A landmark study published in The Lancet Psychiatry demonstrates that trauma-focused therapy significantly reduces PTSD symptoms in psychosis patients, with half no longer meeting PTSD criteria post-treatment, challenging long-standing exclusion of this group from mental health care.
The STAR (Study of Trauma And Recovery) trial, led by researchers at King’s College London and funded by the National Institute for Health and Care Research (NIHR), found that integrating trauma-focused cognitive behavioral therapy (CBTp) with psychosis treatment dramatically improved outcomes for 305 participants. This marks a pivotal shift in mental health care for a population historically excluded from PTSD research.
Breakthrough in PTSD Treatment for Psychosis Patients
The study, the largest of its kind, targeted individuals with co-occurring psychosis and PTSD—a condition affecting up to five times more people than in the general population. Participants experienced intrusive trauma memories, hyperarousal, and avoidance behaviors, often intertwined with psychosis symptoms like delusions and hallucinations. The integrated therapy focused on directly addressing trauma memories, engagement strategies, and flexible, individualized approaches.
Results showed significant improvements across 22 of 27 assessed outcomes, with a moderate-to-large effect size on PTSD symptom severity. The results challenge a longstanding gap in mental healthcare, where people with psychosis have been excluded from trauma-focused therapies,
said Dr. Amy Hardy, a study co-author. Our findings demonstrate that this must change.
Challenging Longstanding Gaps in Mental Healthcare
Historically, people with psychosis were excluded from PTSD research due to fears that trauma-focused therapy might exacerbate psychotic symptoms. The STAR study directly addresses this concern, proving the approach is both safe and effective. This therapy can transform lives and underscores an ethical imperative: clinical services and research should not inadvertently perpetuate trauma survivors' silence through exclusion,
said Dr. Nadine Keen, a joint-therapy lead.
The findings align with broader WHO data highlighting PTSD’s global prevalence—3.9% of the population experiences it at some point—but reveal stark disparities in treatment access. Only 1 in 4 people in low- and middle-income countries seek care, often due to stigma, lack of resources, or misperceptions about treatability. The study’s success in a diverse, multi-site trial suggests scalability, particularly in regions with limited mental health infrastructure.
Professor Emmanuelle Peters, the study’s first author, emphasized the need for systemic change: It is now clear that trauma-focused therapies can be delivered safely and effectively for people with PTSD and psychosis.
Her team at the PICuP Clinic now provides training for clinicians, integrating the therapy into routine care. This shift could redefine standards for treating trauma in psychiatric populations.
What Comes Next: Implementation and Broader Implications
The study’s authors urge policymakers and healthcare commissioners to prioritize implementing trauma-focused CBTp, citing its potential to reduce long-term mental health burdens. With PTSD often linked to cardiovascular and other physical health risks, widespread adoption could yield cascading public health benefits.
However, challenges remain. The WHO notes that stigma and lack of trained providers persist, particularly in under-resourced areas. The STAR team plans to expand their work through the Let’s Talk research trial, focusing on reducing internalized stigma among psychosis patients.
As the field moves forward, the study’s results offer a roadmap for inclusive mental healthcare. With 305 participants demonstrating the therapy’s efficacy, the path is clear: integrating trauma care into psychosis treatment is not only feasible but essential. The next step, as the researchers stress, is ensuring this evidence translates into equitable, widespread practice.
