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TF-CBT and EMDR for young people with trauma and first episode psychosis (using a phasic treatment approach): two early intervention service case studies

Published online by Cambridge University Press:  26 October 2018

Joanna Ward-Brown
Affiliation:
Greater Manchester Mental Health NHS Foundation Trust
David Keane*
Affiliation:
Lancashire Traumatic Stress Service, Lancashire Care NHS Foundation Trust
Gita Bhutani
Affiliation:
Lancashire Traumatic Stress Service, Lancashire Care NHS Foundation Trust
Debbie Malkin
Affiliation:
Lancashire Traumatic Stress Service, Lancashire Care NHS Foundation Trust
Bill Sellwood
Affiliation:
Lancaster University
Filippo Varese
Affiliation:
University of Manchester
*
Author for correspondence: David Keane, Senior Cognitive Therapist and EMDR Consultant, Lancashire Traumatic Stress Service, 18 Euxton Lane, Chorley (email: David.Keane@lancashirecare.nhs.uk).

Abstract

The relationship between trauma and psychosis is well established with a large amount of overlap between the ICD/DSM (International Classification of Diseases/Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria for post-traumatic stress disorder (PTSD) and psychosis and/or schizophrenia. In spite of co-morbidity and evidence of the links and underlying mechanisms, trauma is rarely a focus of intervention in psychosis. Psychosis has often been on the list of exclusion criteria for PTSD research studies. There is a lack of literature on the impact of trauma work with people experiencing psychosis. The National Institute for Health and Care Excellence (NICE) (2014) suggests that Early Intervention in Psychosis (EIP) service users should be assessed for PTSD, and PTSD guidelines (NICE, 2005) followed for those who show signs of post-traumatic stress. There is a need to evaluate the effectiveness of therapeutic approaches for people with PTSD and co-morbid psychosis. These case studies aim to provide initial evidence of how two EIP clients experienced and responded to NICE-recommended psychological therapy for trauma. This study aims to test the feasibility of trauma work delivered via a phasic approach in a novel population. Two EIP clients received psychological therapy [including trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR)] for identified traumatic experiences. Assessment outcome measures were utilized to establish the effectiveness of the interventions. Both clients reported significant improvements following therapy, including reduced trauma-related distress, reduced distress from symptoms of psychosis and improved quality of life. Clients with co-morbid PTSD and symptoms of psychosis are likely to benefit from recommended psychological treatments for PTSD. Further research is required to address generalizability to a larger population.

Type
Practice Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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