Trauma-focused therapy safely improves PTSD symptoms in psychosis patients

People with psychosis and PTSD can safely recover using Trauma-Focused Cognitive Behavior Therapy for psychosis (CBTp), according to a study from King’s College London and South London and Maudsley NHS Foundation Trust (SLaM). Published in The Lancet Psychiatry, the trial found half of participants no longer met PTSD criteria after treatment.

How does Trauma-Focused CBTp help patients with psychosis?

The STAR (Study of Trauma And Recovery) trial demonstrated that an integrated 9-month therapy program is safe and effective for people with co-occurring psychosis and PTSD. According to the research, half of the participants receiving this therapy no longer met PTSD criteria post-treatment, compared to just over 20 percent of those receiving treatment as usual.

Participants showed significant improvements in 22 out of 27 assessed outcomes. These included reductions in PTSD symptom severity, mood disorders like depression and anxiety, and psychosis symptoms such as paranoia and multisensory hallucinations, according to the study results.

Did You Know? PTSD is up to five times more prevalent in people with psychosis than in the general population, with traumatic events often shaping the content of hallucinations and delusions.

Why were these patients previously excluded from trauma therapy?

Clinicians historically avoided delivering trauma-focused therapy in routine clinics because they feared it might worsen psychosis symptoms. As a result, people with psychosis were excluded from nearly all PTSD research trials, according to the study authors.

Dr. Amy Hardy, a Reader in Clinical Psychology at King’s, stated that these results challenge a “longstanding gap in mental healthcare.” She noted that the findings indicate a need for change to ensure those historically denied access receive evidence-based care.

Expert Insight: Samantha Carter suggests that the shift from exclusion to integrated care represents a critical evolution in psychiatric ethics. By proving that direct work on trauma memories is safe, the study removes the clinical hesitation that previously left a highly marginalized population without specialized support.

What are the outcomes for participants and clinics?

The STAR study, funded by the National Institute for Health and Care Research (NIHR), recruited 305 participants across five UK sites: London, Manchester, Newcastle, Oxford, and Sussex. The trial reported an exceptionally low disengagement rate of 6.5 percent, which researchers cite as evidence that the therapy is highly acceptable to patients.

Yes, PTSD can cause psychosis #cptsd #ptsd #trauma #shorts

Shane, a trial participant and current Peer-Support Worker, said the therapy provided tools to reshape trauma memories and rebuild trust and confidence. He stated that the process gave him back a feeling of control and the belief that recovery is possible.

What happens next for this treatment?

The PICuP Clinic, based at SLaM, now provides Trauma-focused CBTp and trains clinicians to deliver the intervention. This training is led by STAR Therapy Leads Dr. Nadine Keen and Dr. Amy Hardy, with support from people with lived experience of trauma and psychosis.

Dr. Nadine Keen stated that the trial may motivate commissioners and services to prioritize the implementation of Trauma-Focused CBTp. Increased adoption could potentially prevent clinical services from inadvertently perpetuating the silence of trauma survivors through exclusion.

Frequently Asked Questions

What is the STAR study?
The Study of Trauma And Recovery (STAR) is the largest multi-site randomized controlled trial to date focusing on trauma-focused therapy for individuals with both psychosis and PTSD.

How long does the integrated therapy last?
The Trauma-Focused-CBTp program used in the study lasts for nine months.

Which symptoms improved during the trial?
According to the research, participants saw improvements in PTSD severity, paranoia, multisensory hallucinations, depression, anxiety, and suicidal ideation.

How do you think integrating trauma care could change the approach to mental health treatment?