From trauma to psychosis: developing an interventionist-causal approach for dissociation and voice-hearing in people with complex trauma

CHAPTER 1: SYSTEMATIC REVIEW Integrated approaches to psychological interventions for trauma and psychosis: a systematic review of case studies ABSTRACT: Objective: Trauma has been proposed to play a role in the development and maintenance of psychosis. Psychological therapy approaches that integrate both psychosis and traumatic experiences are in their infancy with evidence largely consisting of case reports, case series and single case design studies. This review aimed to synthesise the types of psychological interventions described in case studies, their outcomes and methodological quality. Method: Systematic database searches were conducted using a pre-determined search strategy and inclusion criteria to identify case studies reporting psychological therapies for psychosis and trauma among adults. Studies that met inclusion criteria underwent a process of calibration, inter-rater reliability and data extraction. The review was pre-registered with PROSPERO (registration number: CRD42020178384). Results: 17 case studies met inclusion criteria. Psychological interventions included psychotherapy (n=6), integrated CBT for psychosis and trauma (n=2), and trauma-focused approaches (n=9). Methodological quality ranged between poor (n=4), moderate (n=9) and high (n=4). Case studies reported improvements in trauma-related and psychotic symptoms. Case studies also highlighted symptom exacerbation. Conclusions: This review described a wide range of case studies of psychological interventions, mainly from psychotherapeutic and CBT schools. Methodologically robust research is required and improved adherence to SCRIBE reporting standards. CHAPTER 2: MAJOR RESEARCH PROJECT Connection to the Environment with Cognitive Therapy (CONNECT): Exploring trauma, dissociation and voices through targeted psychological intervention using a single-case experimental design. ABSTRACT: Background: When considering pathways from trauma to psychosis, evidence suggests that dissociation plays a pivotal role. Adopting an interventionist-causal stance, the current study investigated whether targeting dissociation through psychological intervention (Connection to Environment with Cognitive Therapy [CONNECT]) lead to improvements in dissociation, Auditory Hallucination Frequency (AH-F) and Distress (AH-D) for people who have experienced trauma. Methods: This study utilised a randomised multiple baseline single-case experimental design. Four participants with dissociation, AH and trauma were randomised to baselines of two, three of four weeks and received eight sessions of CONNECT. Dissociation, AH-F and AH-D were assessed at baseline, pre-intervention, post-intervention and 1-month follow-up, session-by-session, and daily self-report. Data were analysed using visual analysis, Tau-U analysis and Reliable Change Indices. Results: CONNECT led to a significant improvement in dissociation at combined level and non-significant improvements at the individual level. CONNECT did not lead to significant improvements in AH-D or AH-F at the combined or individual level, with the exception of one participant among whom AH-F significantly decreased. Conclusions: Contrary to evidence that dissociation maintains AH, reducing dissociation through targeted psychological intervention did not lead to improvements in AH. Further research is warranted with particular emphasis on interventionist-causal approaches, digital technology and network analysis

The voice characterisation checklist: psychometric properties of a brief clinical assessment of voices as social agents

Aim: There is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches. Methods: The sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach’s alpha) were conducted. Results: The majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice (‘What are they thinking?’) and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters’ global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240–0.859), p < 0.05. Conclusion: The VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practice

The Voice Characterisation Checklist:Psychometric Properties of a Brief Clinical Assessment of Voices as Social Agents

Aim: There is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches. Methods: The sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach’s alpha) were conducted. Results: The majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice (‘What are they thinking?’) and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters’ global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240–0.859), p &lt; 0.05. Conclusion: The VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practise

What researching the benefits system has taught us about being trauma informed when people encounter traumatising systems

No abstract available

The voice characterisation checklist: psychometric properties of a brief clinical assessment of voices as social agents

AimThere is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses degree of voice characterisation, identified as relevant to a new wave of relational approaches.MethodsThe sample comprised participants experiencing distressing voices, recruited at baseline on the AVATAR2 trial between January 2021 and July 2022 (n = 170). Inter-rater reliability (IRR) and internal consistency analyses (Cronbach’s alpha) were conducted.ResultsThe majority of participants reported some degree of voice personification (94%) with high endorsement of voices as distinct auditory experiences (87%) with basic attributes of gender and age (82%). While most identified a voice intention (75%) and personality (76%), attribution of mental states (35%) to the voice (‘What are they thinking?’) and a known historical relationship (36%) were less common. The internal consistency of the VoCC was acceptable (10 items, α = 0.71). IRR analysis indicated acceptable to excellent reliability at the item-level for 9/10 items and moderate agreement between raters’ global (binary) classification of more vs. less highly characterised voices, κ = 0.549 (95% CI, 0.240–0.859), p &lt; 0.05.ConclusionThe VoCC is a reliable and internally consistent tool for assessing voice characterisation and will be used to test whether voice characterisation moderates treatment outcome to AVATAR therapy. There is potential wider utility within clinical trials of other relational therapies as well as routine clinical practise