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Resources for Working with Trauma, Dissociation, and Psychosis

This is a list of books, articles, and links to videos I have found helpful in working with difficulties that arise at the intersection of trauma, dissociation, and psychosis.

Trauma and Psychosis: New directions for theory and therapy Edited by Warren Larkin, Anthony P Morrison  Published by: Routledge Publication Date: 09/28/2006  Warren Larkin and Anthony P. Morrison bring together contributions from leading clinicians and researchers in a range of fields including clinical psychology, mental health, nursing and psychiatry. The book is divided into three parts, providing comprehensive coverage of the relevant research and clinical applications. Part I: Research and Theoretical Perspectives provides the reader with a broad understanding of current and developing theoretical perspectives. Part II: Specific Populations examines the relationship between trauma and psychotic experiences in specific populations. Part III: From Theory to Therapy draws together current knowledge and investigates how it might be used to benefit individuals experiencing psychosis.

 Trauma and Serious Mental Illness (Journal of Psychological Trauma)  by Steven N. Gold (Editor), Jon D. Elhai (Editor) Published by: Routledge Publication Date: 15th April 2008.  For decades, the idea that serious mental illnesses (SMIs) are almost exclusively biologically-based and must be treated pharmacologically has been commonplace in psychology literature. As a result, many mental health professionals have stopped listening to their clients, categorizing their symptoms as manifestations of neurologically-based disturbed thinking. Trauma and Serious Mental Illness is the groundbreaking series of works that challenge this standard view and provides a comprehensive introduction to the emerging perspective of SMIs as trauma-based. This unique collection illustrates how different psychotherapy approaches can lead to reduced symptomatology, decreased psychological distress, and improved functioning in individuals living with SMIs.

“Relationships between trauma and psychosis:  A review and integration” by Anthony P. Morrison, Lucy Frame  and Warren Larkin  British Journal of Clinical Psychology (2003), 42, 331–353.  Objectives. This paper examines the research and theoretical literature on potential links between trauma and psychosis.  Methods. Three main alternatives are considered; can psychosis cause PTSD, can trauma cause psychosis and could psychosis and PTSD both be part of a spectrum of responses to a traumatic event? The more influential studies considered are critically evaluated and methodological considerations specific to research regarding trauma and psychosis are also examined. Results. Evidence is found in support of each of these relationships, and an integrative approach to conceptualizing the relationships is suggested.  Conclusions. Recent conceptualizations of PTSD and psychosis are used to inform the consideration of these different pathways, and the implications for theories of psychosis and trauma and the clinical implications for services for psychotic patients are discussed.

“Trauma-Related Intrusions and Psychosis: An Information Processing Account.”  Steel, C. Fowler, D. Holmes, E. A, BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY 2005, VOL 33; NUMB 2, pages 139-152.  Explores information processing differences involving contextual integration which may both contribute to causing PTSD and psychosis, and which themselves may result from trauma as well as from other possible causes.

“Trauma within psychosis: using a CBT model for PTSD in psychosis” Pauline Callcott, Sally Standart, Douglas Turkington.  Behavioural and Cognitive Psychotherapy, 2004, 32, 239–244  Abstract. Trauma within psychosis is often undiagnosed or untreated. There is a wide body of literature on the efficacy of cognitive behaviour therapy (CBT) for post-traumatic stress disorder (PTSD), but there has been no report of combining CBT for psychosis and CBT for PTSD in modular form. The authors discuss a combined treatment for two patients with psychosis and a history of trauma. The clinical features, process of therapy, and outcome are all described in relation to cognitive therapy models developed for use in PTSD. The implications for therapy, service development, and training are discussed.

Cognitive Behavioral Treatment for Adult Survivors of Childhood Trauma: Imagery Rescripting and Reprocessing, by Smucker, Mervin R.  1999.  This book addresses the specific symptoms and problems experienced by many adult survivors of childhood sexual and emotional abuse. These may include problems with substance abuse, self-mutilating behavior, suicide attempts, eating disorders, dissociative reactions, depression, sexual dysfunctions, and serious interpersonal difficulties. The authors use imaginal exposure treatment and imaginal rescripting to replace the recurring abuse-related images with mastery imagery. They provide a comprehensive description of the cognitive behavioral treatment program that can be implemented with survivors (male and female) of childhood sexual, physical, and emotional abuse.

“Psychological trauma and psychosis: another reason why people diagnosed schizophrenic must be offered psychological therapies.”  Read J, Ross CA.  From the abstract:  “Taken in conjunction with the proven effectiveness of various psychological and psychosocial treatments in ameliorating the symptomatology and improving the quality of life of people diagnosed schizophrenic, the need to address the trauma found in such high rates in this population requires a broadening, and not as some suggest a limitation, of the range of treatments offered. The authors identify and challenge ideologically, rather than empirically, driven assumptions about the etiology of schizophrenia, particularly the distorted but dominant version of the diathesis-stress model, which claims that the diathesis is predominantly or exclusively biogenetic in origin and therefore inaccurately places all psychosocial stressors and traumas exclusively on the stress side of the equation. It is this bias that inhibits many clinicians from taking trauma histories with people diagnosed schizophrenic and from offering appropriate treatment when trauma is disclosed. It is the same bias that leads some to argue for a reduction in the availability of psychological therapies for such people.”

“Adverse childhood experiences and hallucinations”  Charles L. Whitfield , Shanta R. Dube, Vincent J. Felitti Robert F. Anda  Child Abuse & Neglect 29 (2005) 797–810  “Objective: Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. We used data from the ACE study to assess this relationship.  Methods: We conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health behaviors and outcomes in adulthood, which was completed by 17,337 adult HMO members in order to assess the independent relationship of 8 adverse childhood experiences and the total number of ACEs (ACE score) to experiencing hallucinations.  We used logistic regression to assess the relationship of the ACE score to self-reported hallucinations. Results: We found a statistically significant and graded relationship between histories of childhood trauma and histories of hallucinations that was independent of a history of substance abuse. Compared to persons with 0 ACEs, those with 7 or more ACEs had a five-fold increase in the risk of reporting hallucinations.  Conclusion: These findings suggest that a history of childhood trauma should be looked for among persons with a history of hallucinations.”

Why, when and how to ask about childhood abuse“  John Read, Paul Hammersley and Thom Rudegeair  Advances in Psychiatric Treatment (2007) 13: 101-110  “Subscribers to the medical model of the causation of madness and distress emphasise the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care.” Then, this article goes on to provide guidelines on asking patients about childhood abuse.  Also see “Asking the question” a workbook for mental health workers put together by Paul Hammersley Dr Magdalen Fiddler and Peter Bullimore.

Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-Psycho-Social Model” John Read1, Paul Jay Fink2, Thom Rudegeair3, Vincent Felitti4, Charles L. Whitfield5   Clinical Schizophrena & Related Psychoses Vol 2, No. 3, 2008 p. 235-254. “For several decades the conceptualization and treatment of mental health problems, including psychosis, have been dominated by a rather narrow focus on genes and brain functions. Psychosocial factors have been relegated to mere triggers or exacerbators of a supposed genetic predisposition. This paper advocates a return to the original stress-vulnerability model proposed by Zubin and Spring in 1977, in which heightened vulnerability to stress is not, as often wrongly assumed, necessarily genetically inherited, but can be acquired via adverse life events. There is now a large body of research demonstrating that child abuse and neglect are significant causal factors for psychosis. Ten out of eleven recent general population studies have found, even after controlling for other factors, including family history of psychosis, that child maltreatment is significantly related to psychosis. Eight of these studies tested for, and found, a dose-response. Interpreting these findings from psychological and biological perspectives generates a genuinely integrated bio-psycho-social approach as originally intended by Zubin and Spring. The routine taking of trauma histories from all users of mental health services is recommended, and a staff training program to facilitate this is described.”

“Psychotherapy with “Schizophrenia”:  Analysis of Metaphor to Reveal Trauma and Conflict” by Richard Shulman, PhD.  Co-published simultaneously in The Psychotherapy Patient (The Haworth Press, Inc.) Vol. 9, No. 3/4, 1996, pp. 75-106; and: Psychosocial Approaches to Deeply Disturbed Persons (eds: Peter R. Breggin, and E. Mark Stern) The Hawthorn Press, Inc., 1996, pp.75-106.  Available online at http://bit.ly/cZtq4z  Lots of ideas about understanding and working with metaphor.

You can find articles on the “Voice Dialogue” approach at http://bit.ly/15k4vat and at http://www.hearingvoicesmaastricht.eu/page2.php  There is a self help guide to dialogue with voices at www.dirkcorstens.com/new-page-2/

Schizophrenia: Innovations in Diagnosis and Treatment by Colin Ross MD.  Haworth Maltreatment and Trauma Press 2004 “In Schizophrenia: Innovations in Diagnosis and Treatment, Ross presents his theory of the existence of a dissociative subtype of schizophrenia. Similarities with dissociative disorders are explained, and the possibility of recovery with psychological treatment is explored.

The Trauma Model : A Solution to the Problem of Comorbidity in Psychiatry  by Colin A. Ross.  Manitou Communications (December 6, 2000) This book presents detailed evidence pointing at trauma as the usual cause of the common comorbidity of psychiatric disorders, then provides a detailed description of trauma therapy, with case examples.  Talking directly with voices is one of the treatment methods covered.

“Childhood trauma and psychosis: Evidence, pathways, and implications”, W Larkin, J Read.  J Postgrad Med [serial online] 2008 [cited 2008 Nov 2];54:287-93. Available from: http://bit.ly/apOYA3  There is currently a growing body of research examining environmental factors in the etiology of psychosis. Much recent interest has focused on the relationship between childhood trauma and the risk of developing psychotic experiences later in life. Numerous studies of psychiatric patients where the majority are diagnosed psychotic indicate that the prevalence of traumatic experiences in this group is high. This body of research now includes many large-scale population-based studies controlling for possible mediating variables, which together provide persuasive evidence of a dose-response association and are indicative of a causal relationship. Several psychological and biological models have been proposed which offer credible accounts of the processes by which trauma may increase risk of psychotic experience.

Psychosis, Trauma and Dissociation: Emerging Perspectives on Severe Psychopathology  Edited by Andrew Moskowitz, University of Aberdeen, UK; Ingo Schäfer, University Medical Centre Hamburg-Eppendorf, Germany; Martin J. Dorahy, University of Canterbury, New Zealand  “This very interesting book not only connects traumatic experiences with dissociative and psychotic consequences, but clarifies the research into the nature of these links. From the very vivid descriptions of concepts, clinical examples and philosophical considerations and psychodynamics to neuroscientific findings, the authors display a whole new world of possibilities to assist recognizing and reconnecting elements of traumatic experiences, dissociative responses and psychotic attempts to makes sense of all these (self healing?) processes” – from a review in Psychosis by Ivan Urli?

Two stories told in the workshop were those of Peter Bullimore & Eleanor Longden.  You can hear Peter describe his experiences in more detail at http://bit.ly/ayeJq1 The Eleanor Longden Ted Talks video is available at http://www.ted.com/talks/eleanor_longden_the_voices_in_my_head.html  A much longer version of Eleanor Longden telling her story is also available https://www.youtube.com/watch?v=MB869Pk390U Eleanor also has an academic article exploring the role of dissociation in voice hearing at Dissociation, Trauma, and the Role of Lived Experience: Toward a new conceptualization of voice hearing.

Childhood Adversities Increase the Risk of Psychosis: A Meta-analysis of Patient-Control, Prospective- and Cross-sectional Cohort Studies a 2012 summary of the evidence published in Schizophrenia Bulliten.

Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: A randomized clinical trial. JAMA Psychiatry, 72(3), 259-267. doi: 10.1001/jamapsychiatry.2014.2637  “Therapies commonly used to treat PTSD are effective and safe for patients with comorbid PTSD and psychosis, new research suggests.”

The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization, By Onno van der Hart, Ellert R. S. Nijenhuis, Kathy Steele, 2006.  From one review:  “Prior to reading this book, not only did I feel fragmented myself, but the different theories about what had happened to me that were put forward also seemed fragmented and disconnected, like slices at different angles to the truth. As well as advocating a method of integration in the patient, the theory of structural dissociation presented in this book also seems integrative in itself, in showing how different, seemingly unrelated diagnoses can be seen to be derived from the same underlying trauma related processes. As a patient this is not just theoretically interesting but it can help take away a lot of the anxiety, confusion, and skepticism that comes from being sliced and diced in different ways by different mental health professionals.”

Introducing Compassion Focused Therapy is an article that is free on the web.  You can find lots of resources and videos, including videos of a full seminar introducing CFT, at http://www.compassionatemind.co.uk/ There are also lots of free resources and other information at websites like The Compassionate Mind Foundation USA, and Mindful Self Compassion.  Applications of this approach to psychosis are quite new, but are explored in articles like Johnson, D. P., D. L. Penn, et al. “A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia.” Schizophr Res 129(2-3): 137-40 and Mayhew, S. L. and P. Gilbert (2008). “Compassionate mind training with people who hear malevolent voices: a case series report.” Clin Psychol Psychother 15(2): 113-38.

The traumagenic neurodevelopmental model of psychosis revisited is a 2014 article also available at this link.  “The aim of this paper, therefore, is to summarize the literature on biological mechanisms underlying the relationship between childhood trauma and psychosis published since 2001.  A comprehensive search for relevant papers was undertaken via Medline, PubMed and psycINFO. In total, 125 papers were identified, with a range of methodologies, and provided both indirect support for and direct confirmation of the traumagenic neurodevelopmental model. Integrating our growing understanding of the biological sequelae of early adversity with our knowledge of the psychological processes linking early adversity to psychosis is valuable both theoretically and clinically.”

“There is a fault in Reality” – a 31 minute film about people diagnosed with schizophrenia, whose real story was one of trauma.  https://www.youtube.com/watch?v=BEUHt-Ixp1U

Polarity Management: Identifying and Managing Unsolvable Problems by Barry Johnson Ph.D.  “Some complex problems simply do not have “solutions.” The key to being an effective leader is being able to recognize and manage such problems. Polarity Management presents a unique model and set of principles that will challenge you to look at situations in new ways. Also included are exercises to strengthen your skills, and case studies to help you begin applying the model to your own unsolvable problems.”

Trauma & Psychosis” is a free online supplement to the book “Treating Psychosis: A Clinician’s Guide to Integrating Acceptance and Commitment Therapy, Compassion-Focused Therapy, and Mindfulness Approaches within the Cognitive Behavioral Therapy Tradition”

John Read: Childhood Adversity and Psychosis: From Heresy to Certainty is a 50 minute talk by one of the greatest experts in this field that reviews the evidence, with both detail and black humor at points.

The “Positive Outcomes for Dissociative Survivors” website is a great place to learn more about how to help people with dissociative experiences in general (it isn’t oriented around those who also have psychosis.)  To network with colleagues who specialize in working with dissociation, you might want to join the DISSOCIATIVE-DISORDERs email list serve, you can send a request for that to r.a.chefetz@psychsense.net.

Listening and Hearing: A Voice Hearer’s Invitation into Relationship tells the story of Berta Britz, and decades caught in not so helpful “treatment” before she found recovery.

Trauma-Focused Treatment in Psychosis is a thesis about the effectiveness and safety of evidence-based trauma-focused treatments in people with a psychotic disorder.  Both exposure therapy and EMDR were found to be safe and effective.  The entire thesis is available for free at this link.  There is also a mini-documentary about people involved in this study, Trauma Treatment in Psychosis, with English subtitles.

Allen, J. G., Coyne, L., & Console, D. A. (1997). Dissociative detachment relates to psychotic symptoms and personality decompensation. Compr Psychiatry, 38(6), 327-334.

Berenbaum, H., Valera, E. M., & Kerns, J. G. (2003). Psychological trauma and schizotypal symptoms. Schizophr Bull, 29(1), 143-152.

Birchwood, M., Mason, R., MacMillan, F., & Healy, J. (1993). Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychol Med, 23(2), 387-395.

Byrne, S. (2006). A casebook of cognitive behaviour therapy for command hallucinations : a social rank theory approach. Hove, East Sussex ; New York, NY: Routledge.

Chadwick, P. (2006). Person-based cognitive therapy for distressing psychosis. Chichester, England ; Hoboken, NJ: John Wiley & Sons.

Dunmore, E., Clark, D. M., & Ehlers, A. (1999). Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. Behav Res Ther, 37(9), 809-829.

Foote, B., & Park, J. (2008). Dissociative identity disorder and schizophrenia: differential diagnosis and theoretical issues. Curr Psychiatry Rep, 10(3), 217-222.

Heriot-Maitland, C. P. (2008). Mysticism and madness: Different aspects of the same human experience? Mental Health, Religion & Culture, 11(3).

Hirsch, S. R., & Jolley, A. G. (1989). The dysphoric syndrome in schizophrenia and its implications for relapse. Br J Psychiatry Suppl(5), 46-50.

Larkin, W., & Read, J. (2008). Childhood trauma and psychosis: evidence, pathways, and implications. J Postgrad Med, 54(4), 287-293.

Marzillier, S. L., & Steel, C. (2007). Positive schizotypy and trauma-related intrusions. J Nerv Ment Dis, 195(1), 60-64.

McGorry, P. D., Chanen, A., McCarthy, E., Van Riel, R., McKenzie, D., & Singh, B. S. (1991). Posttraumatic stress disorder following recent-onset psychosis. An unrecognized postpsychotic syndrome. J Nerv Ment Dis, 179(5), 253-258.

Morrison, A. P., Bowe, S., Larkin, W., & Nothard, S. (1999). The psychological impact of psychiatric admission: some preliminary findings. J Nerv Ment Dis, 187(4), 250-253.

Moskowitz, A., & Corstens, D. (2008). Auditory Hallucinations: Psychotic Symptom or Dissociative Experience? Journal of Psychological Trauma, 6(2), 35-63.

Nettle, D. (2006). Schizotypy and mental health amongst poets, visual artists, and mathematicians. Journal of Research in Personality, 40(6), 876-890.

Priebe, S., Broker, M., & Gunkel, S. (1998). Involuntary admission and posttraumatic stress disorder symptoms in schizophrenia patients. Compr Psychiatry, 39(4), 220-224.

Read, J., Agar, K., Argyle, N., & Aderhold, V. (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychol Psychother, 76(Pt 1), 1-22.

Read, J., & Argyle, N. (1999). Hallucinations, delusions, and thought disorder among adult psychiatric inpatients with a history of child abuse. Psychiatr Serv, 50(11), 1467-1472.

Read, J., & Fraser, A. (1998). Abuse histories of psychiatric inpatients: to ask or not to ask? Psychiatr Serv, 49(3), 355-359.

Read, J., Hammersley, P., & Rudegeair, T. (2007). Why, when and how to ask about childhood abuse. Advances in Psychiatric Treatment, 13(2), 101.

Rhodes, J., & Jakes, S. (2009). Narrative CBT for psychosis. East Sussex [UK] ; New York, NY: Routledge.

Smucker, M. R., & Dancu, C. V. (1999). Cognitive-behavioral treatment for adult survivors of childhood trauma : imagery rescripting and reprocessing. Northvale, N.J.: J. Aronson.

Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., et al. Childhood Adversities Increase the Risk of Psychosis: A Meta-analysis of Patient-Control, Prospective- and Cross-sectional Cohort Studies. Schizophr Bull. Advance Access published March 29, 2012

Whitson, J. A., & Galinsky, A. D. (2008). Lacking control increases illusory pattern perception. Science, 322(5898), 115-117.  See also Lacking control drives false conclusions, conspiracy theories and superstitions

Sanctuary, Trauma, and Retraumatization – a PowerPoint presentation by The Anna Institute, that details the parallels between the experience of children experiencing abuse and the experience of people experiencing coercive mental health treatment.

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