Implementing trauma-informed approaches in psychosis services

Abstract

This thesis investigates how trauma‑informed care can be conceptualised, operationalised and implemented within psychosis services, with a particular focus on early intervention settings. Grounded in a critical realist paradigm, it examines multilevel mechanisms linking trauma and psychotic experiences alongside the organisational, policy and societal contexts that shape service responses. Five empirical studies are brought together to address overarching questions at service, system, societal, individual and clinical practice levels.

The first study is a systematic review of post‑traumatic growth (PTG) in early intervention services for psychosis, synthesising current evidence on how early psychosis care can promote positive psychological change following trauma and distress. The second study uses framework analysis to examine the extent to which international early psychosis guidelines incorporate trauma‑informed principles across domains such as safety, training, compassionate care and access to appropriate interventions, highlighting substantial variability and important gaps. The third study uses vignette‑based survey methods and regression analyses to compare public attitudes toward traditional biomedical versus trauma‑informed psychosis services, focusing on perceived stigma and service effectiveness.

The fourth study draws on data from the Northern Ireland Youth Wellbeing Study to test an affective pathway model linking adverse and benevolent childhood experiences, depression and anxiety, and psychotic experiences using structural equation modelling. It provides quantitative evidence for both risk and resilience mechanisms, emphasising the role of affective processes and positive experiences in shaping psychosis risk. The fifth study is a qualitative implementation project with clinicians and other professionals working in early intervention services internationally, exploring relational practice, peer support, system strain, and organisational and cultural conditions that facilitate or hinder trauma‑informed care.

Across these studies, the thesis argues that trauma‑informed approaches in psychosis services must be understood as a whole‑systems endeavour rather than a discrete intervention, requiring changes in guidelines, service culture, training, supervision, public communication and clinical practice. It proposes an integrative, multilevel framework for trauma‑informed early psychosis care that connects individual pathways of risk and growth with system and societal contexts, and outlines implications for policy, service development and future research aimed at enhancing safety, dignity and recovery for people experiencing psychosis.

Date of Award	Dec 2026
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Co-operative Awards in Science and Technology (CAST) studentship (Department for the Economy)
Supervisor	Ciaran Mulholland (Supervisor), Gavin Davidson (Supervisor) & Ciaran Shannon (Supervisor)