NEW: Study of Trauma And Recovery (STAR) Trial Results 2026

The STAR trial found that Trauma-Focused Cognitive Behavioural Therapy for psychosis (TF-CBTp) can help people with psychosis and PTSD

Results now published in The Lancet Psychiatry

Read David van den Berg’s comment here: Following a STAR: advancing trauma-focused therapy in psychosis

Read media coverage here:‍ ‍KCL News‍ ‍Life Technology‍ ‍The Conversation

What did the STAR study find?

Findings show this trauma-focused therapy, specially adapted for people with psychosis, is both safe and effective.

TF-CBTp successfully reduced symptoms of PTSD, psychosis and emotional difficulties at the end of therapy.

  • Do people engage well with TF-CBTp?

    Yes, the large majority of participants engaged with the therapy (93.5%), with 85% completing therapy, confirming that the therapy was highly acceptable.

  • Does therapy reduce symptoms of PTSD?

    Yes, around half of those who received the therapy no longer met the criteria for PTSD after TF-CBTp.

    In comparison, just over 20% of people receiving usual care no longer met PTSD criteria.

    Similar improvements were seen for people experiencing complex PTSD (which affects emotional well-being, self-perception and relationships, often resulting from prolonged or repeated trauma).

  • Does TF-CBTp help with other difficulties?

    Yes, overall participants showed significant improvements in a wide range of areas (22 out of 27 outcomes), with effect sizes ranging from large to small, including:

    • PTSD symptoms (flashbacks, nightmares, intrusive thoughts/memories and feeling on edge)

    • Negative impact of distressing beliefs, paranoia, seeing and feeling things that others can’t (but not voices, which got better in both groups)

    • Depression and anxiety

    • Suicidal thoughts

    • Overall psychological recovery and wellbeing

    Interestingly, those who did not receive the STAR therapy also showed some improvements. For example, at 9m follow-up, both groups reported less distress related to voice hearing.

Why is this important?

People with psychosis are much more likely to experience PTSD than the general population, yet they have often been excluded from trauma-focused therapy and research studies.

This has meant many people have been unable to access therapies that could help them understand and manage traumatic experiences.

The STAR trial provides important evidence that this trauma-focused therapy can be delivered safely and effectively, and that it should be made more widely available.

Find out more about training in TF-CBTp

  • “It is now clear that trauma-focused therapies can be delivered safely and effectively for people with PTSD and psychosis. Our results are robust in demonstrating that this intervention, which includes working on the trauma memory directly, a focus on engagement, and a flexible approach tailored to the individual, is safe, highly acceptable and effective on a range of PTSD, psychosis, and emotional well-being outcomes.”

    Professor Emmanuelle Peters, Professor of Clinical Psychology and STAR Lead

  • “STAR therapy gave me the tools to make sense of experiences I had carried for years and changed how I see myself and others. I didn’t just learn ways to manage and reshape trauma memories - I rebuilt trust, confidence, and a sense of connection. It gave me back a feeling of control and the belief that recovery is possible.”

    Shane, STAR Research Participant and Peer Support Worker in the PICuP Clinic

  • “The results challenge a longstanding gap in mental healthcare, where people with psychosis have been excluded from trauma-focused therapies. Our findings demonstrate that this must change, to ensure those historically denied access can receive evidence-based care.”

    Dr Amy Hardy, Joint-Therapy Lead for STAR

  • “We hope the STAR trial will be a gamechanger for the psychological treatment of this highly complex and marginalised population, motivating commissioners and services to prioritise implementation of Trauma-Focused CBTp. This therapy can transform lives and underscores an ethical imperative: clinical services and research should not inadvertently perpetuate trauma survivors’ silence through exclusion.”

    Dr Nadine Keen, Joint-Therapy Lead for STAR

“In conclusion, the STAR trial represents a landmark contribution to the field. The trial establishes a robust empirical foundation while pointing towards a future characterised by integrated, transdiagnostic, and process-based psychological interventions for individuals with PTSD and psychosis.”

Professor David van den Berg

This research was possible thanks to funding by the National Institute for Health and Care Research (Health Technology Assessment).

The trial was run by the King’s Clinical Trials Unit. More than 120 staff in five sites across England (London; Manchester; Newcastle; Oxford and Sussex) were involved in delivering the trial, which took five years to complete.