People with psychotic disorders report high levels of traumatic life experiences in childhood and adulthood (e.g. Varese et al., 2012). Research has demonstrated that psychotic patients exposed to trauma develop a range of post-traumatic symptoms and severe comorbidities. One complex clinical presentation that has received growing clinical and research attention is Complex Post-Traumatic Stress Disorder (CPTSD; Brewin et al 2017; Karatzias et al., 2017). CPTSD is a condition characterised by distressing symptoms believed to arise in response to severe and prolonged traumatic exposures, which include the characteristic symptoms of Post-Traumatic Stress Disorder (PTSD; e.g. avoidance, intrusions and hyperarousal) in addition to other distinct symptom dimensions (affect regulation difficulties, negative self-concept and disturbances in relationships). Evidence suggests that CPTSD is linked to anomalous psychological and neurophysiological processes linked to emotion/threat regulation, as well as a range of negative clinical and functional outcomes (e.g. heightened dissociation, disruption in social relationships).
National clinical guidelines for the treatment and management of psychosis have recently stressed the importance of considering trauma and its sequelae in this clinical population (NICE, 2014). Growing evidence indicates that “simple” PTSD symptoms are prominently involved in the maintenance of distressing psychotic experiences such as hallucinations and paranoia (e.g. Hardy et al., 2016; Varese, Barkus & Bentall, 2012), as well as other difficulties experienced by this client group (e.g. social isolation and poor functioning). However, very little is known about the potential impact of CPTSD on the course and maintenance of psychosis and associated difficulties. Given evidence that effective treatment for CPTSD requires specific adjustments to account for its complex nature (UK Psychological Trauma Society, 2017), research is required to clarify neurophysiological, psychological and clinical factors that are relevant to the assessment, prognosis and treatment of CPTSD in those with psychosis. Therefore, this PhD aims to recruit participants with psychotic illness and: (1) examine the impact of CPTSD on a range of clinical, functional and psychological outcomes in people with psychosis; (2) investigate the potential contribution of CPTSD symptoms in the maintenance of psychotic experiences, (3) use electrophysiological (EEG) methods, explore the potential neurophysiological anomalies that characterise CPTSD in those with psychosis.
The PhD will benefit from supervision from established clinical researchers with expertise in the area of clinical psychology, psychiatry and cognitive neuroscience, and the methodological and statistical procedures necessary to deliver the proposed research (e.g. EEG, quantitative evidence synthesis, advanced statistical analysis).
Dr Filippo Varese - https://www.research.manchester.ac.uk/portal/filippo.varese.html
Professor Rebecca Elliott - https://www.research.manchester.ac.uk/portal/rebecca.elliott.html
Professor Katherine Berry - https://www.research.manchester.ac.uk/portal/Katherine.Berry.html
Professor Sandra Bucci - https://www.research.manchester.ac.uk/portal/Sandra.Bucci.html
Applications are invited from UK/EU nationals only. Applicants must have obtained, or be about to obtain, at least an upper second class honours degree (or equivalent) in a relevant subject.
Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., . . . Reed, G. M. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review. doi: 10.1016/j.cpr.2017.09.001
Hardy, A., Emsley, R., Freeman, D., Bebbington, P., Garety, P. A., Kuipers, E. E., ... & Fowler, D. (2016). Psychological mechanisms mediating effects between trauma and psychotic symptoms: The role of affect regulation, intrusive trauma memory, beliefs, and depression. Schizophrenia Bulletin, 42, S34-43.
Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., ... & Cloitre, M. (2017). Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). Journal of Affective Disorders, 207, 181-187.
Varese, F., Barkus, E., & Bentall, R.P. (2012). Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychological Medicine, 42, 1025-1036. doi:10.1017/S0033291711001826
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., van Os., J & Bentall, R.P. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of prospective, epidemiological and case-control studies. Schizophrenia Bulletin, 38(4), 661-671. doi:10.1093/schbul/sbs050