Trauma-focused therapy helps people with psychosis and PTSD recover better, even if symptoms temporarily worsen. This is shown in doctoral research by clinical psychologist Simone Burger.
Her research shows that trauma is not only common in people with psychosis, but also plays a key role in the onset and persistence of psychotic symptoms. She advocates for better access to trauma therapy in mental health care.
Trauma and psychosis are strongly linked
Many people who experience psychosis have previously experienced profound events, often multiple and often in the form of interpersonal violence. These experiences can lead to post-traumatic stress disorder (PTSD), with symptoms such as nightmares and re-experiences. Burger shows that the more severe the trauma, the more severe the psychotic symptoms can also be, such as hearing voices. This underscores the importance of trauma-focused care in people with psychosis. Yet trauma is still not always routinely recognized or treated in clinical practice.
Trauma-focused therapy: emotionally demanding, but effective
Burger examined trauma-focused therapies, such as EMDR and exposure therapy, in people who have both PTSD and psychosis. The results are promising. Not only do PTSD symptoms decrease, the therapy also seems to indirectly reduce psychotic symptoms such as hearing voices.
Interestingly, temporary worsening of PTSD symptoms during treatment is common. "That can be exciting for both patients and treatment providers," Burger explains "but it says nothing about the final outcome." People who temporarily experienced more symptoms recovered as well as others in the long run.
Patients experience therapy as tough, but valuable
Interviews with participants confirm this picture. They described therapy as emotionally intense, but also meaningful and helpful. Many participants indicated that they got a better grip on their symptoms and developed a better understanding of themselves. Factors such as trust in the practitioner and good supervision proved important in sustaining therapy.
Major implications for mental health care
The findings have clear implications for practice. First, it is essential to routinely screen for traumatic experiences in people with psychotic symptoms. Only then can appropriate, trauma-sensitive care be provided.
In addition, the research shows that temporary exacerbation of symptoms is not a reason to avoid trauma therapy. On the contrary, it can be part of the recovery process and requires proper guidance, not restraint.
More access to trauma therapy urgently needed
Simone Burger concludes that trauma-focused therapies must become more accessible to people with psychosis. Implementation in mainstream care is crucial to provide appropriate and effective treatment to this group.
A large-scale follow-up study is currently underway in which the earlier results will be retested. In doing so, the study will further contribute to better informed care for people with PTSD and psychosis.