BackgroundUnderstanding the interplay between trauma-related psychological mechanisms and psychotic symptoms may improve the effectiveness of interventions for post-traumatic stress reactions in psychosis. Network theory assumes that mental health problems persist not because of a common latent variable, but from dynamic feedback loops between symptoms, thereby addressing the heterogeneous and overlapping nature of traumagenic and psychotic diagnoses. This is a proof-of-concept study examining interactions between post-traumatic stress symptoms, which were hypothesized to reflect trauma-related psychological mechanisms, and auditory hallucinations and delusions.MethodBaseline data from two randomised controlled trials (N = 216) of trauma-focused therapy in people with post-traumatic stress symptoms (87.5% met diagnostic criteria for PTSD) and psychotic disorder were analysed. Reexperiencing, hyperarousal, avoidance, trauma-related beliefs, auditory hallucinations and delusional beliefs were used to estimate a Gaussian graphical model along with expected node influence and predictability (proportion of explained variance).ResultsTrauma-related beliefs had the largest direct influence on the network and, together with hypervigilance, were implicated in the shortest paths from flashbacks to delusions and auditory hallucinations.ConclusionsThese findings are in contrast to previous research suggesting a central role for re-experiencing, emotional numbing and interpersonal avoidance in psychosis. Trauma-related beliefs were the psychological mechanism most associated with psychotic symptoms, although not all relevant mechanisms were measured. This work demonstrates that investigating multiple putative mediators may clarify which processes are most relevant to trauma-related psychosis. Further research should use network modelling to investigate how the spectrum of traumatic stress reactions play a role in psychotic symptoms.

中文翻译：

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创伤后压力和精神病症状的网络分析

背景了解创伤相关心理机制和精神病症状之间的相互作用可能会提高精神病创伤后应激反应干预措施的有效性。网络理论假设心理健康问题持续存在不是因为一个共同的潜在变量，而是来自症状之间的动态反馈循环，从而解决了创伤性和精神病诊断的异质性和重叠性。这是一项概念验证研究，检查创伤后应激症状之间的相互作用，这些症状被假设为反映与创伤相关的心理机制，以及幻听和妄想。方法来自两项随机对照试验的基线数据（ñ= 216) 对有创伤后应激症状（87.5% 符合 PTSD 诊断标准）和精神病性障碍患者进行的以创伤为中心的治疗进行了分析。使用重新体验、过度唤醒、回避、创伤相关信念、幻听和妄想信念来估计高斯图形模型以及预期的节点影响和可预测性（解释方差的比例）。结果创伤相关信念对网络的直接影响最大并且，与过度警觉一起，与从闪回到妄想和幻听的最短路径有关。结论这些发现与先前的研究形成对比，这些研究表明重新体验、情绪麻木和人际交往在精神病中的回避具有核心作用。创伤相关信念是与精神病症状最相关的心理机制，尽管并未测量所有相关机制。这项工作表明，调查多个推定的介质可以阐明哪些过程与创伤相关的精神病最相关。进一步的研究应该使用网络模型来研究创伤应激反应谱如何在精神病症状中发挥作用。