Psychological trauma as a transdiagnostic risk factor for mental disorders, and results from a first multicentre randomised controlled trial into the efficacy of an adjunctive trauma-focused therapy in bipolar disorder.

Abstract

Psychological trauma has been associated with an increased risk for a range of mental disorders but its potential role as a transdiagnostic risk factor has not been systematically evaluated, and there is scant evidence of how to treat this comorbidity in patients with severe mental disorder. This thesis therefore has two main objectives. Firstly, to analyse the role of psychological trauma as a transdiagnostic risk factor across mental disorders through an umbrella review. Secondly, to examine the characteristics of people with a specific disorder, Bipolar Disorder (BD), and comorbid trauma, and to investigate the possibility of improving its clinical course with an adjunctive trauma-focused psychotherapy such as Eye Movement Desensitisation and Reprocessing (EMDR), adapted for BD._x000D_ The umbrella review synthesised evidence from existing published systematic reviews and meta-analyses regarding the association between psychological trauma and any mental disorder, to provide an overall odds ratio (OR). Evidence was graded for its quality using Ioannidis' criteria for umbrella reviews, and assessed against TRANSD transdiagnostic criteria. The results showed highly suggestive evidence that psychological trauma is associated with nearly triple the risk of experiencing a mental disorder (OR = 2.92), and meets criteria as a transdiagnostic risk factor._x000D_ For the second objective of the thesis, a randomised controlled trial (RCT) was carried out in a multicentre study comprising Hospital Benito Menni, Hospital Clínic, and Hospital del Mar Barcelona in the Barcelona area. Seventy-nine people with BD were recruited into the study. Inclusion criteria were: a) two to six affective relapses in the previous year, b) currently not in acute phase of BD (as determined by the Bipolar Depression Rating Scale and Young Mania Rating Scale), c) a history of psychological trauma and current symptoms. Subjects were randomised to receive 20 weekly one-hour sessions of either EMDR Bipolar protocol, or a control non-trauma-focused therapy, Supportive Therapy (ST). Affective symptoms, affective relapses, psychosocial functioning, and cognition were assessed at baseline, post-treatment, and at 12 and 24 months post-treatment as follow-up visits. Of note, to further monitor patients' mood, affective symptoms were also assessed at two weeks and three months. _x000D_ For this second part, two studies were carried out. In the first of these, a descriptive analysis was carried out with the baseline data, and the results showed no difference in trauma symptom profile between BD subtype, which concurs with previous evidence. There was also little difference in terms of clinical course depending on the type of trauma suffered or if there was a lifetime diagnosis of post-traumatic stress disorder, suggesting that in a traumatised sample with a high level of subsyndromal symptoms the impact of specific abuse types or a PTSD diagnosis is diminished._x000D_ Regarding the second study where the two interventions were compared, the results showed that EMDR therapy was superior to ST in reducing subsyndromal depressive, mixed and hypomanic symptoms and in improving psychosocial functioning at six months post-treatment. Hospitalisation, relapse, and dropout rates were similar across the two treatment arms. Trauma symptoms reduced in both treatment arms as compared to baseline but there was no significant difference between EMDR and ST. There was no significant change in cognition in either treatment arm. _x000D_ In summary, the thesis shows for the first time through an umbrella review that psychological trauma is a transdiagnostic risk factor for mental disorder. Furthermore, it shows through a multicentre RCT that EMDR therapy can be safely applied in BD patients and may alleviate affective symptoms.

Date of Award	17 Oct 2023
Original language	English
Supervisor	Benedikt Lorenz Amann . (Director), Anna Moreno Alcaraz (Director) & Marta Torrens Melich (Director)