TRIPP: TRauma-Informed Psychotherapy for Psychosis
Traumatic experiences, and their symptomatic and functional consequences, are becoming increasingly important in the treatment of first episode psychosis (FEP). Our recent data shows that post-traumatic stress disorder (PTSD) in FEP is common and results from both childhood trauma and acute psychosis (47% and 39% respectively). Thus far, trials of the treatment of trauma symptoms in psychosis have focussed on PTSD symptoms. However, other potential sequelae of trauma, such as dissociation have been found to be prevalent in those with trauma and psychosis, some of which have been implicated in the development of hallucinations and delusions. Further, these symptoms are often co-morbid with each other and, as such, treatment of several of these sequelae within one therapeutic intervention may be optimal. We have developed a trauma-informed psychotherapy for psychosis (TRIPP). A trial of TRIPP is currently underway. TRIPP treatment involves two phases: the first of which comprises two concurrent modules: a safety/coping module that aims to build emotional coping resources for talking about trauma and an assessment module that leads to an individual formulation that involves developing an understanding of the relationship between traumas and current symptoms. The second phase includes several treatment modules (e.g., emotional exposure/disclosure; dialogue with voices, combating avoidance) that are conducted in a flexible manner. This trial is unique as it is targeting PTSD, dissociative and psychotic symptomatology; and it is a treatment being delivered within the current case management model of a public mental health treatment service, so requires no extra resource for implementation.