A Whole System Effort: Implementing Narrative Exposure Therapy in Early Intervention for Psychosis Services

Post-traumatic stress disorder (PTSD) and psychosis may present as part of a continuum of responses to traumatic events. Despite emerging evidence on effectiveness of trauma interventions for PTSD in psychosis, implementation remains poor in Early Intervention for Psychosis (EIP) services around the world, partly due to scarcity of trauma‑adapted protocols and complex training requirements. Narrative Exposure Therapy (NET), a short intervention with minimum training requirements, offers scalability potential. This paper reports preliminary Patient and Public Involvement work with key stakeholders (people with psychosis who received NET, their carers, NET therapists, and members of the wider EIP multidisciplinary team) for the co-production of a "NET in EIP" delivery manual to be used in a feasibility randomized control trial. Recommendations included sharing the rationale for trauma work and expectations during therapy with the client, carers, and multidisciplinary mental health professionals when setting up NET as this therapy offer is likely to be unexpected in an EIP setting; considering the person in context; embedding ongoing close monitoring during NET; and adopting a whole system approach to ensure ongoing encouragement and support.