Exploring attachment, trauma, and cannabis use in psychotic disorders: a qualitative study of patient and family perspectives

Abstract Background Psychotic disorders substantially impact individuals psychologically, occupationally, and socially. Although modifiable risk factors such as insecure attachment styles, history of psychological trauma, and substance use disorders (of which cannabis is the most frequent) are known to increase risk, it remains unclear how they may interact with each other to create pathways of vulnerability. More importantly, it is also unknown to what extent patients and their families recognize and address these risks to prevent illness, or support recovery. To address this gap, this study aimed to explore how patients and their family members understand the role of attachment, trauma, and cannabis use in the onset and recovery from psychotic disorders. Ultimately, these findings will be used to better inform interventions needed to support optimal recovery.

Method: Patients and family members were recruited from the Early Psychosis Intervention Program in Saskatoon and the Schizophrenia Society of Saskatchewan. Semi-structured interviews were conducted with 17 patients experiencing first-episode psychosis and 9 family members of individuals with psychosis. Data was analyzed using reflexive thematic analysis, following Braun and Clarke’s 6-phase framework. Strategies such as reflexive journaling and triangulation across participant groups were used to ensure rigour.

Results: Three major themes were generated. Theme 1 described the pre-help seeking period, marked by early confusion and misinterpretation of emerging psychotic symptoms, which often led to delays in initial help seeking, and created emergency situations. Theme 2 outlines the illness period itself, and describes participants understandings of trauma, attachment, and cannabis. While they partially understood their role in illness severity, these risks were rarely understood to have a cumulative role that create pathways of vulnerability in their illness. Finally, Theme 3 highlights recovery, which was often understood to be facilitated by family relationships, psychoeducation provided by specialized clinics, and renewed hope.

Conclusion: Our findings reveal that patients and their families often have varying and inadequate understanding of the common risk factors affecting early psychosis. While the psychoeducation offered in the specialized clinic is highly valued and meaningful to recovery, it is not always accessible or sufficient to alleviate these risks. The results highlight the necessity for targeted interventions aimed at increasing knowledge translation and treatment engagement.