Trauma-focused therapy safely improves PTSD symptoms in psychosis patients
· News-MedicalNew research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London and published in The Lancet Psychiatry has found that people with psychosis experiencing Post Traumatic Stress Disorder (PTSD) can benefit from a Trauma-Focused therapy integrated with Cognitive Behavior Therapy for psychosis (CBTp).
PTSD is characterized by intrusive trauma memories such as 'flashbacks' and other types of re-experiencing, negative appraisals, hyperarousal, and avoidance of trauma reminders. The prevalence of PTSD in people with psychosis is up to five times that in the general population, with PTSD symptoms often intertwined with psychosis symptoms such as delusions and hallucinations, and traumatic events often shaping their content.
In the past people with psychosis have been excluded from almost all PTSD research trials, and clinicians were wary of delivering Trauma-Focused therapy in routine clinics for fear of making the psychosis symptoms worse. But this study showed that an integrated Trauma-Focused-CBTp, lasting 9-months, was safe and highly effective with this group. Half of the participants who received the therapy no longer met PTSD criteria post-therapy, compared to just over 20 per cent receiving treatment as usual, despite all participants reporting repeated and multiple traumas. A similar pattern was found for complex PTSD.
There were exceptionally low rates of disengagement from therapy (6.5 per cent), demonstrating the therapy is highly acceptable.
Overall participants showed significant improvements in 22 out of 27 assessed outcomes. The primary outcome, PTSD symptom severity, demonstrated a moderate-to-large effect size, with additional effects ranging from large to small across psychosis symptoms (paranoia and multisensory hallucinations), mood disorders (depression, anxiety and suicidal ideation), and psychological recovery.
Dr Amy Hardy, Reader in Clinical Psychology at King's and the joint-last author and joint-Therapy Lead for the study, said: "The results challenge a longstanding gap in mental healthcare, where people with psychosis have been excluded from trauma-focused therapies. Our findings demonstrate that this must change, to ensure those historically denied access can receive evidence-based care."
Professor Peters leads a specialist psychological therapies team for outpatients with psychosis, the PICuP Clinic, based at SLaM. PICuP now provides Trauma-focused CBTp and training in the intervention to clinicians working with individuals with psychosis, led by the STAR Therapy Leads Dr Nadine Keen (PICuP Coordinator) and Dr Amy Hardy (PICuP and SLaM Psychology & Psychotherapy Trauma Informed Care for Psychosis Lead), alongside people with lived experience of trauma and psychosis who received the therapy in the trial.
One such participant, Shane now works as a Peer-Support Worker in PICuP and with Professor Peters on the Let's Talk research trial at King's and South London and Maudsley, delivering a peer-led programme to address internalised stigma for people with psychosis. He said: "STAR therapy gave me the tools to make sense of experiences I had carried for years and change how I see myself and others. I didn't just learn ways to manage and reshape trauma memories - I rebuilt trust, confidence, and a sense of connection. It gave me back a feeling of control and the belief that recovery is possible."
This research was possible thanks to funding by the National Institute for Health and Care Research (Health Technology Assessment). Over 120 people in five UK sites (London; Manchester; Newcastle; Oxford and Sussex) were involved in delivering the trial, which took five years to complete.
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