When Nadine Keen began working with trauma survivors at South London and Maudsley NHS Foundation Trust, she noticed a painful pattern: people with psychosis were routinely denied access to trauma-focused therapy, excluded not by choice but by clinical caution. Now, the STAR study—led by researchers at King’s College London and involving 305 participants across five UK sites—has shattered that barrier with compelling evidence that integrated trauma-focused cognitive behavioral therapy (CBTp) is not only safe but transformative for people living with both psychosis and PTSD. For decades, clinicians avoided addressing trauma directly in this group, fearing it might worsen delusions or hallucinations. But the results, published in The Lancet Psychiatry, tell a different story—one of resilience, recovery, and long-overdue inclusion.
PTSD affects up to five times more people with psychosis than the general population, often intertwining with symptoms like paranoia and flashbacks. Yet, until now, this dual diagnosis has been met with therapeutic silence. The STAR trial challenged that status quo by delivering a nine-month course of integrated trauma-focused CBTp, carefully tailored to each individual. The outcomes were striking: half of those who received the therapy no longer met the diagnostic criteria for PTSD afterward, compared to just over 20% in the treatment-as-usual group. Even more remarkably, 22 out of 27 measured outcomes showed significant improvement—from reductions in multisensory hallucinations and paranoia to meaningful declines in depression, anxiety, and suicidal ideation.
The therapy’s acceptability was equally impressive. With a disengagement rate of only 6.5%, it proved not only effective but deeply resonant with a population too often marginalized in mental health care. Professor Emmanuelle Peters, who leads the PICuP Clinic at SLaM, emphasized that working directly with trauma memories—once considered too risky—is now proven safe and impactful. The intervention’s success has already sparked change: PICuP now offers trauma-focused CBTp and trains clinicians across services, guided by study leads Dr. Nadine Keen and Dr. Amy Hardy, alongside people with lived experience who participated in the trial.
This isn’t just a clinical breakthrough—it’s a moral one. As Dr. Keen put it, excluding trauma survivors from care risks perpetuating their silence. The STAR trial doesn’t just open a door; it demands we walk through it. With implementation already underway in London, Manchester, Newcastle, Oxford, and Sussex, the vision is clear: a future where no one is turned away from healing because of a diagnosis.