Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T20:47:41.822Z Has data issue: false hasContentIssue false
  • English
  • Français

Distress, Psychotic Symptom Exacerbation, and Relief in Reaction to Talking about Trauma in the Context of Beneficial Trauma Therapy: Perspectives from Young People with Post-Traumatic Stress Disorder and First Episode Psychosis

Published online by Cambridge University Press:  24 April 2017

Janet Tong ,
Katrina Simpson ,
Mario Alvarez-Jimenez  and
Sarah Bendall
Janet Tong
Affiliation:
School of Psychological Sciences, Monash University, Australia
Katrina Simpson
Affiliation:
School of Psychological Sciences, Monash University, Australia
Mario Alvarez-Jimenez
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, The University of Melbourne, Australia
Sarah Bendall*
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, The University of Melbourne, Australia
*
Correspondence to Sarah Bendall, Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3056, Australia. E-mail: sarah.bendall@orygen.org.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Of young people with first episode psychosis (FEP), over half report exposure to childhood trauma and consequent co-morbid post-traumatic stress disorder (PTSD) or symptoms. Currently no evidence-based interventions exist for PTSD in FEP. Clinicians report concerns that trauma-focused interventions with young people with FEP could result in distress and symptom exacerbation. Scant research suggests that talking about trauma in therapy can be distressing for some people. Aims: To explore young people's reactions to a trauma-focused treatment for PTSD in FEP. Method: Semi-structured interviews were conducted with eight participants (age 18–27 years) with co-morbid PTSD and FEP, after completing a trauma-focused intervention. Transcripts were analysed using an interpretative phenomenological approach. Participants’ baseline and end-of-treatment PTSD and psychotic symptoms were assessed. Results: Three themes related to participants’ reactions were identified from the analysis: (1) distress in session; (2) feeling relieved in and out of session; and (3) symptom exacerbation out of session. All but one participant reported experiencing increased distress in session. Four participants described PTSD, psychotic symptoms and/or suicidal ideation worsening in immediate reaction to talking about trauma in therapy sessions. 86% of participants showed improvement in their PTSD and psychotic symptoms at end of treatment. All participants described the intervention as beneficial and worthwhile. Conclusions: Results suggest that feelings of distress are to be expected from individuals with PTSD and FEP during trauma-focused treatment. Psychotic and PTSD symptom exacerbation can occur in PTSD treatment in FEP. Clinicians should be aware of, plan for, and clearly inform their clients of treatment risks.

Keywords

PTSDfirst episode psychosisyoung peoplequalitative methodsCBTtraumatrauma therapysubjectivepsychotherapycognitive behavioural therapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 6 , November 2017 , pp. 561 - 576
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bady, S. L. (1985). The voice as a curative factor in psychotherapy. Psychanalytic Review, 72, 479–490.Google Scholar
Becker, C. B., Zayfert, C. and Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277–292. doi: 10.1016/s0005-7967(03)00138-4 CrossRefGoogle ScholarPubMed
Bendall, S. (2014). TRauma-Informed Psychotherapy for Psychosis (TRIPP): an overview. Paper presented at the 9th International Conference on Early Psychosis, Tokyo, Japan.Google Scholar
Bendall, S., Alvarez-Jimenez, M., Hulbert, C. A., McGorry, P. D. and Jackson, H. J. (2012). Childhood trauma increases the risk of post-traumatic stress disorder in response to first-episode psychosis. Australian and New Zealand Journal of Psychiatry, 46, 35–39. doi: 10.1177/0004867411430877 Google Scholar
Bendall, S., Alvarez-Jimenez, M., Nelson, B. and McGorry, P. (2013). Childhood trauma and psychosis: new perspectives on aetiology and treatment. Early Intervention in Psychiatry, 7, 1–4. doi: 10.1111/eip.12008 Google Scholar
Bernstein, E. M. and Putnam, F. W. (1986). Development, reliability and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.Google Scholar
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R. and Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systemic Reviews, 12, CD003388. doi: 10.1002/14651858.CD003388.pub4 Google Scholar
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D., Gusman, F. D., Charney, D. S. and Keane, T. M. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8, 75–90. doi: 10.1002/jts.2490080106 Google Scholar
de Bont, P. A., van den Berg, D. P., van der Vleugel, B. M., de Roos, C., de Jongh, A., van der Gaag, M. and van Minnen, A. M. (2016). Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders. Psychological Medicine, 46, 2411–2421. doi: 10.1017/S0033291716001094 Google Scholar
Deacon, B. (2012). The ethics of exposure therapy for anxiety disorders. In Neudeck, P. and Wittchen, H.-U. (eds), Exposure Therapy Rethinking the Model – Refining the Method. Springer.Google Scholar
Dittmann, I. and Jensen, T. K. (2014). Giving a voice to traumatized youth – experiences with trauma-focused cognitive behavioral therapy. Child Abuse and Neglect, 38, 1221–1230. doi: 10.1016/j.chiabu.2013.11.008.Google Scholar
Early Psychosis Prevention and Intervention Centre (EPPIC) (2010). Australian Clinical Guidelines for Early Psychosis. Melbourne: University of Melbourne.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, research version, patient edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A. and Alvarez-Conrad, J. (2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology, 70, 1022–1028. doi:10.1037//0022-006x.70.4.1022 CrossRefGoogle ScholarPubMed
Frueh, B. C., Cusack, K. J., Grubaugh, A. L., Sauvageot, J. A. and Wells, C. (2006). Clinician's perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness. Psychiatric Services, 57, 1027–1032.CrossRefGoogle ScholarPubMed
Frueh, B. C., Grubaugh, A. L., Cusack, K. J., Kimble, M. O., Elhai, J. D. and Knapp, R. G. (2009). Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: a pilot study. Journal of Anxiety Disorders, 23, 665–675. doi: 10.1016/j.janxdis.2009.02.005 CrossRefGoogle ScholarPubMed
Gairns, S., Alvarez-Jimenez, M., Hulbert, C., McGorry, P. and Bendall, S. (2015). Perceptions of clinicians treating young people with first-episode psychosis for post-traumatic stress disorder. Early Intervention in Psychiatry, 9, 12–20. doi: 10.1111/eip.12065 CrossRefGoogle ScholarPubMed
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E. et al. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry, 50, 410–472. doi: 10.1177/0004867416641195 Google Scholar
Gray, M. J., Litz, B. T., Hsu, J. L. and Lombardo, T. W. (2004). Psychometric properties of the life events checklist. Assessment, 11, 330–341. doi: 10.1177/1073191104269954 Google Scholar
Hundt, N. E., Barrera, T. L., Arney, J. and Stanley, M. A. (2016). ‘It's worth it in the end’: Veterans’ experiences in prolonged exposure and cognitive processing therapy. Cognitive and Behavioral Practice. doi: 10.1016/j.cbpra.2016.02.003 Google Scholar
Jackson, C., Trower, P., Reid, I., Smith, J., Hall, M., Townend, M. et al. (2009). Improving psychological adjustment following a first episode of psychosis: a randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms. Behaviour Research and Therapy, 47, 454–462. doi: 10.1016/j.brat.2009.02.009 Google Scholar
Jayawickreme, N., Cahill, S. P., Riggs, D. S., Rauch, S. A., Resick, P. A., Rothbaum, B. O. and Foa, E. B. (2014). Primum non nocere (first do no harm): symptom worsening and improvement in female assault victims after prolonged exposure for PTSD. Depression and Anxiety, 31, 412–419. doi: 10.1002/da.22225 CrossRefGoogle ScholarPubMed
Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S. and Ustun, T. B. (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry, 20, 359–364. doi: 10.1097/YCO.0b013e32816ebc8c Google Scholar
Krakow, B., Hollifield, M. and Warner, T. D. (2000). Placebo effect in post-traumatic stress disorder. Journal of the American Medical Association, 284, 563.Google Scholar
Larsen, S. E., Wiltsey Stirman, S., Smith, B. N. and Resick, P. A. (2016). Symptom exacerbations in trauma-focused treatments: associations with treatment outcome and non-completion. Behaviour Research and Therapy, 77, 68–77. doi: 10.1016/j.brat.2015.12.009 Google Scholar
Leucht, S., Kane, J. M., Kissling, W., Hamann, J., Etschel, E. and Engel, R. (2005). Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry, 187, 366–371. doi: 10.1192/bjp.187.4.366 Google Scholar
McGorry, P. D. and Edwards, J. (1998). The feasibility and effectiveness of early intervention in psychotic disorders: the Australian experience. International Clinical Psychophamarcology, 13 (supplement 1), S57.Google Scholar
National Insitute for Health and Care Excellence (NICE) (2014). Psychosis and Schizophrenia in Adults: Prevention and Management. https://www.nice.org.uk/guidance/cg178 Google Scholar
Pascual-Leone, A. (2009). Dynamic emotional processing in experiential therapy: two steps forward, one step back. Journal of Consulting and Clinical Psychology, 77, 113–126.Google Scholar
Peuskens, J. and Link, C. G. G. (1997). A comparison of quetiapine and chlorpromazine in the treatment of schizophrenia. Acta Psychiatrica Scandinavica, 96, 265–273. doi: 10.1111/j.1600-0447.1997.tb10162.x Google Scholar
Ronconi, J. M., Shiner, B. and Watts, B. V. (2014). Inclusion and exclusion criteria in randomized controlled trials of psychotherapy for PTSD. Journal of Psychiatric Practice, 20, 25–37. doi: 10.1097/01.pra.0000442936.23457.5b CrossRefGoogle ScholarPubMed
Rosner, R., Konig, H., Neuner, F., Schmidt, U. and Steil, R. (2014). Developmentally adapted cognitive processing therapy for adolescents and young adults with PTSD symptoms after physical and sexual abuse: study protocol for a randomized controlled trial. Trials, 15, 195. doi: 10.1186/1745-6215-15-195 Google Scholar
Shearing, V., Lee, D. and Clohessy, S. (2011). How do clients experience reliving as part of trauma-focused cognitive behavioural therapy for posttraumatic stress disorder? Psychology and Psychotherapy: Theory, Research and Practice, 84, 458–475. doi:10.1111/j.2044-8341.2010.02012.x Google Scholar
Smith, J. A. and Osborn, M. (2007). Interpretative phenomenological analysis. In Smith, J. A. (ed), Qualitative Psychology: A Practical Guide to Research Methods. Sage.Google Scholar
Tong, A., Sainsbury, P. and Craig, J. (2007). Consolidated critera for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349–357. doi: 10.1093/intqhc/mzm042 CrossRefGoogle Scholar
Trauelsen, A. M., Bendall, S., Jansen, J. E., Nielsen, H. G., Pedersen, M. B., Trier, C. H. et al. (2015). Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis. Schizophrenia Research, 165, 52–59. doi: 10.1016/j.schres.2015.03.014 CrossRefGoogle ScholarPubMed
van den Berg, D. P., de Bont, P. A., van der Vleugel, B. M., de Roos, C., de Jongh, A., Van Minnen, A. and van der Gaag, M. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for post-traumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry, 72, 259–267. doi: 10.1001/jamapsychiatry.2014.2637 Google Scholar
van den Berg, D. P., de Bont, P. A. J. M., van der Vleugel, B. M., de Roos, C., de Jongh, A., van Minnen, A. and van der Gaag, M. (2016). Trauma-focused treatment in PTSD patients with psychosis: symptom exacerbation, adverse events, and revictimization. Schizophrenia Bulletin, 42, 693–702. doi: 10.1093/schbul/sbv172 CrossRefGoogle ScholarPubMed
van Minnen, A., Zoellner, L. A., Harned, M. S. and Mills, K. (2015). Changes in comorbid conditions after prolonged exposure for PTSD: a literature review. Current Psychiatry Reports, 17, 549. doi: 10.1007/s11920-015-0549-1 Google Scholar
Ventura, J., Lukoff, D., Nuechterlein, K., Liberman, R., Green, M. and Shaner, A. (1993). Brief Psychiatric Rating Scale (Expanded, version 4.0). Los Angeles: UCLA Department of Psychiatry and Behavioural Sciences. Clinical Research Center for Schizophrenia and Psychiatric Rehabilitation.Google Scholar
Vincent, F., Jenkins, H., Larkin, M. and Clohessy, S. (2013). Asylum-seekers’ experiences of trauma-focused cognitive behaviour therapy for post-traumatic stress disorder: a qualitative study. Behaviour and Cognitve Psychotherapy, 41, 579–593. doi: 10.1017/S1352465812000550 Google Scholar
Weathers, F. W., Keane, T. M. and Davidson, J. R. T. (2001). Clinician-administered PTSD scale: a review of the first ten years of research. Depression and Anxiety, 13, 132–156. doi: 10.1002/da.1029 Google Scholar
Submit a response

Comments

No Comments have been published for this article.