Trauma-Focused Cognitive Behavioural Therapy (TF-CBTp)
For people experiencing PTSD and psychosis
Aiming to improve the lives of trauma survivors experiencing psychosis
The STAR trial was an NIHR-funded trial that evaluated if TF-CBTp is safe, acceptable, and effective for people with distressing symptoms of PTSD and psychosis.
About the Study of Trauma and Recovery (STAR) trial
Stressful or traumatic events are common in people experiencing psychosis
Trauma often goes unrecognised in people experiencing psychosis
TF-CBTp aims to support recovery from trauma in people experiencing psychosis
Stressful, difficult or traumatic events are common in people experiencing psychosis. These can have a range of effects and get in the way of living life.
Trauma-focused talking therapy is recommended for people who are experiencing post-traumatic stress difficulties.
However, traumatic events and their effects are often not recognised in people experiencing psychosis. As a result, trauma-focused therapies are not always offered.
Our integrated trauma-focused therapy for psychosis (TF-CBTp) aims to address this by supporting recovery from trauma in people experiencing psychosis.
What is Trauma-Focused CBT for psychosis?
Trauma-Focused CBTp is a type of Cognitive-Behavioural Therapy (as known as CBT) that helps people with psychosis to understand and learn to manage the common effects of trauma.
Common effects of trauma include:
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Everyone reacts in their own way to trauma, although fear, sadness, anger, guilt and shame are common feelings.
Fear is about feeling threatened or in danger, sadness about what has been lost, anger about things that were unjust, guilt about things we did or did not do, and shame about feeling judged.
These feelings can impact on us and get in the way of life. Noticing your feelings can help you start to change them.
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Memories of traumatic events are different to everyday memories. They can feel as if parts of the trauma are happening again.
They intrude when we do not want them to, including when we’re sleeping. This can leave us feeling upset and out of control.
Recognising how memories are affecting you can help you start to manage them.
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Traumatic events can leave us feeling like other people can’t be trusted, and the world is not a safe place.
We may be more on the lookout for signs of danger and find it hard to be around people.
Noticing these fears can help you start to find ways of feeling safer.
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Going through something traumatic affects how we feel and think about ourselves.
We may think what happened or how it affected us was because of something wrong with us, or what we did.
When we feel bad about ourselves, we often give ourselves a hard time, and feel even worse.
Recognising this can be a step towards starting to build up a different, more helpful way of seeing yourself.
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People often hear voices or see, smell or feel things, which are reminders of trauma.
Voices may be of past people who hurt us or may say negative things that are similar to what people were told in the past.
Voices and visions can leave us feeling upset, scared, confused and not in control.
Sharing your experiences is the first step towards finding a way of managing what’s going on.
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Avoiding reminders of past traumatic events is a very common way of trying to push away feelings and memories about the past.
It makes sense that we want to avoid painful things, though avoidance can fuel our fears and leads to other problems.
Noticing what you avoid can help you start to do things differently.
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Traumatic experiences set our minds and bodies to be on high alert for signs of threat, leaving us feeling jumpy, irritable and on edge.
Being alert is useful when we are in danger but it makes it difficult to switch-off and relax.
Noticing how you get aroused can help you start to calm things down.
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Feeling numb, empty or unreal can be our mind’s automatic response to dealing with intense emotions, memories and thoughts.
It helps distance us or dissociate from painful things, and can be a way of surviving difficult experiences.
But it can be scary in itself, especially if it makes us feel unreal and confused about who we are.
Noticing these feelings can help you start to manage them.
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It’s common to get caught up in thinking about what happened. Questions like ‘Why me?’, ‘Should I have done things differently?’ and ‘Will life ever be different?’ can go round and round.
These questions tend to be impossible to answer and so we get stuck.
Noticing how you get caught up in thoughts can help you start to break the cycle.
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Traumatic events often involve being hurt or abused by people, which impacts on our relationships.
Trusting others can be difficult and may mean we avoid sex, or we can depend on sex too much.
Problems feeling close to people can leave us feeling isolated.
Recognising how trauma has affected your relationships can help you start to improve them.
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Alcohol & drugs can be a way of trying to cope with difficult situations. This may help in the short-term although in the long run it does not change things and can cause more problems.
What can I expect from TF-CBTp?
TF-CBTp aims to help people feel better and rebuild their life.
Typically, therapy follows these stages:
Finding out about difficulties and hopes for change during therapy
Learning about common effects of trauma
Understanding how the difficulties developed and what keeps them going
Trying out ways of managing problems differently
Helping traumatic memories and other distressing experiences such as voices and visions feel less overwhelming and more manageable
Making a plan for how to continue managing any problems after therapy has ended.
Testimonials
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“It opened the door…
The STAR trial did what the other therapy didn’t, it took me back to the roots and it actually gave me an insight as to why things are happening...And it gave me confidence there is an opportunity to battle against these things.”
Peter, STAR participant
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"It has been very rewarding, useful and life changing.
Before I would just have these memories and bottle things up until it overflows. With this therapy…you can stop, think, apply everything you have learnt. It’s more manageable and I keep on the bright side rather than on the dark side.”
Leena, STAR participant

