Reducing psychosis risk by targeting trauma (RESTART)

Trauma (e.g. childhood maltreatment) is a major risk factor for psychosis; epidemiological data suggests that targeting trauma could reduce psychosis incidence by 33%.

We can now identify individuals at high risk of developing psychosis using clinical criteria known as At Risk Mental States (ARMS), but available therapies for preventing the onset of psychosis in people experiencing ARMS are not sufficiently effective.

Between 54-90% of individuals experiencing ARMS have a history of trauma; trauma is associated with more severe prodromal symptoms and functional impairments in this group, leading to greater risk of transition to psychosis.

It is not known if psychological therapies that are effective for trauma-related mental health problems could be used to improve clinical and functional outcomes in this group, hence representing innovative interventions for the prevention of psychosis.

The project aims to: 1) Identify tractable trauma-related mechanisms associated with greater prodromal symptom severity and functional impairment in people experiencing ARMS; 2) Adapt the protocols of four therapies that ameliorate these trauma-related mechanisms and improve their acceptability to this target group; 3) Conduct a feasibility multi-arm trial evaluating the acceptability of these adapted therapies, and the feasibility of conducting a future multi-arm definitive trial.

The research will involve three work-packages (WP) delivered over 45 months.

WP1 will analyse additional data that will be collected from a subsample of ARMS participants (N = 150) from an ongoing NIHR-funded cohort study (HTA:17/31/05).

Structural equation modelling will be used to identify key trauma-related mechanisms associated with functional impairment and more severe prodromal symptoms.

WP2 will involve qualitative work and PPI (in depth-interviews with 12-20 ARMS individuals and 12-20 NHS staff; nominal consensus meetings with six 'experts by experience' and six 'experts by profession') to select, based on WP1 findings, the trauma therapies most suited to improving clinical and functional outcomes in this group and adapt them to the specific needs of people experiencing ARMS.

WP3 will be a feasibility multi-arm randomised controlled trial with 100 ARMS participants allocated to TAU or the trauma therapies adapted in WP2.

Participants will be followed up for 8 months using qualitative and quantitative assessments to evaluate treatment acceptability, the feasibility of conducting a future definitive multi-arm trial and the potential inclusion of adaptive procedures in a future definitive trial.

My research will provide unique insight into the impact of trauma on people experiencing ARMS and identify important trauma intervention targets.

It will deliver bespoke therapy protocols for improving trauma sequelae as well as prodromal symptoms and functional impairments associated with greater risk for transition to psychosis in people experiencing ARMS.

These protocols will be clinically-relevant, valuable and acceptable to patients, accessible to frontline services and ready for service implementation following a definitive efficacy and cost-effectiveness evaluation. I will establish collaborations with international experts and centres of excellence in the treatment of ARMS.

I will disseminate findings through tailored events for people with lived-experience of ARMS and other stakeholders as well as through publications in high-impact journals and presentations and workshops at international conferences.