Distress, Psychotic Symptom Exacerbation, and Relief in Reaction to Talking about Trauma in the Context of Beneficial Trauma Therapy: Perspectives from Young People with Post-Traumatic Stress Disorder and First Episode Psychosis

Janet Tong, Katrina Simpson, Sarah Bendall, Mario Alvarez-Jimenez

Research output: Contribution to journalArticleResearchpeer-review

28 Citations (Scopus)


Background: Of young people with first episode psychosis (FEP), over half report exposure to childhood trauma and consequent co-morbid post-traumatic stress disorder (PTSD) or symptoms. Currently no evidence-based interventions exist for PTSD in FEP. Clinicians report concerns that trauma-focused interventions with young people with FEP could result in distress and symptom exacerbation. Scant research suggests that talking about trauma in therapy can be distressing for some people. Aims: To explore young people's reactions to a trauma-focused treatment for PTSD in FEP. Method: Semi-structured interviews were conducted with eight participants (age 18–27 years) with co-morbid PTSD and FEP, after completing a trauma-focused intervention. Transcripts were analysed using an interpretative phenomenological approach. Participants’ baseline and end-of-treatment PTSD and psychotic symptoms were assessed. Results: Three themes related to participants’ reactions were identified from the analysis: (1) distress in session; (2) feeling relieved in and out of session; and (3) symptom exacerbation out of session. All but one participant reported experiencing increased distress in session. Four participants described PTSD, psychotic symptoms and/or suicidal ideation worsening in immediate reaction to talking about trauma in therapy sessions. 86% of participants showed improvement in their PTSD and psychotic symptoms at end of treatment. All participants described the intervention as beneficial and worthwhile. Conclusions: Results suggest that feelings of distress are to be expected from individuals with PTSD and FEP during trauma-focused treatment. Psychotic and PTSD symptom exacerbation can occur in PTSD treatment in FEP. Clinicians should be aware of, plan for, and clearly inform their clients of treatment risks.

Original languageEnglish
Pages (from-to)561-576
Number of pages16
JournalBehavioural and Cognitive Psychotherapy
Issue number6
Publication statusPublished - Nov 2017


  • CBT
  • cognitive behavioural therapy
  • first episode psychosis
  • psychotherapy
  • PTSD
  • qualitative methods
  • subjective
  • trauma
  • trauma therapy
  • young people

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