Trauma-Focused Treatment in Early and Lifetime Psychosis: A Scoping Review

Despite high rates of trauma exposure and posttraumatic stress disorder (PTSD) in individuals living with psychosis, there is limited knowledge regarding which trauma-focused treatments are most appropriate to address comorbid psychosis and PTSD, particularly in early psychosis, a clinically and developmentally distinct period.

This scoping review aims to understand the extent and type of evidence available to address PTSD symptoms at different stages of psychosis (ie, early psychosis versus lifetime diagnosis). Regarding early psychosis, our review considers studies involving individuals who are within 5 years of illness onset or are enrolled in early intervention services for first episode psychosis. The review was pre-registered in Open Science Framework. Three databases (PubMed, PsycINFO, Web of Science) were searched using specific keywords related to psychosis, trauma, and treatment. PRISMA-ScR guidelines for scoping reviews were followed.

Twenty-one original studies (four in early psychosis) were included in the review. We report on types of traumas addressed; treatments provided and key outcomes; participant perspectives on treatments and contextual factors impacting implementation such as characteristics of providers who delivered treatments and cultural considerations.

Identified studies suggest a growing evidence base for addressing PTSD symptoms in psychosis; however, treatments are lengthy and have complex training requirements which pose challenges for implementation in routine care, particularly in time-limited early psychosis programs. More work is needed regarding identifying optimal treatment dose and understanding which treatment elements contribute to outcomes and are tolerable for participants.