Psychological Trauma and Mental Disorders

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Questions and Answers

What is the recommended duration for trauma-focused psychological treatment for PTSD resulting from a single event?

  • 12-16 sessions
  • 4-6 sessions
  • 8-12 sessions (correct)
  • 6-8 sessions

What is a key focus of Phase Two in Trauma-Focused CBT?

  • Developing safety and stability in personal circumstances
  • Memory work to contextualize and elaborate memories (correct)
  • Assessing emotional responses
  • Setting therapeutic goals

Which of the following statements is true regarding trauma-informed care?

  • Every interaction with a trauma survivor has the potential to activate a trauma response. (correct)
  • Trauma-informed organizations require all staff to have trauma-specific training.
  • Trauma-informed care can be provided without specific trauma-related training.
  • Trauma-informed care does not need to consider the survivor's safety.

What factor is particularly important when addressing PTSD with complex needs?

<p>Building time to develop trust (B)</p> Signup and view all the answers

What signifies a trauma-informed organization?

<p>A design that realizes, recognizes, and responds to trauma while resisting retraumatization (B)</p> Signup and view all the answers

What is the focus of Trauma Informed Care (TIC)?

<p>To ensure trauma-related needs are addressed within an organization (C)</p> Signup and view all the answers

Which of the following is NOT one of the components of the 3 E's of trauma?

<p>Effectiveness (D)</p> Signup and view all the answers

According to the bio-psycho-social model, what influences vulnerability to trauma?

<p>Both risk and resilient factors influence vulnerability (C)</p> Signup and view all the answers

What does the principle of 'Resist' in TIC aim to achieve?

<p>To prevent service practices that may cause additional trauma (B)</p> Signup and view all the answers

What should organizations recognize according to TIC principles?

<p>The widespread impact of trauma on individuals (A)</p> Signup and view all the answers

What is one of the recommended practices in the NHS Trauma-Informed Mental Health Policies?

<p>Assess for PTSD and trauma reactions in individuals with psychosis (C)</p> Signup and view all the answers

How can trauma be experienced in relation to psychosis?

<p>Trauma may occur alongside or result from psychosis (A)</p> Signup and view all the answers

What is one way organizations can make relationships safer within TIC?

<p>By viewing relationships as healing rather than traumatic (C)</p> Signup and view all the answers

What was a primary reason for creating the Trauma & Life Events Checklist?

<p>To simplify the assessment process (B), To avoid diagnostic definitions of trauma (C)</p> Signup and view all the answers

What conclusion was drawn from the meta-analysis regarding trauma-focused therapy for PTSD in psychosis?

<p>Memory work is essential in treatment (C)</p> Signup and view all the answers

What was the outcome of the meta-analysis on trauma-focused therapy's effect on delusions?

<p>Only reached significance at follow-up (B)</p> Signup and view all the answers

Which technique was found to be beneficial for individuals with voices linked to trauma?

<p>Imagery rescripting (D)</p> Signup and view all the answers

How many sessions does the Integrated tf-CBTp trial proposed by STAR involve?

<p>26 sessions (A)</p> Signup and view all the answers

What is the main focus of the trauma-focused therapies mentioned for psychosis?

<p>PTSD symptoms (D)</p> Signup and view all the answers

What is one of the trials underway for Trauma-Focused Therapy for Psychosis?

<p>EMDR for trauma in early intervention (B)</p> Signup and view all the answers

What effect did trauma memory techniques have on voices according to recent findings?

<p>Beneficial impact for people with linked trauma (A)</p> Signup and view all the answers

What is a significant barrier to conducting routine trauma assessments according to the content?

<p>Fear of retraumatisation due to inappropriate questioning (D)</p> Signup and view all the answers

What percentage of service users was recorded as having been asked about trauma in the audit of the REVA policy implementation?

<p>17% (A)</p> Signup and view all the answers

Which of the following is NOT highlighted as a requirement for trauma assessments in the content?

<p>Conducting assessments without informed consent (C)</p> Signup and view all the answers

What was the main focus of inpatients regarding trauma inquiry in the content?

<p>Desire for routine enquiry and support information (D)</p> Signup and view all the answers

What issue arises from the current enquiry prompt regarding trauma assessments?

<p>It may not be specific enough for all types of trauma (A)</p> Signup and view all the answers

What is a significant risk factor associated with childhood psychological trauma?

<p>Psychosis with an odds increase of 3x (D)</p> Signup and view all the answers

Which of the following is NOT a term related to childhood psychological trauma?

<p>Acute stress reaction (A)</p> Signup and view all the answers

According to the Bradford Hill Criteria, which statement is TRUE about trauma and psychosis?

<p>Alterations in brain regions involved in emotion regulation are plausible mechanisms (D)</p> Signup and view all the answers

What might be a potential outcome if psychological trauma could be eradicated?

<p>Reduction in psychosis prevalence by 30% (B)</p> Signup and view all the answers

What type of response might individuals with a history of childhood trauma exhibit?

<p>Blunted cortisol responses (D)</p> Signup and view all the answers

Which factor does NOT contribute to the Bradford Hill Criteria for assessing trauma's impact on mental health?

<p>Financial impact on healthcare systems (D)</p> Signup and view all the answers

What neurological alteration is suggested for individuals exposed to childhood trauma?

<p>Alterations in grey matter volume (A)</p> Signup and view all the answers

Which of the following mental disorders has been linked to childhood psychological trauma?

<p>Psychosis (D)</p> Signup and view all the answers

What is an essential consideration when addressing PTSD with complex needs?

<p>Building trust and ensuring personal safety (A)</p> Signup and view all the answers

Which phase of Trauma-Focused CBT involves memory work to contextualise and elaborate memories?

<p>Phase Two (B)</p> Signup and view all the answers

In trauma-informed care, what assumption can be made about interactions with trauma survivors?

<p>Every interaction can trigger a trauma response (A)</p> Signup and view all the answers

How do trauma-focused treatments differ from general interventions?

<p>They address specific trauma-related issues (D)</p> Signup and view all the answers

What is a unique aspect of trauma-focused therapy compared to other forms of therapy?

<p>It includes a focus on contextualizing trauma memories (C)</p> Signup and view all the answers

What are the two main factors that influence the development of trauma according to the theory of latent vulnerability?

<p>Risk and resilient factors (D)</p> Signup and view all the answers

What is a primary goal of Trauma Informed Care (TIC)?

<p>To address trauma-related needs and reduce incidents of trauma (A)</p> Signup and view all the answers

Which of the following best describes the 'Events' component of the 3 E's of trauma?

<p>Any event that is psychologically or physically threatening (D)</p> Signup and view all the answers

How does the 'Relation' focus in TIC approach relationships within therapeutic settings?

<p>Creating safe, trustworthy, collaborative, and empowering relationships (A)</p> Signup and view all the answers

What is one of the key recommendations for trauma-informed care in managing psychosis?

<p>Assessing for PTSD and other trauma reactions (B)</p> Signup and view all the answers

In the context of TIC, what does the term 'Resist' refer to?

<p>Minimizing the possibility of service-induced trauma (D)</p> Signup and view all the answers

What is considered a systemic approach within Trauma Informed Care (TIC)?

<p>Organizational practices that address trauma-related needs (C)</p> Signup and view all the answers

Which of the following describes the 'Experience' component of the 3 E's of trauma?

<p>It refers to the immediate reactions to a traumatic event. (A)</p> Signup and view all the answers

What was a key reason for developing the shortened version of the Trauma & Life Events Checklist?

<p>To make it less time-consuming for routine use (B)</p> Signup and view all the answers

What have meta-analyses concluded about the effectiveness of trauma-focused therapy for PTSD in individuals with psychosis?

<p>Memory work should be included in treatment (D)</p> Signup and view all the answers

What outcome was reported regarding trauma memory techniques for voices linked to trauma?

<p>They are supportive when addressing linked traumatic memories (D)</p> Signup and view all the answers

What does the upcoming trial 'EASE' focus on in the context of trauma-focused therapy for psychosis?

<p>EMDR for trauma in early intervention (C)</p> Signup and view all the answers

What effects did the meta-analysis of 12 studies find regarding trauma-focused therapy's impact on delusions?

<p>Effects on delusions were small but significant at follow-up (A)</p> Signup and view all the answers

Which of the following statements is true according to the emerging evidence about treatment approaches for psychosis?

<p>Trauma techniques can specifically address voices linked to trauma (B)</p> Signup and view all the answers

What is a common barrier to routine inquiry about trauma assessments?

<p>Potential for retraumatisation (D)</p> Signup and view all the answers

Why is there an increasing interest in trauma-informed care (TIC) for psychosis both nationally and internationally?

<p>To effectively integrate trauma-focused therapies into psychosis treatment (D)</p> Signup and view all the answers

What percentage of service users were recorded as having been asked about trauma during the implementation audit?

<p>17% (D)</p> Signup and view all the answers

What is the primary goal of the trials underway for Trauma-Focused Therapy for Psychosis?

<p>To evaluate varying trauma-focused interventions (C)</p> Signup and view all the answers

Which of the following is emphasized as a necessity before conducting a trauma assessment?

<p>Obtaining informed consent (C)</p> Signup and view all the answers

What outcome did inpatient service users want from routine trauma inquiry?

<p>More support and information (A)</p> Signup and view all the answers

What is a noted issue with the enquiry prompt used in trauma assessments?

<p>It lacks proper specificity for the abuse types (C)</p> Signup and view all the answers

What is the risk factor associated with childhood psychological trauma in relation to psychosis?

<p>Increases the odds of experiencing psychosis by 3x (A)</p> Signup and view all the answers

Which statement about the Bradford Hill Criteria is correct?

<p>It includes a measure of association strength (A)</p> Signup and view all the answers

What could be a potential outcome of eradicating psychological trauma according to the content?

<p>A 30% reduction in prevalence of psychosis (D)</p> Signup and view all the answers

What neurological alterations are associated with childhood trauma?

<p>Alterations in the hypothalamic-pituitary-adrenal axis (C)</p> Signup and view all the answers

What does the term 'childhood maltreatment' refer to?

<p>Neglect and various forms of abuse experienced in childhood (C)</p> Signup and view all the answers

Which is NOT considered a potential outcome of childhood psychological trauma?

<p>Physical health improvement (D)</p> Signup and view all the answers

What did Freud contribute to the understanding of psychological trauma?

<p>A link between childhood events and later mental disorders (C)</p> Signup and view all the answers

How does childhood trauma potentially influence cortisol responses?

<p>It can lead to either heightened or blunted cortisol responses (C)</p> Signup and view all the answers

What is a key component of Phase One in Trauma-Focused CBT?

<p>Assessment and goal setting (D)</p> Signup and view all the answers

When should the duration of trauma-focused psychological treatment be extended?

<p>When multiple traumatic events have occurred (A)</p> Signup and view all the answers

What assumption is made about trauma-informed care interactions with survivors?

<p>Every interaction has the potential to activate a trauma response (B)</p> Signup and view all the answers

Which statement is false regarding trauma-specific treatments?

<p>They are necessary for care to be trauma-informed (D)</p> Signup and view all the answers

What does the term 'Effects' refer to in the 3 E's of trauma?

<p>The cognitive and emotional outcomes of trauma (C)</p> Signup and view all the answers

Which of the following is a principle of Trauma Informed Care (TIC)?

<p>Recognize the prevalence of trauma and its impacts (A)</p> Signup and view all the answers

How should organizations approach the issue of retraumatization in TIC?

<p>By adapting practices to minimize additional trauma (C)</p> Signup and view all the answers

What role does the concept of 'Resist' play within Trauma Informed Care?

<p>It focuses on preventing secondary trauma in service delivery (B)</p> Signup and view all the answers

Which statement correctly describes the bio-psycho-social model in relation to trauma?

<p>It integrates biological, psychological, and social aspects of trauma. (D)</p> Signup and view all the answers

What is a recommendation for organizations implementing TIC principles?

<p>To develop trauma-specific therapies and training for staff (D)</p> Signup and view all the answers

What is a primary focus of NHS Trauma-Informed Mental Health Policies?

<p>To assess for PTSD and related trauma experiences in individuals with psychosis (D)</p> Signup and view all the answers

In the context of TIC, how should relationships be approached?

<p>As collaborative, trustworthy, and empowering (C)</p> Signup and view all the answers

What is a significant limitation of the longer version of the Trauma & Life Events Checklist?

<p>It is cumbersome and not suitable for routine use. (A)</p> Signup and view all the answers

What approach is suggested for trauma memory techniques related to voices in psychosis?

<p>Reciting memories of traumatic events. (B)</p> Signup and view all the answers

What was a conclusion regarding trauma-focused therapy from the meta-analysis on PTSD in psychosis?

<p>Memory work should be included in treatment. (B)</p> Signup and view all the answers

What does the mini-TALE include that distinguishes it from the longer version?

<p>Inclusion of experiences of discrimination. (D)</p> Signup and view all the answers

Which factor was observed to affect the results of trauma-focused therapy on hallucinations and negative symptoms?

<p>Complexity of trauma history. (A)</p> Signup and view all the answers

What was found regarding the effectiveness of trauma-focused therapies on delusions during follow-up assessments?

<p>Only small effects reached significance at follow-up. (D)</p> Signup and view all the answers

What type of trauma-focused therapy trial is associated with the EASE study?

<p>16 sessions of EMDR for trauma in early intervention. (C)</p> Signup and view all the answers

What can be inferred about the future of trauma-informed care (TiC) for psychosis from the content?

<p>Trials for trauma-focused therapies are being developed. (B)</p> Signup and view all the answers

What is a significant barrier to conducting routine trauma assessments?

<p>Concern about potential retraumatisation (A)</p> Signup and view all the answers

What does the current enquiry prompt regarding trauma assessments fail to align with?

<p>Best practice guidance for trauma assessments (D)</p> Signup and view all the answers

What is a proposed recommendation for improving trauma inquiries in mental health settings?

<p>Offer mandatory training for healthcare professionals (B)</p> Signup and view all the answers

How should questions about trauma be framed to ensure they are effective?

<p>Specific and direct to target particular experiences (B)</p> Signup and view all the answers

What is the relationship between childhood psychological trauma and the development of psychosis?

<p>Childhood trauma can increase the risk of developing psychosis. (D)</p> Signup and view all the answers

According to the Bradford Hill Criteria, which criterion involves exposure to trauma predicting future mental health outcomes?

<p>Temporality (B)</p> Signup and view all the answers

What percentage of psychosis prevalence could potentially be reduced by eradicating psychological trauma?

<p>30% (A)</p> Signup and view all the answers

Which of the following does NOT describe childhood psychological trauma?

<p>Severe academic pressure (A)</p> Signup and view all the answers

What type of brain alterations have been suggested to occur in individuals exposed to childhood trauma?

<p>Alterations in limbic regions (B)</p> Signup and view all the answers

Which common misconception regarding trauma and psychosis does the content address?

<p>Psychosis is only caused by genetic factors. (B)</p> Signup and view all the answers

What physiological response might individuals with a history of childhood trauma exhibit?

<p>Altered cortisol responses (C)</p> Signup and view all the answers

Which of the following statements best reflects the impact of childhood trauma on treatment response?

<p>Trauma is linked to more severe symptoms and poorer treatment response. (D)</p> Signup and view all the answers

What is a key benefit of involving patients and public in research studies?

<p>Makes studies more relevant to participants (A)</p> Signup and view all the answers

Which practice is suggested to start early in the research process?

<p>Valuing all contributions to the research (D)</p> Signup and view all the answers

How is public involvement distinguished from public engagement in research?

<p>Public involvement means collaborating on research decisions, unlike engagement which is more informative (D)</p> Signup and view all the answers

What organizational action is essential for improving public involvement in research?

<p>Implementing guidance, policies, and systems to support public involvement (B)</p> Signup and view all the answers

What is a recommended approach when developing research materials?

<p>Use inclusive approaches to engage diverse contributors (B)</p> Signup and view all the answers

What are the alterations associated with the hypothalamic-pituitary-adrenal (HPA) axis in the context of trauma?

<p>Dysregulation of stress response mechanisms (B)</p> Signup and view all the answers

What is the significance of the theory of latent vulnerability in understanding trauma effects?

<p>It highlights the variations in individual responses to trauma (A)</p> Signup and view all the answers

Which component is NOT one of the 3 E's of trauma according to Trauma Informed Care principles?

<p>Effect (B)</p> Signup and view all the answers

Which aspect of trauma-informed care emphasizes organizational policies regarding trauma?

<p>Workforce training on trauma recognition (B)</p> Signup and view all the answers

What is a critical consideration in developing trauma-informed therapies?

<p>Integrating biological models with psychological and social factors (D)</p> Signup and view all the answers

What percentage of service users were recorded as having been asked about trauma in the REVA policy implementation audit?

<p>17% (B)</p> Signup and view all the answers

What is a critical requirement for trauma assessments under the CPA?

<p>Routine enquiry about trauma (C)</p> Signup and view all the answers

What is a significant risk of discussing trauma with individuals during assessments?

<p>Potential retraumatisation (C)</p> Signup and view all the answers

Which aspect of existing trauma assessments has been criticized according to the content?

<p>They often rely on a tick box exercise. (B)</p> Signup and view all the answers

What should staff obtain before conducting trauma assessments to ensure ethical practice?

<p>Informed consent specific to trauma questions (D)</p> Signup and view all the answers

Which of the following best describes a challenge faced by the NHS workforce regarding trauma assessments?

<p>Lack of training on how to ask trauma-related questions (C)</p> Signup and view all the answers

What is a common misconception about individuals' awareness of their trauma history?

<p>Many individuals are unaware they have experienced trauma. (C)</p> Signup and view all the answers

What is one reason that the trauma enquiry prompt is not considered best practice?

<p>It lacks sensitivity and does not fit best practice guidance. (B)</p> Signup and view all the answers

What is the primary function of Advance Choice Documents (ACDs)?

<p>They allow individuals to express treatment preferences when well. (D)</p> Signup and view all the answers

Which of the following names is NOT commonly associated with Advance Choice Documents?

<p>Health Action Plans (B)</p> Signup and view all the answers

What aspect is emphasized in the co-production strategy for the Brain and Genomics project?

<p>Expand the concept of 'expertise through experience.' (C)</p> Signup and view all the answers

Why is feedback from the SUAG valuable for clinicians involved in projects?

<p>It addresses concerns about the risk/benefit balance. (C)</p> Signup and view all the answers

What do Advance Choice Documents typically include?

<p>Personal preferences regarding illness and treatments. (A)</p> Signup and view all the answers

Which group demonstrated the most insightful analysis of the paper according to the given context?

<p>The SUAG members engaged in discussions. (B)</p> Signup and view all the answers

What is a key benefit of Advance Choice Documents for family and friends?

<p>They provide clarity on the individual's treatment preferences. (C)</p> Signup and view all the answers

In the context of ACDs, what role do health professionals play?

<p>They use ACDs to inform treatment decisions during crises. (B)</p> Signup and view all the answers

What is a recommendation for individuals who show signs of post-trauma stress in relation to psychosis?

<p>Follow NICE recommendations for PTSD (C)</p> Signup and view all the answers

In trauma-focused psychological treatment for PTSD, what is indicated when several problems need to be addressed?

<p>Extend treatment beyond 12 sessions (C)</p> Signup and view all the answers

What should be built into the care process when handling PTSD with complex needs?

<p>Time for developing trust (B)</p> Signup and view all the answers

What is the focus of Trauma-Focused CBT for psychosis?

<p>Integrating trauma experiences with cognitive restructuring (B)</p> Signup and view all the answers

What aspect is essential when planning support for patients after the end of therapy?

<p>Planning ongoing support and resources (B)</p> Signup and view all the answers

In trauma-informed care, how should interactions with survivors be approached?

<p>Assuming they may have experienced trauma (D)</p> Signup and view all the answers

What outcome is suggested for trauma memory techniques in recent findings related to voices?

<p>Potential reduction in distress linked to voices (D)</p> Signup and view all the answers

What is one of the key factors to consider when assessing trauma in relation to psychosis?

<p>Cultural beliefs about mental health (C)</p> Signup and view all the answers

What is the primary focus of Phase One in trauma therapy?

<p>Assessment, goal setting, and formulation (A)</p> Signup and view all the answers

Which statement best describes the relationship between trauma-informed care and trauma-specific treatments?

<p>Trauma-informed care can be provided without trauma-specific training. (A)</p> Signup and view all the answers

What is a unique aspect of trauma-focused therapy as highlighted in the content?

<p>Concentration on memory work to elaborate trauma (B)</p> Signup and view all the answers

In the context of trauma-informed care, what should be recognized during every interaction with trauma survivors?

<p>Possibility of triggering a trauma response (A)</p> Signup and view all the answers

Which phase of trauma therapy is primarily focused on psychoeducation?

<p>Phase One (D)</p> Signup and view all the answers

Which statement is not true regarding trauma-informed organizations?

<p>They must have staff trained in trauma-specific therapy. (A)</p> Signup and view all the answers

What are the main components of trauma-focused CBT in terms of patient experience?

<p>Memory work and emotional experiences (C)</p> Signup and view all the answers

What assumption is made about care when interacting with trauma survivors?

<p>Each interaction can inadvertently trigger trauma responses. (D)</p> Signup and view all the answers

Flashcards

Childhood Psychological Trauma

Adverse events in childhood, including neglect, abuse (physical, sexual, emotional), that can have lasting impacts on mental and physical health.

Trauma & Psychosis Link

Childhood trauma strongly associated with increased risk of psychosis (3x higher odds).

Population Attributable Risk

Proportion of psychosis cases attributable to childhood trauma; estimated at 30%.

Bradford Hill Criteria

A set of criteria (strength, consistency, temporality, biological gradient, plausibility) used to assess the evidence for a causal link between trauma and mental health outcomes like psychosis.

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Strength & Consistency (Bradford Hill)

Trauma consistently associated with increased psychosis risk, as seen in meta-analysis.

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Temporality (Bradford Hill)

Trauma exposure before psychosis onset; stopping trauma reduces symptoms.

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Biological Mechanism (Trauma & Mental Illness)

Potential biological pathways (HPA axis, brain alterations, neurotransmitters) linking childhood trauma to mental health conditions.

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Future Research Need

More research is required to completely understand the exact mechanisms behind the link between trauma and later mental health conditions.

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Trauma-Focused CBTp

A specific type of therapy that combines trauma-focused CBT and CBT for psychosis. It helps people process traumatic memories, manage emotions, and challenge negative thoughts related to trauma.

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Phases of Trauma-Focused CBTp

The therapy is divided into three phases: Assessment & Goal Setting, Trauma-Focused CBT, and CBT for Psychosis. Each phase builds upon the previous one, addressing specific aspects of the client's needs.

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Trauma-Informed Care

A way of working that acknowledges the impact of trauma on people's lives and incorporates this understanding into every interaction. It aims to avoid retraumatization.

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Trauma-Specific Treatment

A therapy aimed at directly addressing the effects of trauma, usually involving specialized training for therapists. It differs from general trauma-informed care.

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Trauma Response Activation

An assumption of trauma-informed care is that every interaction with a trauma survivor has the potential to trigger a past trauma response.

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Latent Vulnerability Theory (McCroy & Viding, 2015)

A theory suggesting that risk factors and resilience factors interact to create a vulnerability to mental illness, like psychosis, later in life. It emphasizes the role of both risk and protective factors in developing mental health issues.

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Trauma

Any event – psychological or physical – perceived as threatening or harmful, along with the cognitive, emotional, behavioural, physiological, and interpersonal reactions to it.

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Trauma-Informed Care (TIC)

A system approach to mental health services that recognizes the impact of trauma on individuals and works to reduce the likelihood of further trauma in the service delivery process.

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Trauma Effects

The range of cognitive, emotional, behavioral, physiological, and interpersonal consequences of one or many traumatic events.

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Trauma-Informed Organization

An organization that has adapted its policies, procedures, and attitudes to understand and address patients' past trauma and to reduce the chance of additional trauma being caused by the organization's actions.

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Trauma-focused Therapy

Therapeutic approaches that directly address past or present trauma, such as EMDR, to reduce symptoms and increase well-being.

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Adverse Events

Difficult, stressful events in life, broadly defined, that can be a precursor to or occur during or after psychosis.

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Re-traumatization

Experiencing further trauma during mental health services or care.

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Routine Trauma Inquiry

A standard practice in healthcare settings where individuals are asked about their history of trauma. This is intended to identify potential trauma-related needs and provide appropriate care.

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REVA Policy Audit

A review of healthcare organizations' implementation of trauma-informed care policies, specifically focusing on whether routine inquiries about trauma are conducted.

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Retraumatization Risk

The potential to trigger or re-experience past traumatic experiences during the process of asking about trauma, especially if done without proper training or sensitivity.

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Informed Consent for Trauma Assessment

Obtaining explicit permission from an individual before conducting a trauma assessment, ensuring they understand the process and potential risks involved.

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Trauma-Informed Care Training

Specialized education and training for healthcare professionals on how to ask sensitive questions about trauma, conduct assessments, and provide trauma-informed care.

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TALE Checklist Purpose

The TALE Trauma & Life Events Checklist was created to assess trauma experiences in people with psychosis. It's shorter than existing measures and focuses on events most likely impacting mental health.

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Mini-TALE

A shortened version of the TALE Checklist designed for routine use in mental health teams. It includes events most likely affecting mental health and wellbeing in people with psychosis.

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Trauma-Focused Therapy for Psychosis: Effectiveness?

Meta-analysis of studies shows trauma-focused therapy has a small effect on delusions in psychosis, with more significant improvements seen at follow-up.

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Trauma Memory Techniques & Voices

Emerging evidence suggests that trauma memory techniques, like prolonged exposure and imagery rescripting, might be beneficial for reducing auditory hallucinations.

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Trauma-Informed Care in Psychosis

A practice that recognizes the impact of trauma on people with psychosis and incorporates this understanding into every interaction, aiming to avoid re-traumatization.

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Trauma-Focused Therapy Trials in Psychosis

Several ongoing clinical trials are evaluating different types of trauma-focused therapy for psychosis, including therapies like STAR.Peters, EASE.Bentall, and Re.Process.

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STAR.Peters Trauma Therapy

One of multiple ongoing trials for trauma-focused therapy in psychosis, this trial uses Integrated tf-CBTp (26 sessions over 9 months).

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EASE.Bentall EMDR Therapy

Another ongoing trial for trauma-focused therapy in psychosis, this trial uses EMDR (16 sessions over 6 months) for trauma in people with early intervention psychosis.

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Childhood Trauma and Psychosis

Early experiences of neglect, abuse (physical, sexual, emotional), or other adverse events can significantly increase the risk of developing psychosis later in life.

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3x Higher Odds

Studies show that individuals who experience childhood trauma are three times more likely to develop psychosis compared to those who haven't.

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Temporal Association

One of the Bradford Hill criteria suggesting that the trauma exposure must happen before the development of psychosis.

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Biological Gradient

A Bradford Hill criteria suggesting that the more severe the trauma, the more severe the symptoms, and the poorer the treatment response.

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HPA Axis

A complex biological system that controls the body's response to stress. Trauma can disrupt the HPA axis, leading to mental health difficulties.

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Brain Alterations

Childhood trauma can change how the brain processes threats and emotions, particularly in areas involved in fear and memory.

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Latent Vulnerability Theory

This theory proposes that a combination of risk factors and protective factors creates a vulnerability to developing mental illnesses like psychosis later in life.

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What are the 3 E's of Trauma?

The 3 E's of Trauma describe the broad spectrum of trauma, extending beyond diagnostic criteria for PTSD. They encompass the event, the experience, and the effects.

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What are the key goals of TIC?

TIC aims to: realize the widespread impact of trauma, recognize trauma, respond appropriately to trauma-related needs, resist retraumatization, and build safe and trusting relationships.

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What is routine trauma inquiry?

Routine trauma inquiry is a standard practice in healthcare where individuals are asked about their history of trauma. This helps identify potential trauma-related needs and provide appropriate care.

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Evidence for Trauma-Focused Therapy in Psychosis

Emerging research suggests that trauma-focused therapy can be beneficial for people with psychosis, particularly for reducing auditory hallucinations and improving overall well-being.

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Routine Enquiry about Trauma

Asking every patient about their experiences of trauma, including abuse and violence, as part of standard care.

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Why Ask Specific Questions?

Instead of a general question, it's important to ask precise questions about different types of abuse (physical, sexual, emotional) to ensure understanding and avoid retraumatization.

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TALE Checklist

A shorter checklist designed specifically for assessing trauma experiences in people with psychosis, taking into account the challenges of using longer measures in clinical settings.

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Trauma Memory Techniques

Specialized therapeutic techniques, like prolonged exposure and imagery rescripting, used to help individuals process traumatic memories and reduce the impact of trauma on symptoms like hallucinations.

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Trauma-Focused Therapy for Psychosis

A therapeutic approach that combines trauma-focused therapies with CBT for psychosis. This approach aims to help people with psychosis address the impact of trauma on their symptoms and overall well-being.

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STAR.Peters

A study that evaluates the effectiveness of Integrated Trauma-Focused CBTp (tf-CBTp) for people with psychosis, lasting 26 sessions over 9 months.

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EASE.Bentall

A research study that examines the effectiveness of EMDR (Eye Movement Desensitization and Reprocessing) for trauma in people with early intervention psychosis.

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Trauma-Focused Therapy Trials

Ongoing research studies investigating the effectiveness of different trauma-focused therapy approaches for people with psychosis.

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Childhood Trauma

Negative experiences in childhood, such as neglect or abuse (physical, sexual, or emotional), that can have long-lasting impacts on mental and physical health.

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3 E's of Trauma

This framework describes the broader spectrum of trauma, going beyond just the diagnostic criteria for PTSD. It includes the event, the experience, and the effects.

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Trauma-Focused Therapy Trials (Psychosis)

Ongoing research studies exploring the effectiveness of different trauma-focused therapy approaches for individuals with psychosis.

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STAR.Peters Study

A research study that evaluates the effectiveness of Integrated Trauma-Focused CBTp (tf-CBTp) for people with psychosis, lasting 26 sessions over 9 months.

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EASE.Bentall Study

A research study that examines the effectiveness of EMDR (Eye Movement Desensitization and Reprocessing) for trauma in people with early intervention psychosis.

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Trauma-Focused Therapy for Psychosis (tf-CBTp)

Combines trauma-focused CBT (cognitive behavioral therapy) and CBT for psychosis, addressing the impact of trauma on psychotic symptoms and improving coping skills.

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Evidence for Trauma-Focused Therapy

Emerging research suggests that trauma-focused therapy shows some benefit for people with psychosis, particularly in reducing auditory hallucinations and improving overall well-being.

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Why Specific Questions?

It's important to ask precise questions about different types of abuse (physical, sexual, emotional) to ensure understanding and avoid retraumatization.

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Public Involvement in Research

A process where members of the public are actively involved in all stages of research, from planning to dissemination.

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Public Involvement vs. Public Engagement

Public involvement is active participation in research projects, while public engagement is more about sharing information and raising awareness.

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Benefits of Public Involvement

Public involvement makes research more relevant, improves study design, enhances communication, and leads to a better research experience for participants.

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Organizational Commitment to Public Involvement

Many health organizations have signed commitments to prioritize and support public involvement in research.

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Best Practices for Public Involvement

Start early, be inclusive, value contributions, and ensure influence on outcomes.

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Advance Choice Documents (ACDs)

Written or spoken records made by individuals with fluctuating mental illness, outlining their preferred treatment if they become unwell.

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SUAG

A group of individuals with lived experience of mental illness who provided valuable input on advance decision making.

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Impact of SUAG input

The feedback from the SUAG helped address concerns from clinicians, making them more likely to participate in the project.

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Co-production

A process where individuals with lived experience actively contribute to research and service design.

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Brain and Genomics Hub

A research group focusing on mental health, aiming to shift from viewing participants as isolated individuals to a supportive community.

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Expertise through Experience

Recognizing the valuable knowledge and insights gained from living with a condition, alongside traditional expertise.

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Expand Scope

Broadening the reach and impact of the research project, possibly by including diverse communities or tackling additional related issues.

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Assess Impact

Evaluating the effectiveness and influence of the research project on individuals, services, and the wider community.

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Study Notes

Psychological Trauma and Mental Disorder

  • Freud linked childhood sexual abuse to later mental disorders in the 1890s
  • Freud recognised childhood events have lasting impacts

Childhood Psychological Trauma - Definition

  • Adverse childhood events include neglect, physical, sexual, or emotional abuse
  • Different terms for this include childhood maltreatment, adverse childhood experiences, early life stress, and developmental trauma

Childhood Psychological Trauma - Risk Factor

  • Associated with a 3x increased risk of psychosis (Varese, 2012)
  • Population attributable risk for psychosis is 30% (Kirkbride, 2010)
  • Reducing psychological trauma could reduce psychosis prevalence by 30%
  • Trauma is linked to many psychiatric and poor physical health outcomes (Daníelsdótti, 2024; Nelson, 2020)

Childhood Psychological Trauma - Mechanism

  • Research suggests psychological and neurological processes are involved in trauma and psychosis (Bloomfield, 2021; Pollok, 2022; Yang, 2023)
  • Grey matter volume alterations are observed in those exposed to childhood trauma
  • Individuals with psychosis and a history of trauma show higher (Aas, 2019) or blunted cortisol responses (Bloomfield, 2019)
  • Strong and consistent association between trauma & psychosis (Meta-analysis (Varese, 2012))
  • Trauma exposure precedes psychosis onset (Kelleher, 2013)
  • Biological gradient: more severe trauma leads to more severe symptoms; poorer treatment response
  • Plausible biological mechanisms: alterations in the hypothalamic-pituitary-adrenal (HPA) axis, brain alterations in threat processing, emotion regulation in limbic regions, and dopamine transmission (Merritt, 2024; Egerton, 2016; Bloomfield, 2019)

Future Work

  • Need deeper knowledge of vulnerability mechanisms (McCroy & Viding, 2015)
  • Importance of risk and resilient factors
  • Integrate bio-psycho-social model
  • Implement trauma-informed therapies

What is Trauma?

  • The 3 E's: Event, Experience, Effects
  • Trauma is much broader than PTSD criteria
  • Any psychological or physical threat
  • Range of cognitive, emotional, behavioural, physiological, and interpersonal reactions
  • Recurring range of cognitive, emotional, behavioral, physiological, and interpersonal effects
  • Can be a precursor to psychosis; can accompany psychosis; or result from psychosis

Trauma Informed Care (TIC)

  • Organisational approach addressing trauma-related needs
  • Views trauma as "everybody's business"
  • Acknowledges commonality of trauma
  • Recognises trauma effects and routine enquiry
  • Asking about traumatic experiences
  • Access to trauma-specific support (e.g., EMDR)

Recommendations for TIC in Psychosis

  • NICE Guidance for Schizophrenia (2014) to assess for PTSD in clients with psychosis
  • NICE Guidance for PTSD (2018) trauma-focused psychological treatment (CBT or EMDR)
  • Trauma-Focused CBT for Psychosis (tf-CBTp) - NICE guidelines followed with support based on individual needs

Routine Enquiry about Trauma in the UK

  • CPA requires routine enquiry about trauma
  • Only 17% of service users had the abuse question asked in 53 trusts
  • This is not in line with best practice (Brooker et al., 2016)

Talking Trauma in MDTs

  • Many have experienced trauma but few are assessed
  • Inpatients want routine enquiry
  • Assessing trauma in psychosis: trauma checklist

Is Trauma-Focused Therapy Safe and Effective for Psychosis?

  • Meta-analysis of studies show some small, positive effects on delusions at follow-up but not on hallucinations and negative symptoms
  • Trauma memory techniques can have beneficial impacts on voices (Brand et al., 2018, 2020a, 2020b)
  • Imagery rescripting is helpful in some cases

Future of TIC for Psychosis

  • Increasing international attention to TIC
  • Evaluation of optimal TIC approach needed
  • Trauma-focused therapy trials underway (e.g., STAR)

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