In the first part of this course I'm going to focus primarily on the links between

trauma and psychosis

or get more into the role of dissociation as a mediating variable later on.

Let's start with that question.

How are the subjects of trauma and psychosis connected.

Now the mainstream mental health system approach for years has just been to say
that they aren't for

example illness management recovery is considered a fairly mainstream and

progressive approach.

But in one of its published workbook's Here's what it tells people about
schizophrenia.

Schizophrenia is nobody's fault.

That means that you do not cause the disorder and neither did your family members
or anyone else.

Scientists believe that the symptoms of schizophrenia are caused by a chemical

imbalance in the brain.

So in other words what they're doing is totally denying a possible connection

between anyone's actions

or decisions and the symptoms of schizophrenia.

If that were true then the problems that get people diagnosed with schizophrenia
could be created by

any kind of mistreatment or by or even by any way that the person chose to respond
to abuse or trauma

or confusing events.

The cognitive or CBT approach that I'll be talking about Hawai takes a very
different perspective.

CBT therapists pay a lot of attention to the role of mistaken beliefs or beliefs
that don't fit current

circumstances in these sorts of beliefs can easily arise due to experiences that
are confusing and overwhelming

such as trauma and sense mistaken beliefs play a key role in psychosis.

It follows that traumas should be considered as a possible cause of psychosis.

And then CBT also sees people as capable of choosing to change their beliefs.

So people are a passive victims of any problem caused by those mistaken boys.

Now this cognitive or CBT understanding isn't just a theory someone came up with.

It's firmly rooted in research that shows a complex intertwined relationship

between psychosis and trauma.

Most importantly the trauma and adverse childhood experiences can contribute to
making psychosis much

more likely later on.

There's now extensive large scale studies to back this up.

We view it somewhat but that evidence is really summarized by the article.

Childhood child maltreatment and psychosis returned to a genuinely integrated bio

psychosocial model.

If you click on the Resources tab there's a link to view that article in fall if
you like.

But to start with there there's now over 50 studies exploring the trauma histories
of people who later

been diagnosed with psychosis.

In other words they asked people who had experience psychosis.

What was your what was your childhood like and asked about abuse and what they
found was something like

60 to 90 percent did report child Javid maltreatment and abuse with a lower number
is often associated

with studies that defined abuse more narrowly.

Now someone worried that studies like this would be biased due to psychotic people
being more likely

to report abuse that didn't happen.

But studies looking at whether abuse reports are reliable or not found that they
could find corroborating

evidence for the reports of the people you know who have had experience psychotic
psychosis and were

reporting childhood abuse that the corroborating evidence was just as likely to be
found there.

As in if you ask people who had never been psychotic about their abuse.

The corroborating evidence was found in about the same proportion of cases.

So at least as far as we can tell people who are currently psychotic seem on
average to be telling stories

about real abuse in their past.

We will also get a little later in this chorus get into how to work with people
when it does seem more

likely they may be reporting things that didn't happen.

Possibly delusional stories.

Now another way to look at this issue is to start with people that we know have
been traumatized and

then follow up to see how likely they are to later become psychotic.

Now most of the studies done this way found that psychosis appeared more strongly
related to childhood

trauma and adversity than did things like anxiety disorders and depression
disorders that are also more

likely.

We know after childhood adversity then there's the question of dosage effect that
is does an increase

in trauma tend to lead to more psychosis.

And as of 2008 all eight studies that looked for this kind of dosage effect and
found that one study

for example found that those most seriously abused were 50 times more likely to
show the most serious

psychotic symptoms.

And another study goes with all five of the types of trauma being considered were
193 times more likely

to be psychotic.

Compare that with how biological psychiatry is something that makes a person two or
three times as likely

to be psychotic.

That's often written up as being quite significant.

Now we're talking about one hundred and ninety three times so and then we'll
discuss this more later

on.

But there's also evidence that trauma and abuse can often change the brain in ways
that makes later

psychosis more likely.

And then another kind of evidence is the fact that we can often see just logical
and meaningful connections

between the psychotic symptoms a person is experiencing now and what are normal
reactions to traumatic

experience.
That's something we're going to be exploring a lot more later in this course.

So this graph just shows the result of one study that happens to be the only one I
have a graph for

but note on the graph.

CPA means childhood physical abuse and CSA stands for childhood sexual abuse.

As you can see adding more types of trauma strongly increases the likelihood of a
psychotic response.

Now given the stress vulnerability model which says that stress can lead to
psychosis and those who

are vulnerable it just follows logically that trauma would play a role and
psychosis traumas actually

is stress at a very high level.

And we know that trauma and increases stress in the future for people unless and
until we get it resolved

people are vulnerable to be retried at times sometimes by otherwise minor things.

For example a person might be hypervigilant for more danger and so they become
oversensitive and too

easily stressed.

Some of that would be physiological.

For example having high levels of stress hormones

so I also want to emphasize that the relationship between trauma and psychosis is
more complex than

just trauma causing psychosis.

It's also true it can go the other way that psychosis can cause trauma.

One way can do that is by causing the person to perceive threats as worse than they
are or even seeing

a threat when none exists.

And still has psychological threat.

If you see it another way is that being psychotic can cause people to actually
create more truly traumatic

situations for themselves.

You know a person's poor judgment while they're psychotic can lead to real
disasters.

And then once those happen once more traumas have been created.

Research shows that people with psychosis when they are subjected to traumatic
events they have a higher

rate of becoming traumatized in response and showing PTSD symptoms and that sort of
thing.

Now it's also true that the social and mental health system responds to psychosis
can cause more trauma.

You know for example family and friends might become very critical or withdraw
support the mental health

system you know comes in and you know using the medical model it avoids moral
blame.

But then it usually induces a sense of helplessness.

And that also we know helplessness aggravates trauma.

And people are convinced or just the passive victim of an act of illness they feel
more helpless.

And then you know the more helpless they are the more traumatized they can feel by
things going on are

out of control and then often with forced treatment and things like seclusion and
restraint forced medication

can be very traumatizing to people.

So then when when psychosis and social and mental health system responses to
psychos this causes more

trauma that trauma can then turn it around and feed more psychosis.

So then we can have trauma causing psychosis causing trauma and more psychosis.

You know in other words a lot of vicious circles can get going this way and people
can get stuck in

those vicious circles for years or even for life.

But it isn't hopeless.

And if we work to understand these vicious circles and how they work we can
sometimes help people emerge

from them and regain control of their lives exploring ways to do that.

Of course it's going to be the most important part of this course.