Empowering the silenced: the STAR (Study of Trauma and Recovery) therapy guide for delivering integrated Trauma-Focused Cognitive Behaviour Therapy for psychosis (TF-CBTp)

Background The STAR (Study of Trauma and Recovery) trial showed that integrating evidence-based therapies for Post-Traumatic Stress Disorder (PTSD) and psychosis resulted in significant improvements in PTSD, psychosis, and emotional difficulties, with exceptionally low disengagement rates.Methods We outline the therapy guide for delivering Trauma-Focused Cognitive-Behaviour Therapy for Psychosis (TF-CBTp) and its therapeutic values, principles, and theoretical underpinnings. Based on theoretical models highlighting the interplay between PTSD and psychosis, the therapy assumes similar underlying psychological mechanisms that are targeted together.Results TF-CBTp comprises four phases: (1) assessment and goal setting; (2) formulation; (3) formulation-driven model-based interventions, consisting of a) rebuilding life, b) promoting control, psychoeducation and emotional regulation and c) addressing trauma memories, anomalous experiences and associated meanings; (4) consolidation and staying well. Throughout therapy, there is a strong emphasis on engagement, developing a strong therapeutic relationship, and fostering a sense of control. Therapy was intended to be delivered over nine months, with approximately 26 weekly/twice-weekly individual sessions offered over 6 months followed by three monthly boosters. However, in practice additional sessions or a longer duration were often required.Discussion Further research should develop and evaluate care pathways to support safe, equitable, and effective implementation of TF-CBTp.