Two people making sense of a story: narrative exposure therapy as a trauma intervention in early intervention in psychosis

<b>Background:</b> Narrative exposure therapy (NET) is a recommended intervention for people with multiple trauma histories; however, research is lacking into its use with people experiencing psychosis, many of whom report multiple trauma histories. <b>Objective:</b> This study aimed to explore experiences of NET in early intervention in psychosis (EIP) services. <b>Method:</b> Eight clinicians and four experts with lived experience (experts by experience) of psychosis and multiple trauma were interviewed on a single occasion using two versions (clinician and expert by experience) of a semi-structured interview schedule. Data was analysed using thematic analysis. <b>Results:</b> Five overarching themes were generated, relating to fear and avoidance of memories, importance of trust, organizing memories and making new meaning, reconnecting with emotions, and considerations when delivering NET in EIP. <b>Conclusions:</b> Directly addressing the impact of multiple trauma in people experiencing first episode psychosis is frightening and emotive, but helps to address painful memories and organize them into a personal narrative. Increases in distress and anomalous experiences were carefully considered by clinicians, but typically outweighed by the benefits of NET. Challenges were comparable to those described in non-psychosis research. Implications for clinical practice and future research are outlined. Many people experiencing psychosis report multiple trauma histories. Narrative exposure therapy (NET) is a recommended intervention for people with multiple trauma histories, but research into its use with people experiencing psychosis is limited.This qualitative study found that clinicians and experts by experience in early intervention in psychosis services valued NET for its effect on organizing memories, reducing their emotional impact, and making new meaning around experiences, and that challenges of NET were similar to those described in non-psychosis research.Some participants described experiencing distress and dysregulation during NET, including an increase in anomalous experiences. Although this was typically temporary and outweighed by NET’s benefits, careful assessment before and flexibility during the intervention are considered important for building engagement and trust. Many people experiencing psychosis report multiple trauma histories. Narrative exposure therapy (NET) is a recommended intervention for people with multiple trauma histories, but research into its use with people experiencing psychosis is limited. This qualitative study found that clinicians and experts by experience in early intervention in psychosis services valued NET for its effect on organizing memories, reducing their emotional impact, and making new meaning around experiences, and that challenges of NET were similar to those described in non-psychosis research. Some participants described experiencing distress and dysregulation during NET, including an increase in anomalous experiences. Although this was typically temporary and outweighed by NET’s benefits, careful assessment before and flexibility during the intervention are considered important for building engagement and trust.

### 背景：
叙事暴露疗法（Narrative Exposure Therapy, NET）是针对多重创伤史人群的推荐干预方案，但目前针对其在精神病性障碍人群中的应用研究仍较为匮乏——这类群体中多数报告存在多重创伤史。
### 研究目的：
本研究旨在探索精神病性障碍早期干预（Early Intervention in Psychosis, EIP）服务中应用叙事暴露疗法的相关体验。
### 研究方法：
本研究采用分别适配临床医生与亲历者专家的两个半结构化访谈提纲版本，对8名临床医生及4名兼具精神病性障碍与多重创伤史亲历体验的专家（即亲历者专家）开展单次访谈，并采用主题分析法对访谈数据进行分析。
### 研究结果：
本研究共提炼出五大核心主题，涵盖创伤记忆的恐惧与回避、信任关系的重要性、记忆梳理与意义重构、情绪再联结，以及在精神病性障碍早期干预服务中实施叙事暴露疗法的注意事项。
### 研究结论：
针对首发精神病性障碍人群直接处理多重创伤的影响，虽会引发强烈的情绪反应与恐惧，但有助于梳理痛苦的创伤记忆并将其整合成连贯的个人叙事。临床医生会谨慎评估干预过程中出现的痛苦水平与异常体验变化，但总体而言叙事暴露疗法的获益超过其潜在风险。该疗法的应用挑战与非精神病性障碍相关研究中报告的情况基本一致，本文还阐述了该疗法对临床实践的启示与未来研究方向。

许多精神病性障碍人群报告存在多重创伤史。叙事暴露疗法（NET）是针对多重创伤史人群的推荐干预方案，但目前针对其在精神病性障碍人群中的应用研究仍较为匮乏。本项定性研究发现，精神病性障碍早期干预服务中的临床医生与亲历者专家均认可叙事暴露疗法的价值：该疗法能够帮助梳理创伤记忆、降低其情绪影响，并帮助个体为自身经历赋予新的意义；且该疗法的应用挑战与非精神病性障碍相关研究中描述的情况基本一致。部分参与者报告在接受叙事暴露疗法期间出现了痛苦与情绪失调，包括异常体验增多的情况。尽管这类反应通常为一过性，且其获益超过潜在风险，但干预前的细致评估与干预过程中的灵活调整，被认为是建立参与度与信任关系的关键。