Trauma-focused psychological interventions for psychosis: Meta-analytic evidence of differential effects on delusions and hallucinations

This systematic review and meta-analysis evaluated the effects of trauma-focused interventions (TFI)s (CBT, EMDR) on psychosis-related outcomes in individuals with psychotic disorders or subclinical symptoms.

Article Abstract

“Childhood trauma is a well-established risk factor for the onset and persistence of psychotic symptoms. Consequently, trauma-focused interventions (TFIs) are increasingly incorporated into psychosis treatment, though their effectiveness in reducing hallucinations and delusions remains unclear. This systematic review and meta-analysis evaluated the effects of TFIs on psychosis-related outcomes in individuals with psychotic disorders or subclinical symptoms. Thirty-six studies (N = 1,384) were included, with 18 (N = 806) contributing to meta-analyses. Study quality and risk of bias were assessed using AXIS, Cochrane RoB2, and GRADE. Pre–post analyses showed small reductions in hallucinations (g = −0.37; adjusted g = −0.28; K = 15) and medium reductions in delusions (g = −0.55; K = 14), with younger participants benefiting more. In controlled trials, TFIs did not significantly reduce hallucinations at the end of treatment or follow-up (g = −0.12 and −0.01; both K = 7), whereas delusions showed significant reductions at both time points (g = −0.44 and g = −0.48; both K = 7). No significant effect on negative symptoms was observed at the end of trial (g = −0.02; K = 6), though a small improvement appeared at follow-up (g = −0.26; K = 6). TFIs produced small but significant reductions in PTSD symptoms at both time points (K = 6). No consistent effects were found for secondary outcomes: depression (K = 7), anxiety (K = 5), or quality of life (K = 3), though functioning improved at follow-up (K = 6). TFIs appear particularly effective in reducing delusions, but show limited benefit for hallucinations and other secondary outcomes. Further work is needed to design and test symptom-specific psychological interventions for distinct psychotic experiences.“

—Description from publisher

Article Access

Open Access

Toutountzidis, D., Ricketts, E., & Laws, K. R. (2026). Trauma-focused psychological interventions for psychosis: Meta-analytic evidence of differential effects on delusions and hallucinations. Psychological Medicine. https://doi.org/10.1017/S0033291725103036

About the Journal

‘Psychological Medicine is a leading international journal in the fields of psychiatry, clinical psychology and the related basic sciences. The journal includes original articles reporting key research being undertaken worldwide, together with literature reviews and shorter editorials by distinguished scholars.”

—Description from publisher

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Date
January 9, 2026

Creator(s)
Diamantis Toutountzidis, Emily Ricketts, Keith R. Laws

Topics
Childhood Trauma, Psychosis/Schizophrenia

Practice & Methods
Comparative Studies, Efficacy

Extent
19 pages

Publisher
Cambridge University Press

Rights
Copyright © The Author(s), 2026. Published by Cambridge University Press

APA Citation
Toutountzidis, D., Ricketts, E., & Laws, K. R. (2026). Trauma-focused psychological interventions for psychosis: Meta-analytic evidence of differential effects on delusions and hallucinations. Psychological Medicine. https://doi.org/10.1017/S0033291725103036

Audience
EMDR Therapists, Other Mental Health Professionals

Language
English

Content Type
Article, Meta-analyses/Systematic Reviews, Peer-Reviewed

Access Type
External Resource, Open Access

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