Therapists' experience of the lifeline in narrative exposure therapy.

This study aimed to explore the therapist experience of delivering the lifeline component of narrative exposure therapy (NET), an intervention for individuals with posttraumatic stress disorder resulting from exposure to multiple traumatic events. The lifeline in NET involves constructing a chronological representation of the client's life using physical symbols to depict traumatic events as well as positive experiences. A semistructured interview was conducted with 16 therapists experienced in delivering the lifeline component of NET to adult clients. The data from these interviews were analyzed using thematic analysis. Five overarching domains were identified, each encapsulating three themes. The first domain pertains to the overlapping purposes of the lifeline, united by the vital function of developing the therapeutic relationship. The second domain describes the value and potential therapeutic mechanisms of the lifeline's "whole life" perspective. The third domain speaks to the intensely emotional nature of the lifeline process and some of the challenges this presents. The fourth domain relates to the physicality of the lifeline and the value this adds beyond a purely verbal method. The final domain encompasses several challenges described by therapists as well as potential areas for further development. This study provides a rich account of the novel lifeline component in NET. The findings provide direction for refinement of clinical practice and avenues for future research.

Corrigendum: "It hurt but it helped": A mixed methods audit of the implementation of trauma-focused cognitive-behavioral therapy for psychosis.

[This corrects the article DOI: 10.3389/fpsyt.2022.946615.].

"It hurt but it helped": A mixed methods audit of the implementation of trauma- focused cognitive-behavioral therapy for psychosis.

Background: Emerging evidence supports the safety, acceptability, and efficacy of trauma therapies for people experiencing post-traumatic stress and psychosis, despite common concerns about iatrogenic harm when processing trauma memories for this population. However, to date there have been no mixed-method studies examining whether trauma-focused therapy can be implemented in routine care. This study reports an audit of a post-traumatic stress in psychosis clinic based in an inner-city trust in the U.K. National Health Service. Materials and methods: People under the care of psychosis community mental health teams with a significant history of past trauma were referred to the clinic by their multidisciplinary clinicians. Referral outcomes were recorded, including the proportion of people for whom trauma-focused cognitive-behavior therapy for psychosis was indicated. Post-traumatic stress symptoms were assessed pre- and post-therapy for clinically significant change on the Post-traumatic Stress Checklist (version 4) and Post-traumatic Stress Checklist (version 5). A subgroup of service users was also interviewed about their experience of therapy, with transcripts analyzed using inductive thematic analysis. Results: Seventy one service-users were referred to the clinic between 2014 and 2018, of which 51 (71.8%) attended an assessment. Of these, 20 (39.2%) were identified as having clinically significant PTSD symptoms with re-experiencing and were offered trauma-focused cognitive-behavior therapy for psychosis. Sixteen (80%) accepted and completed therapy, with no dropouts, and received a mean of 17.54 sessions (SD = 17.60, range = 12-91). There were no serious adverse events related to therapy. Clinically significant change was observed in 68.8% (n = 11) of the therapy group and post-therapy six people (37.5%) no longer met the threshold for clinically significant PTSD. Six service users completed an interview about their therapy experiences with findings organized within four main themes and associated subthemes: (1) Perseverance, (2) Establishing safety, (3) The challenges of therapy, and (4) Rebuilding one's life after trauma. Conclusion: Trauma-focused cognitive-behavior therapy for psychosis can be safe, acceptable, and effective when implemented in routine care. Lived experience perspectives highlight the emotional demands of therapy and long-term impact of trauma, thus underscoring the necessity of sufficient support and continuity of care both during and after therapy.