The effectiveness and tolerability of trauma‐focused psychotherapies for psychotic symptoms: A systematic review of trauma‐focused psychotherapies

Summary & key facts

Researchers looked at studies of therapies that focus on past trauma to see if they help people with psychotic symptoms. They checked about 2,600 papers and found 17 studies with roughly 850 people. Overall, these trauma-focused therapies were safe and people mostly stayed in treatment, but the proof that they reduce psychotic symptoms is weak. There was some early support for therapies that ask people to safely recall or face traumatic memories, but the researchers say larger and better studies are needed to be sure.

Key facts:

• The review started with about 2,600 papers and ended up including 17 studies with about 850 people in total.
• Trauma-focused psychotherapies were generally well tolerated, and the studies reported very few harmful events.
• On average about 20% of people left treatment early, which the authors interpreted as fairly good acceptability.
• Overall evidence that these therapies reduce psychotic symptoms was weak across the included studies.
• There was tentative evidence that exposure-based approaches, where people safely recall or face traumatic memories, might be more helpful than other approaches.
• The authors concluded that more rigorous and larger trials are needed to determine if trauma-focused therapies truly help reduce psychotic symptoms.

Abstract

INTRODUCTION: Psychological trauma is an established risk factor for psychosis. Trauma-focused psychotherapies (TFPT) have been suggested as a potential treatment for reducing psychotic symptoms in those who have experienced trauma. We therefore sought to investigate the effectiveness, tolerability, and acceptability of TFPT for psychotic symptoms. METHODS: We conducted a systematic review of studies of any form of TFPT that measured psychotic symptoms across a broad range of diagnoses. RESULTS: From 2584 papers initially identified, 17 studies (857 participants) met eligibility criteria. TFPT were found to be well tolerated, with very few adverse events. Acceptability was also high, with a mean dropout rate of 20%. CONCLUSIONS: Whilst the evidence of effectiveness for TFPT in reducing psychotic symptoms is weak, we found tentative evidence in favour of exposure-based interventions. Methodologically rigorous trials investigating the efficacy of TFPT for the treatment of psychotic symptoms are needed to assess this promising intervention.

Topics

Posttraumatic Stress Disorder Research Psychiatric care and mental health services Schizophrenia research and treatment

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Adverse effect Clinical psychology Internal medicine Intervention (counseling) Medicine Psychiatry Psychological intervention Psychology Psychosis Psychotherapist Tolerability

Conditions & symptoms

PTSD