Post-traumatic Growth in Psychosis: A Systematic Review and Narrative Synthesis

Abstract Background and Objective: People with psychosis report experiences of highly traumatic events. Positive change or post-traumatic growth (PTG) can occur as a result of traumatic experiences. Yet there is limited attention on PTG in psychosis, possibly due to the negative impact of psychotic symptoms on functioning and quality of life. The aim of this review was to identify relationships between PTG and psychosis and to develop a conceptual framework synthesising facilitators of PTG in psychosis.Method: Ten electronic databases were searched in seven languages, whilst five journals and grey literature were searched in English. Quantitative studies were eligible if examining the association or temporal relationship between PTG and one or more variables. Qualitative studies were eligible if describing PTG arising from experiences of psychosis. Findings from quantitative papers were grouped by their analysis method, whilst a narrative synthesis was conducted of findings in qualitative papers.Results: 37 papers were included. Mediators of PTG in psychosis included meaning in life, coping self-efficacy, core beliefs, and self-reported recovery. Seven facilitators of PTG in psychosis were identified: Personal identity and strength, Receiving support, Opportunities and possibilities, Strategies for coping, Perspective shift, Emotional experience, and Relationships, giving the acronym PROSPER.Conclusions: Individuals with psychosis can grow from traumatic experiences. Clinicians can support PTG through the provision of trauma-informed care that supports positively valued identity changes. For researchers, the findings provide an evidence-based theoretical framework for conceptualising PTG, which can be validated through longitudinal cohort studies and underpin the development of new clinical interventions.