ABSTRACT
Psychosis is often a confusing and terrifying experience to those who experience it. Sometimes strong emotions, images, memories and thoughts connected to past traumatic experience can become caught up in the turmoil of the experience of psychotic symptoms. In such circumstances cognitive behavioural therapy (CBT) for psychosis can help an individual make sense of psychotic experiences by making links between emotional states, thoughts, beliefs, traumatic life events and their sequelae and psychotic symptoms. Assisting people to make sense of psychotic and emotional experience by discussing psychological formulations can help them make connections between seemingly unconnected events or beliefs and disabling and distressing psychotic symptoms. In this chapter we describe how understanding and validating people’s experiences of traumatic events, and incorporating them into individualised formulations of psychosis, can shape CBT interventions. We illustrate how understanding the relationship between trauma and psychosis influences clinical intervention in CBT. Three individual cases are described and formulated using cognitive conceptualisations of psychosis (Garety et al. 2001; Morrison 2001; see also Fowler et al., Chapter 5 in this volume). Interventions are driven by the Fowler et al. (1995) manual of CBT for psychosis. Clinically the emphasis is on formulating psychosis but in these selected cases traumatic events are understood as key to the development and maintenance of psychotic symptoms. The cases show how CBT techniques developed for posttraumatic stress disorder can be adapted for work in psychosis. We argue that drawing on CBT for PTSD without adaptation would fail to consider the other important factors that are clearly implicated in the development of
psychotic beliefs and experiences. Thus, the case illustrations are considered in the context of cognitive behavioural theories of the relationship between trauma and psychosis.
