Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings.

BACKGROUND: Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. METHODS: A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. RESULTS: Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. CONCLUSIONS: The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.

Psychological therapies for auditory hallucinations (voices): current status and key directions for future research.

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.

How healers manage the pluralistic healing context: the perspective of indigenous, religious and allopathic healers in relation to psychosis in Uganda.

This paper examines the relationships between service providers involved in caring for people with 'psychosis' in Uganda. Data from qualitative research investigating conceptualisations of 'madness' held by indigenous, religious and allopathic healers in urban Uganda are used to explore the attitudes of these different service providers towards each other. Case-vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers and real cases were discussed by allopathic doctors, and their discourse was analysed. The healers varied in their attitudes towards other parts of the healing context. The indigenous and religious healers were tolerant of allopathic medicine, although the religious healers were inclined to explain its success in terms of a Christian or Islamic framework. In contrast, the allopathic healers made little reference to religious healers and were ambivalent towards indigenous healers. Finally, the relationship between the religious and indigenous healers emerged as one of conflict. The religious healers negated the beliefs and methods of the indigenous healers, whilst the indigenous healers regarded indigenous spirituality and evangelical Christianity as incompatible. Historical and social psychological perspectives are used to understand these differences. There appear to be opportunities for greater dialogue between indigenous and religious healers and allopathic doctors and this could contribute to a more integrative model of care for individuals with psychotic experiences in Uganda.