The ‘Reducing Psychosis Risk by Targeting Trauma’ Trial: Protocol of a Feasibility Randomised Controlled Trial of Trauma-Focused Cognitive Behavioural Therapy and Eye Movement Desensitisation and Reprocessing Therapy for People With At-Risk Mental States

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry Pub Date : 2025-10-04 DOI:10.1111/eip.70095

Filippo Varese, Kim Cartwright, Amanda Larkin, Marina Sandys, Aidan Flinn, Alice Newton, Jasmine Lamonby, Mica Samji, Clare Holden, Samantha Bowe, David Keane, Nadine Keen, Amy Hardy, Debra Malkin, Richard Emsley, Kate Allsopp

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Abstract

Background

Trauma exposure is pervasive in people with an At Risk Mental State (ARMS) and is associated with adverse clinical and functional outcomes. While promising developments have been made in treating trauma in psychosis, evidence regarding the efficacy of trauma therapies in ARMS individuals is limited. This trial aims to evaluate the feasibility of conducting a future randomised controlled trial (RCT) to determine the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (TF-CBT) in people with ARMS.

Method

Seventy ARMS individuals with a history of trauma will be randomised to receive 24 sessions of EMDR plus treatment as usual (TAU), 24 sessions of TF-CBT+TAU, or TAU alone. Feasibility will be determined against pre-specified thresholds for recruitment, retention, treatment engagement, and fidelity. To examine the promise of efficacy of EMDR and TF-CBT, participants will complete a battery of clinical and mechanistic measures at baseline and 9-month post-randomisation, including assessments of attenuated psychotic symptoms and post-traumatic symptoms. Clinical notes will be reviewed to identify transitions to first episode psychosis up to 12 months post-randomisation. Qualitative interviews with trial participants, therapists, and professional stakeholders will explore the acceptability of EMDR and TF-CBT and factors to facilitate future implementation of trauma therapies in routine practice.

Conclusions

If a large-scale RCT is deemed feasible, it will be possible to establish whether EMDR and/or TF-CBT represent beneficial treatments to augment existing evidence-based care for individuals at ultra-high risk for future psychosis, potentially reducing transition rates and improving clinical outcomes for ARMS individuals.

Abstract Image

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“以创伤为目标降低精神病风险”试验：一项以创伤为重点的认知行为疗法和眼动脱敏和再加工疗法对高危精神状态患者的可行性随机对照试验方案

背景：创伤暴露在高危精神状态（ARMS）人群中普遍存在，并与不良的临床和功能结果相关。虽然在治疗精神创伤方面取得了可喜的进展，但关于创伤治疗在ARMS个体中的疗效的证据有限。本试验旨在评估未来进行随机对照试验（RCT）的可行性，以确定眼动脱敏和再处理（EMDR）和创伤聚焦认知行为疗法（TF-CBT）对ARMS患者的疗效。方法70例有创伤史的ARMS患者随机分为EMDR加常规治疗（TAU） 24次、TF-CBT+TAU 24次或单独TAU 3组。可行性将根据预先规定的招聘、保留、治疗参与和忠诚的阈值来确定。为了检验EMDR和TF-CBT的疗效前景，参与者将在基线和随机化后9个月完成一系列临床和机制测量，包括精神病症状减轻和创伤后症状的评估。将审查临床记录，以确定随机化后12个月内向首发精神病的转变。与试验参与者、治疗师和专业利益相关者的定性访谈将探讨EMDR和TF-CBT的可接受性以及促进未来在常规实践中实施创伤治疗的因素。如果大规模的随机对照试验被认为是可行的，将有可能确定EMDR和/或TF-CBT是否代表有益的治疗方法，以增强对未来精神病超高风险个体的现有循证护理，潜在地降低转换率并改善ARMS个体的临床结果。

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来源期刊

Early Intervention in Psychiatry 医学-精神病学

CiteScore

4.80

自引率

5.00%

发文量

112

审稿时长

6-12 weeks

期刊介绍： Early Intervention in Psychiatry publishes original research articles and reviews dealing with the early recognition, diagnosis and treatment across the full range of mental and substance use disorders, as well as the underlying epidemiological, biological, psychological and social mechanisms that influence the onset and early course of these disorders. The journal provides comprehensive coverage of early intervention for the full range of psychiatric disorders and mental health problems, including schizophrenia and other psychoses, mood and anxiety disorders, substance use disorders, eating disorders and personality disorders. Papers in any of the following fields are considered: diagnostic issues, psychopathology, clinical epidemiology, biological mechanisms, treatments and other forms of intervention, clinical trials, health services and economic research and mental health policy. Special features are also published, including hypotheses, controversies and snapshots of innovative service models.