A new multicentre pragmatic trial in The Lancet Psychiatry by Peters and colleagues randomized 305 adults receiving secondary mental-health care at five UK sites. All participants had both PTSD and psychosis. They received either treatment as usual or nine months of trauma-focused CBT integrated with CBT for psychosis, or TF-CBTp. The therapy was flexible, individualized, and formulation-based, integrating direct trauma-memory work with attention to psychotic experiences, engagement, avoidance, appraisals, and recovery.
Following treatment, approximately half of participants offered TF-CBTp no longer met criteria for PTSD, compared with just over 20% receiving usual care. The primary PTSD outcome showed a moderate-to-large effect, and disengagement from therapy was only 6.5%. Benefits were also reported across several psychosis, mood, and recovery outcomes. This was, however, a substantial nine-month specialist intervention—not evidence that unmodified exposure procedures can simply be added to routine psychosis treatment without appropriate formulation and competence.
Clinical Takeaway: Psychosis need not be treated as an automatic contraindication to trauma-focused therapy. Routinely assess PTSD and examine how trauma memories, negative appraisals, voices or paranoia, avoidance, dissociation, and safety behaviours may interact. When trauma work is indicated, prioritize engagement, proceed flexibly, monitor risk and psychosis symptoms, and integrate direct memory work within a CBTp-informed formulation rather than treating PTSD and psychosis as unrelated problems.
Article:
Trauma-Focused Therapy Integrated With Cognitive Behavioural Therapy for Psychosis for People With Post-Traumatic Stress Disorder and Psychosis: The STAR Trial