Narrative exposure therapy in early intervention in psychosis services (NETp): protocol of a multi-site feasibility...

Cumulative interpersonal traumatisation increases the risk of psychosis and is linked to psychotic symptom severity and reduced recovery rates. Psychosis and treatment themselves can also be traumatising, with a first episode of psychosis posing challenges to one's identity. Despite a growing evidence base for the safety and effectiveness of trauma therapies for psychosis, implementation remains poor in early intervention for psychosis (EIP) services, partly due to resource constraints. Narrative exposure therapy (NET) is an effective intervention for post-traumatic stress disorder in ethnically diverse populations. Crucially it has potential to address barriers to implementation of trauma therapies in EIP as it has a brief duration with minimal training requirements. This feasibility study will evaluate the feasibility and acceptability of conducting a definite trial of NET in people with early psychosis.

An individually randomised parallel groups feasibility randomised controlled trial with embedded qualitative evaluation will be conducted. 50 individuals with first episode psychosis and a history of multiple trauma under the care of an EIP service in two NHS trusts in England will be recruited. Participants will be randomised to receive either 15 sessions of NET in addition to treatment as usual or treatment as usual alone. Assessor blinded assessments will be conducted at baseline, 4 months (post-intervention) and 8 months (follow-up). Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects to inform planning for a fully powered trial. Qualitative interviews will be carried out with participants allocated to NET and clinicians to investigate acceptability, barriers and facilitators, possible mechanisms of change, potential benefits or harms and recommendations. A sub-study in the NET group will investigate acceptability of completing Experience Sampling Data daily during therapy to monitor changes on candidate primary and secondary outcomes.

This study received REC/HRA ethical approval from the London - City & East Research Ethics Committee (REC) (25/LO/0350). The results of the study will be reported and disseminated at international conferences and in open-access peer-reviewed scientific journals.

ISRCTN39471182.