Narrative Exposure Therapy in Early Intervention in Psychosis: A feasibility Randomised Control Trial (RCT) study

Research question: Our overall research questions are whether it is feasible and acceptable to deliver, and test through a pilot randomised control trial, Narrative Exposure Therapy in Early Intervention for Psychosis (EIP) services to reduce symptoms of Post-Traumatic Stress Disorder (PTSD); and whether preliminary evidence from this study is congruent with the intervention being effective.

If feasible and promising evidence are reported, this will inform the evaluation of the effectiveness of this intervention in a future fully powered randomised controlled trial.

Background: Repeated trauma is very common in people with first episode of psychosis, with prevalence reports up to 80%, with post-traumatic symptoms reported in about half of those (42%). Reduced recovery from psychosis is associated with the presence of cumulative trauma and co-morbid PTSD.

Accordingly, the National Institute of Clinical Excellence (NICE) recommends that EIP should routinely assess for trauma and offer evidence-based trauma psychological interventions for PTSD, and that these should be accessible for people from ethnic minorities.

However, in practice trauma interventions are not routinely offered to people in EIP, partly because of the scarcity of training and trauma adapted protocols.

NET has a well-established evidence base and it seems particularly well-suited for this group, given it is specifically designed to address cumulative traumatisation and identity across the lifespan at a point when recovery trajectories are at crossroads.

NET compares favourably to other trauma therapies because of its brevity, low dropout rates in a range of ethnically diverse populations, and because its broad therapist requirements.

This means professionals like nurses and occupational therapists can deliver NET (rather this being exclusively done by psychology professionals). This renders NET huge scalability potential. Aims and Objectives: We aim to adapt and conduct a feasibility study on NET in EIP.

We will evaluate acceptability, willingness to be recruited and randomised to NET + TAU or TAU alone; identify adaptations needed when delivering NET in a larger RCT; and also assess acceptability of outcome measures.

We intend to assess whether this intervention can be tested through a definitive trial and to make an initial assessment of its potential effectiveness.

Methods and timelines for delivery: Months 1-4: We will co-produce the trial protocol and NET manual for EIP with people with lived experience, EIP clinicians and key stakeholders.

Months 5-26: An individually randomised parallel groups feasibility RCT with embedded qualitative component will be undertaken.

Fifty participants from EIP services (40% of whom will be from ethnic minorities) in two sites will be randomly allocated to either NET plus TAU or TAU control. Participants in both arms will complete assessments at baseline, 4- and 8-months post- randomization.

Anticipated Impact and Dissemination: The results of the feasibility study should result in preliminary indications of the likely effectiveness of NET in EIP.

This could increase the offer of trauma focussed interventions and improve outcomes for people in EIP, reducing delays in recovery and therefore expense and suffering for service users and their carers. Dissemination will include scientific papers, social media, a blog and plain English summaries.