Trauma-Focused Treatment in Psychosis: A Systematic Review

A majority of patients with psychosis have experienced trauma, but trauma-focused (TF) treatment is not routinely offered. The current systematic review set out to examine the effect of TF treatments in patients with a psychotic disorder and comorbid trauma symptoms on symptoms of (1) trauma, (2) psychosis and (3) anxiety, depression and psychosocial functioning.

A systematic search following the PRISMA guideline yielded 17 studies reported in 19 records.

Overall, results indicated positive effects of TF treatment on trauma symptoms (87.5% of the studies), especially for TF CBT, EMDR and PE for psychosis, with indications of improvements to be stable over time. Positive outcomes were also reported for psychosis symptoms (72.2% of the studies). Results were inconclusive for depression (56% of the studies), anxiety (44.4% of the studies) and functioning (66.7% of the studies), which also were less frequently reported as outcomes in the included studies.

The present findings give preliminary support for the effect of TF treatment on trauma and psychosis symptoms, but there is more uncertainty for anxiety, depression and psychosocial functioning, which need more research. Support was found for treatments delivered both individually and by group. The current evidence base on TF treatment in psychosis is, however, still at an early stage and is challenged by methodological issues.