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I caught up to Early Psychosis services expert, change agent extraordinaire and overall interesting person, Nev Jones, after her return from Milan, Italy where she participated in the International Early Psychosis Association (IEPA) conference. Nev is the Director of Research at Felton Institute CCOR (Client Centered Outcomes Research in Public Mental Health).
So Nev, what were some of the more interesting trends you saw at IEPA?
It’s never possible to attend everything you want to with multiple concurrent sessions, but there was a strong undercurrent of research focused on adverse childhood experiences (ACEs), including both individual trauma and structural adversity (for instance, growing up in a disadvantaged neighborhood). Many of these presentations focused on the contributions of ACEs and other social factors, including migration, to later development of psychosis. (While still relatively under-acknowledged in the US, the relationship between early trauma and psychosis is now empirically well established and it’s critical that US clinicians start building trauma-informed approaches and trauma work into psychosis treatment programs. See a brief and accessible overview of the trauma-early psychosis research literature here).
In terms of contributing factors to the development of psychosis, there were definitely the more conventional presentations focused on biology. However, Mark van der Gaag and his lab (Amsterdam), presented a series of studies concerning repeated social stressors. By creating a “virtual café” they exposed subjects to an environment where everyone is a different race, and appear unfriendly or hostile. I also saw a great presentation on Melbourne-based researcher Sarah Bendall’s important work developing and evaluating TRIPP (trauma informed psychotherapy for psychosis), one of the first attempts to develop therapeutic interventions focused on trauma within the context of recent onset psychosis.)
Sounds interesting. What else did you learn?
This may at least partly be due to the fact that early psychosis services are much newer in the US than in countries like Canada and Australia, but I saw a range of innovative, outside-the-box projects that one just doesn’t see here in the States. For instance, an early psychosis intervention revolving around participation in adventure sports (e.g. rock climbing, white water rafting), and a martial arts intervention for at-risk youth. What I like about these sorts of projects is that they help move us away from the conventional symptoms focus of most early psychosis services, and reorient to the reality that most young people are probably far more interested in navigating a series of Class 4 rapids with a group of peers, than sitting around in a circle at a mental health center in group therapy discussing their coping strategies. A lot of processing, and a lot of healing, happens indirectly, by forging new relationships, tackling new challenges, and collaboratively engaging in activities that are actually legitimately cool.
Very cool. Did you present on anything?
I did two presentations as well as a poster. The poster focused on young people’s experiences of sexuality and the sex- or gender-driven themes so often present in voices or belief systems. My own research has found that around 50% of service users experience some sort of sexual content, including voices that talk about sex, unusual (positive and negative) erotic experiences, and/or themes related to past sexual trauma. It’s critical that these experiences are validated, discussed and explored, but often these sorts of themes leave clinicians feeling uncomfortable and so they simply avoid the subject. I also presented on a pair of twin SAMHSA-funded higher ed toolkits that we developed at the Felton Institute (“Supporting the full inclusion of students with early psychosis in higher education”) with extensive student and family input. The toolkits themselves are helpful (actually long overdue!) but still really just a first step in addressing the substantial educational disparities and barriers that students with early psychosis face. We’re now meeting with city and community college staff and trying to take this to the next level in terms of resources, trainings, and program development.
Nev is the director of research at Felton Institute CCOR (Client Centered Outcomes Research in Public Mental Health) and an active early psychosis services researcher and change agent. For more on Nev’s work on peer leadership in early psychosis see an archived webinar here.