Can people with psychosis safely process traumatic events?

Historically, clinicians have been cautious about using trauma‑focused therapies—especially those that involve revisiting traumatic memories—with individuals who experience psychosis. PTSD symptoms such as intrusive memories and hyperarousal can overlap with or amplify psychotic phenomena, raising fears of symptom escalation during the intense process of working through traumatic events. This was speculative rather than research-based, as people with psychosis were often excluded from clinical trials of trauma therapies. But a major study now offers evidence that questions the clinical lore. Findings from the largest randomized controlled trial to date examining trauma‑focused therapy for people with both PTSD and psychosis, the Study of Trauma and Recovery (STAR) trial, were published in the July 2026 issue of The Lancet Psychiatry. This study from the UK, which has generally been ahead of the US and other countries when it comes to treating psychotic disorders with psychotherapy, challenges conventional wisdom in multiple ways. First, over 90% of patients with co-occurring PTSD and psychosis successfully engaged in cognitive-behavioral therapy with integrated trauma-focused components, and few dropped out. Second, the treatment was shown to be safe; there were no serious adverse events related to the procedures. And, third, the treatment was effective not only in reducing PTSD symptoms but also delusions, paranoia, and several kinds of hallucinations. The STAR trial suggests that avoiding trauma work out of fear of destabilizing individuals with psychosis may inadvertently prolong their suffering, leaving core drivers of distress untouched.

Citation:

Peters E, Swan S, Underwood R et al.

Trauma-focused therapy integrated with cognitive behavioural therapy for psychosis for people with post-traumatic stress disorder and psychosis (the STAR trial): a multicentre, pragmatic, randomised trial in the UK

The Lancet Psychiatry, 13, 549-566