Narrative exposure therapy enters early psychosis care through a feasibility trial
Early intervention psychosis services may be preparing for a trauma treatment that was built to fit the constraints of routine care. A new multi-site feasibility randomised controlled trial will test narrative exposure therapy for people with first episode psychosis who also carry a history of multiple trauma, a combination that often complicates recovery and stretches standard service models.
Psychosis and trauma frequently travel together. Cumulative interpersonal traumatisation increases the risk of psychosis, is linked to greater symptom severity, and is associated with poorer recovery rates. The psychiatric insult does not stop with the index episode: the experience of psychosis itself, along with treatment exposure and service contact, can add another layer of distress. For some patients, a first episode of psychosis disrupts identity as much as it disrupts perception, which is one reason trauma-focused approaches have gained clinical interest in this setting.
The protocol is careful in its ambitions. It does not claim to prove efficacy yet. Its immediate purpose is to determine whether a definitive trial is realistic, acceptable and operationally workable inside early intervention in psychosis services, where staffing, time and training demands often decide whether a therapy survives contact with routine practice.
Why NETp is being tested in early intervention services
Narrative exposure therapy has already shown effectiveness for post-traumatic stress disorder in ethnically diverse populations. Its appeal in psychosis services lies in a practical feature that usually matters more than theory: the treatment is brief and does not require extensive specialist training. Those characteristics may help it overcome barriers that have slowed the implementation of trauma therapies in early psychosis pathways.
The protocol positions NET as a possible bridge between evidence and service delivery. In settings where demand is high and clinician time is limited, a therapy with a manageable format may be easier to embed than longer or more resource-intensive interventions. The study will explore whether that promise holds up in people living with recent-onset psychosis and trauma histories, a group that often faces fragmented care if psychological treatment is too complex to deliver at scale.
One sentence captures the practical pressure behind the trial: if a trauma therapy cannot be delivered inside EIP services, it rarely reaches the patients who may need it most.
Trial design, participants and treatment structure
The study will use an individually randomised, parallel-group design with an embedded qualitative evaluation. Fifty participants will be recruited across two NHS trusts in England. Eligibility is focused: individuals must have first episode psychosis, a history of multiple trauma and current care within an EIP service.
Participants will be randomised to receive either 15 sessions of NET in addition to treatment as usual or treatment as usual alone. Assessments will be completed by blinded assessors at baseline, at 4 months after randomisation, and again at 8 months for follow-up. The protocol does not present a clinical endpoint for superiority testing; instead, it will generate the operational data needed to judge whether a larger trial can be built with confidence.
Feasibility outcomes sit at the center of the design. Recruitment, retention and completion rates will be measured to show whether this population can be enrolled and followed through a therapy study of this kind. Those numbers will matter because feasibility failure can arise from any stage of the pathway: screening, consent, attendance, exposure to trauma material, or the burden of repeated research assessments.
What the embedded qualitative work is designed to capture
The qualitative component gives the protocol an important clinical dimension. Participants assigned to NET and clinicians will be interviewed to examine acceptability, barriers and facilitators, possible mechanisms of change, potential benefits or harms, and recommendations for future delivery. In trauma work, patient experience is not a side issue. It shapes uptake, adherence and tolerability, especially when symptoms of psychosis and trauma memories may interact in ways that are hard to model from scale scores alone.
A daily Experience Sampling Data sub-study in the NET arm will go one step further. It will test whether participants find it acceptable to complete brief daily monitoring during therapy so researchers can track change across candidate primary and secondary outcomes. That approach could help map symptom fluctuation in real time, rather than relying only on clinic-visit snapshots. For a treatment that aims to alter autobiographical memory processing and reduce distress linked to trauma reminders, that kind of dense sampling may be especially informative.
Ethics approval and trial governance
The study received REC/HRA ethical approval from the London – City & East Research Ethics Committee under reference 25/LO/0350. It is registered as ISRCTN39471182.
The investigators plan to report results in international conferences and open-access peer-reviewed journals. No efficacy results are available in the protocol, and none should be inferred from the trial design itself. The immediate question is whether the intervention can be delivered with acceptable uptake and follow-through in a real EIP pathway, not whether it already changes symptoms or recovery trajectories.
For clinicians, the practical value of the trial will come from what it reveals about implementation. Can trauma-focused work be added to early psychosis care without overburdening services? Will participants engage with repeated sessions that ask them to recount distressing experiences in a structured narrative format? Can routine teams support this model with minimal extra training? Those are the questions that determine whether a promising intervention stays in the journal pages or reaches everyday care.
What a successful feasibility signal would mean for practice
If recruitment, retention and completion are acceptable, the study will provide the groundwork for a fully powered trial in a population that has often been under-served by trauma therapy research. The protocol is built around a clinically important hypothesis: that addressing trauma early in psychosis care may help reduce the persistent load of distress that can complicate recovery. NET’s brief format and lower training burden make it a plausible candidate for EIP services, where scalability is as important as efficacy.
The trial will not answer the full treatment question on its own. It is designed to determine whether the question can be answered properly in a larger study, using a model that respects both the complexity of psychosis and the operational limits of front-line services. What remains unknown is whether patients will complete the intervention, whether clinicians will find it workable, and whether the daily sampling strategy can be sustained without adding unacceptable burden.
Those are the constraints that will decide whether NETp advances to a definitive trial.