Week 1 (twee artikelen en een illustratie)
Chapter 10: Trauma, Post-Traumatic Stress, and Psychosis (Hardy et al.)
Overview
This chapter introduces how trauma contributes to psychotic symptoms, with a specific focus
on psychological mechanisms, diagnostic overlaps, and individualized formulation. It
provides the conceptual foundation for understanding post-traumatic stress in psychosis
(PTSp) and lays the groundwork for treatment (expanded in Chapter 19).
Key Concepts
➤ Trauma
Defined as any event that represents a physical or psychological threat to the self. This
includes interpersonal abuse, neglect, and even internal experiences (like threatening voices)
that are subjectively traumatic.
➤ Post-Traumatic Stress in Psychosis (PTSp)
A transdiagnostic concept that emphasizes symptoms over diagnostic categories (e.g., PTSD
vs. psychosis). It supports personalized intervention based on how trauma-related difficulties
manifest in each person.
➤ Autobiographical Memory
Trauma can distort memory processing:
• Over-encoded sensory-perceptual information (e.g., smell, pain, shame) → vivid
flashbacks.
• Under-encoded context/meaning → disorganized, fragmented memories that intrude
uncontrollably.
Evidence on Trauma in Psychosis
• Childhood trauma is highly prevalent in people with psychosis.
• Victimization traumas (e.g., sexual, emotional, physical abuse) are 4–6 times more
common in psychosis than in the general population.
• 50–60% of individuals with psychosis report trauma related to psychiatric
treatment (e.g., involuntary hospitalizations, restraint).
Core Psychological Mechanisms
1. Emotion dysregulation (fear, shame, suppression)
2. Maladaptive beliefs (e.g., “I am bad,” “Others will hurt me”)
3. Avoidance strategies (e.g., isolation, dissociation, substance use)
, 4. Memory intrusions (e.g., flashbacks, nightmares)
5. Thematic and direct links between trauma and psychotic content:
o Thematic: e.g., voices reflecting abuse themes.
o Direct: e.g., voices repeating abuser’s exact words.
🧍 Janet’s Case Example (also illustrated in Figure 10.1)
Janet, a fictional character, experienced:
• Childhood sexual and physical abuse by her father.
• Neglect by her mother and bullying at school.
• Developed beliefs of worthlessness and expectations of harm from others.
• Experienced vivid flashbacks (e.g., taste/smell from trauma), nightmares, and voices
repeating past abuse.
Her symptoms—like paranoia, dissociation, and negative core beliefs—are explained by the
interaction between trauma, memory, beliefs, and emotion regulation.
Chapter 19: Trauma Therapies in Psychosis (van den Berg et al.)
Two Types of Interventions
1. Trauma-Informed Therapy (CBTp)
o Includes trauma in case formulation (e.g., how trauma influences voices).
o Focuses on beliefs, coping, and meaning-making.
2. Trauma-Focused Therapy (TFT)
o Directly targets trauma memories.
o Includes:
§ Prolonged Exposure (PE)
§ EMDR
§ Cognitive Restructuring (CR)
§ Narrative Exposure Therapy (NET)
§ Imagery Rescripting
, Evidence Summary
➤ PE & EMDR
• Show strong evidence of reducing:
o PTSD symptoms
o Paranoia
o Negative beliefs
• Safe and do not exacerbate psychotic symptoms
• Effective even without pre-therapy stabilization
➤ Cognitive Restructuring
• Effective in general PTSD
• Mixed findings in psychosis:
o Some trials show no significant benefits for psychosis subgroups
o May be more effective with adaptations
➤ Functional Outcomes
• TFTs show neutral to positive side effects on depression, anxiety, and psychosis
symptoms.
• PE and EMDR may not significantly reduce hallucinations or improve social
functioning.
Therapy Principles: Trauma-Focused CBT for Psychosis (tf-CBTp)
A Phased Approach
Phase 1: Assessment & Formulation
• Understand current problems in the context of trauma.
• Set goals and build trust.
• Use psychoeducation to explain symptoms as understandable responses to trauma.
Phase 2: Reprocessing
• Work with trauma memories using EMDR, PE, rescripting.
• Contextualize or directly modify distressing memories.
• Introduce new coping and relational strategies.
Phase 3: Integration & Recovery
• Rebuild life values, relationships, and daily functioning.
• Consolidate gains and build protective factors.
Chapter 10: Trauma, Post-Traumatic Stress, and Psychosis (Hardy et al.)
Overview
This chapter introduces how trauma contributes to psychotic symptoms, with a specific focus
on psychological mechanisms, diagnostic overlaps, and individualized formulation. It
provides the conceptual foundation for understanding post-traumatic stress in psychosis
(PTSp) and lays the groundwork for treatment (expanded in Chapter 19).
Key Concepts
➤ Trauma
Defined as any event that represents a physical or psychological threat to the self. This
includes interpersonal abuse, neglect, and even internal experiences (like threatening voices)
that are subjectively traumatic.
➤ Post-Traumatic Stress in Psychosis (PTSp)
A transdiagnostic concept that emphasizes symptoms over diagnostic categories (e.g., PTSD
vs. psychosis). It supports personalized intervention based on how trauma-related difficulties
manifest in each person.
➤ Autobiographical Memory
Trauma can distort memory processing:
• Over-encoded sensory-perceptual information (e.g., smell, pain, shame) → vivid
flashbacks.
• Under-encoded context/meaning → disorganized, fragmented memories that intrude
uncontrollably.
Evidence on Trauma in Psychosis
• Childhood trauma is highly prevalent in people with psychosis.
• Victimization traumas (e.g., sexual, emotional, physical abuse) are 4–6 times more
common in psychosis than in the general population.
• 50–60% of individuals with psychosis report trauma related to psychiatric
treatment (e.g., involuntary hospitalizations, restraint).
Core Psychological Mechanisms
1. Emotion dysregulation (fear, shame, suppression)
2. Maladaptive beliefs (e.g., “I am bad,” “Others will hurt me”)
3. Avoidance strategies (e.g., isolation, dissociation, substance use)
, 4. Memory intrusions (e.g., flashbacks, nightmares)
5. Thematic and direct links between trauma and psychotic content:
o Thematic: e.g., voices reflecting abuse themes.
o Direct: e.g., voices repeating abuser’s exact words.
🧍 Janet’s Case Example (also illustrated in Figure 10.1)
Janet, a fictional character, experienced:
• Childhood sexual and physical abuse by her father.
• Neglect by her mother and bullying at school.
• Developed beliefs of worthlessness and expectations of harm from others.
• Experienced vivid flashbacks (e.g., taste/smell from trauma), nightmares, and voices
repeating past abuse.
Her symptoms—like paranoia, dissociation, and negative core beliefs—are explained by the
interaction between trauma, memory, beliefs, and emotion regulation.
Chapter 19: Trauma Therapies in Psychosis (van den Berg et al.)
Two Types of Interventions
1. Trauma-Informed Therapy (CBTp)
o Includes trauma in case formulation (e.g., how trauma influences voices).
o Focuses on beliefs, coping, and meaning-making.
2. Trauma-Focused Therapy (TFT)
o Directly targets trauma memories.
o Includes:
§ Prolonged Exposure (PE)
§ EMDR
§ Cognitive Restructuring (CR)
§ Narrative Exposure Therapy (NET)
§ Imagery Rescripting
, Evidence Summary
➤ PE & EMDR
• Show strong evidence of reducing:
o PTSD symptoms
o Paranoia
o Negative beliefs
• Safe and do not exacerbate psychotic symptoms
• Effective even without pre-therapy stabilization
➤ Cognitive Restructuring
• Effective in general PTSD
• Mixed findings in psychosis:
o Some trials show no significant benefits for psychosis subgroups
o May be more effective with adaptations
➤ Functional Outcomes
• TFTs show neutral to positive side effects on depression, anxiety, and psychosis
symptoms.
• PE and EMDR may not significantly reduce hallucinations or improve social
functioning.
Therapy Principles: Trauma-Focused CBT for Psychosis (tf-CBTp)
A Phased Approach
Phase 1: Assessment & Formulation
• Understand current problems in the context of trauma.
• Set goals and build trust.
• Use psychoeducation to explain symptoms as understandable responses to trauma.
Phase 2: Reprocessing
• Work with trauma memories using EMDR, PE, rescripting.
• Contextualize or directly modify distressing memories.
• Introduce new coping and relational strategies.
Phase 3: Integration & Recovery
• Rebuild life values, relationships, and daily functioning.
• Consolidate gains and build protective factors.
