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Cognitive behavioural therapy for psychosis targeting trauma, voices and dissociation: a case report

Published online by Cambridge University Press:  01 March 2019

Laura McCartney
Affiliation:
Early Intervention in Psychosis Service, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
Maggie Douglas
Affiliation:
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Filippo Varese
Affiliation:
University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Zochonis Building, 2nd floor, Room 2.40, Brunswick Street, Manchester M13 9PL
Douglas Turkington
Affiliation:
Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
Anthony P. Morrison
Affiliation:
University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Zochonis Building, 2nd floor, Room 2.40, Brunswick Street, Manchester M13 9PL
Robert Dudley*
Affiliation:
Early Intervention in Psychosis Service, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK School of Psychology, Newcastle University, Newcastle upon Tyne, UK
*
*Author for correspondence: Robert Dudley, Early Intervention in Psychosis Service, Tranwell Unit, Queen Elizabeth Hospital, Gateshead NE10 9RW (email: rob.dudley@ntw.nhs.uk).

Abstract

Trauma and dissociation may be important factors contributing to the experiences of distressing voice hearing. However, there is scant mention of how to target and treat such processes when working with people with psychosis. This case study reports on an initial attempt to work with dissociation and trauma memories in a person with voices. A single case approach was used, with standardized measures used before, during and after 24 sessions of cognitive therapy, and at 6-month follow-up. In addition, session-by-session measures tracked frequency and distress associated with voices and dissociation. The participant reported significant improvements in terms of reduced frequency and distress of dissociation, and voice hearing, as well as improvement in low mood at the end of treatment. At follow-up there were enduring benefits in terms of dissociation and trauma-related experiences, as well as broad recovery but not of change in voices. This case illustrated the potential benefit of targeting dissociation and exposure to trauma memories in producing general symptom improvement and specific reductions in dissociation and voice hearing at end of treatment.

Type
Case Study
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Recommended follow-up reading

Callcott, P, Dudley, R, Standardt, S, Freeston, M, Turkington, D (2010). Treating trauma in the context of psychosis: a case series. In Hagen, , Turkington, , Berge, and Grawe, (eds), CBT for Psychosis: A Symptom Based Approach. Routledge.Google Scholar
Morrison, AP, Frame, L, Larkin, W (2003). Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychology 42, 331353.Google Scholar
Pilton, M, Varese, F, Berry, K, Bucci, B (2015). The relationship between dissociation and voices: a systematic literature review and meta-analysis. Clinical Psychology Reviews 40, 138155. doi: 10.1016/j.cpr.2015.06.004Google Scholar
van den Berg, DP, de Bont, PA, van der Vleugel, BM, de Roos, C, de Jongh, A, Van Minnen, A, et al. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry 72, 259267.Google Scholar

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