Bethlem Royal Hospital

STAR Trial Demonstrates Trauma-Focused CBT Is Safe and Effective for PTSD in Patients with Psychosis, Challenging Decades of Clinical Exclusion

- The landmark STAR trial, the largest multicenter RCT of trauma-focused therapy for co-occurring psychosis and PTSD, enrolled 305 participants across five UK sites and found the integrated intervention both safe and highly effective. - Half of participants receiving trauma-focused CBT for psychosis (CBTp) no longer met PTSD criteria post-therapy, compared to just over 20% in the treatment-as-usual arm, with a 6.5% therapy disengagement rate. - Significant improvements were observed across 22 of 27 assessed outcomes, including PTSD severity, paranoia, hallucinations, depression, anxiety, and suicidal ideation. - The findings directly challenge the longstanding practice of excluding psychosis patients from trauma-focused therapy trials, an exclusion that researchers now call indefensible as a safety rationale.