Trauma-focused CBT for psychosis beneficial in patients with PTSD, psychosis

Trauma-focused cognitive behavioural therapy (CBT) for psychosis (CBTp) may help improve symptoms in patients with co-occurring post-traumatic stress disorder (PTSD) and psychosis, as shown in the STAR trial.

STAR was conducted across five sites in the UK and included 305 participants (mean age 38.9 years, 56 percent female, 76 percent White). The participants were randomly assigned to undergo trauma-focused CBTp plus treatment as usual (n=154) or treatment as usual only (control; n=151). Trauma-focused CBTp was a 9-month intervention that integrated trauma-focused therapeutic components with CBT.

PTSD symptom severity was assessed using clinician-administered PTSD scale for DSM-5 (CAPS-5) at 4 months (mid-therapy) and 9 months (primary endpoint). Other outcomes included (1) PTSD remission from diagnosis and clinically significant change, individual symptom clusters, post-traumatic cognitions, and dissociation; (2) psychosis symptoms; (3) mood disorders; (4) psychological recovery; and (5) social functioning, assessed at the same timepoints.

Compared with the control group, the CBTp group showed a significantly greater decrease in total CAPS-5 scores, with a moderate-to-large effect size (Cohen’s d, –0.73). Improvements were observed in both groups at the 4-month timepoint, but only the CBTp group showed continued improvement through 9 months, with scores in the control group plateauing.  

Results for secondary outcomes consistently favoured CBTp, with 22 of 27 outcomes being significantly improved with the CBTp vs the control group (p<0.05). PTSD remission occurred in 50 percent of participants in the CBTp group vs 22 percent in the control group (odds ratio [OR], 0.11, 95 percent confidence interval [CI], 0.03–0.32; p=0.0001), while clinically significant change in CAPS-5 score was observed in 45 percent vs 27 percent in the respective groups (OR, 4.45, 95 percent CI, 1.59–12.44; p=0.0044).

Serious adverse events occurred in 78 participants in each group, but none were unexpected and related to trial procedures.