The effectiveness and tolerability of trauma-focused interventions for trauma symptoms in individuals who have psychosis: A systematic review and meta-analysis

BACKGROUND AND HYPOTHESIS: People with psychosis and a trauma history have worse clinical and functional outcomes compared to those without a trauma history. Services often don't provide trauma-focused interventions for psychosis. This meta-analysis of randomised controlled trials (RCTs) aimed to compare multiple outcomes of safety, feasibility, acceptability, clinical and cost effectiveness of different trauma-focused therapies (TFTs) for people with psychosis. STUDY DESIGN: For this meta-analysis and systematic review, Embase, PsycINFO and Medline were searched until 5th January 2026 for original RCTs of TFTs for individuals with psychosis, with the design consistent with PRISMA guidelines. Outcomes were the safety, feasibility, acceptability and effectiveness of these treatments. Meta analyses were conducted when at least three studies reported quantitative measures of clinical outcomes. Cochrane Revised Risk of Bias tool for RCTs was used for quality assessment. STUDY RESULTS: Ten RCTs were included. Eye Movement Desensitization and Reprocessing (EMDR), prolonged exposure (PE) and cognitive therapies (CR) were safe, acceptable and cost effective. EMDR vs treatment-as-usual (TAU) significantly reduced positive psychotic symptoms post-treatment, but not at 6-month follow-up (studies = 4, outcomes = 9, g = 0.21, p = 0.05). EMDR significantly reduced PTSD symptoms post-treatment (studies = 3, outcomes = 6, g = 0.84, p < 0.001) and at 6-month follow-up (studies = 4, outcomes = 8, g = 0.63, se = 0.10, p < 0.001) vs TAU. PE showed reductions in PTSD symptoms and paranoia, and CR's showed reductions in PTSD symptoms post-treatment (vs TAU). CONCLUSIONS: EMDR has the most published studies suggesting its potential to be an effective treatment for this population. Further RCTs are required to assess symptom outcomes and healthcare costs of all interventions examined.