,8]. This results in increased demand across mental health services [9]. Several Empirically Supported Treatments (ESTs) for trauma-related disorders exist, few are integrated into EP care [11]
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