A MAJOR UK trial has found that a trauma-focused therapy combined with cognitive behavioural therapy for psychosis significantly reduced PTSD symptoms in people with both PTSD and psychosis, a group often excluded from such therapy over fears it could destabilise them.
PTSD Is Common and Undertreated in Psychosis
People with psychosis have high rates of PTSD, which is associated with a poor prognosis, yet post-traumatic symptoms are often intertwined with psychosis symptoms such as delusions and hallucinations, with traumatic events frequently shaping how psychosis presents. Despite emerging evidence from small trials that treating PTSD is safe and feasible in this group, large-scale trials had been lacking, prompting researchers to test a trauma-focused therapy integrated with CBT for psychosis.
Testing Trauma-Focused Therapy Across Five UK Sites
The STAR trial was a rater-blind, parallel-group, pragmatic randomised controlled trial conducted across five UK sites. Adults with co-occurring PTSD and psychosis in secondary care were randomly assigned, on a 1:1 basis and stratified by site, to trauma-focused CBT for psychosis plus treatment as usual, or to treatment as usual alone. The therapy was a flexible, individualised intervention lasting nine months. The primary outcome was PTSD symptom severity at nine months. Between October 2020 and March 2023, 305 participants were randomly assigned, with a mean age of 38.9 years; 144 (94%) of those in the therapy group engaged with it, and 241 (79%) provided primary outcome data at nine months.
Therapy Group Showed Significant Reductions in PTSD Symptoms
At nine months, PTSD symptom severity was significantly reduced in the therapy group, with an adjusted mean difference of −8.67 (95% CI −13.41 to −3.94; p=0.0003; Cohen’s d −0.73). Significant effects were also seen on 22 of 27 secondary outcomes, including psychosis symptoms such as delusions and paranoia, mood outcomes, and psychological recovery, though there were no effects on voices or social functioning. PTSD remission occurred in 62 (50%) of 125 participants in the therapy group compared with 25 (22%) of 116 in the treatment-as-usual group (OR 0.11, 95% CI 0.03–0.32; p=0.0001), giving a number needed to treat of four.
A Case for Wider Access to Trauma-Focused Care
The authors concluded that trauma-focused therapy is safe, highly acceptable and effective for people with PTSD and psychosis, and that this underserved population should no longer be denied access to trauma-focused psychological care.
Reference
Peters E et al. Trauma-focused therapy integrated with cognitive behavioural therapy for psychosis for people with post-traumatic stress disorder and psychosis (the STAR trial): a multicentre, pragmatic, randomised trial in the UK. The Lancet Psychiatry. 2026;13(7):54966.
Featured image: peopleimages.com on Adobe Stock
- Author:
