Background: Trauma exposure is pervasive in people with an At Risk Mental State (ARMS) and is associated with adverse clinical and functional outcomes. While promising developments have been made in treating trauma in psychosis, evidence regarding the efficacy of trauma therapies in ARMS individuals is limited. This trial aims to evaluate the feasibility of conducting a future randomised controlled trial (RCT) to determine the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma Focused Cognitive Behavioural Therapy (TF-CBT) in people with ARMS. Method: 75 ARMS individuals with a history of trauma will be randomised to receive 24 sessions of EMDR plus treatment as usual (TAU), 24 sessions of TF-CBT+TAU, or TAU alone. Feasibility will be determined against pre-specified thresholds for recruitment, retention, treatment engagement, and fidelity. To examine the promise of efficacy of EMDR and TF-CBT, participants will complete a battery of clinical and mechanistic measures at baseline and 9-month post-randomisation, including assessments of attenuated psychotic symptoms and post-traumatic symptoms. Clinical notes will be reviewed to identify transitions to first episode psychosis up to 12-months post-randomisation. Qualitative interviews with trial participants, therapists, and professional stakeholders will explore the acceptability of EMDR and TF-CBT and factors to facilitate future implementation of trauma therapies in routine practice.  Conclusions: If a large-scale RCT is deemed feasible, it will be possible to establish whether EMDR and/or TF-CBT represent beneficial treatments to augment existing evidence-based care for individuals at ultra-high risk for future psychosis, potentially reducing transition rates and improving clinical outcomes for ARMS individuals.

Objective(s): There are high rates of trauma in people who experience psychosis and a focus on the negative impact. The current study explores people’s perceptions of factors that facilitate positive adjustment and Post Traumatic Growth (PTG) following trauma, which is important for developing interventions to support resilience and well-being. Methods: Semi-structured interviews were completed by eleven people with experiences of both trauma and psychosis. Transcripts were subject to thematic analysis. Results: Participants welcomed the idea of growth and stressed the importance of hearing growth stories from other people with similar experiences and practitioners. However, growth was considered a sensitive topic that clinicians should introduce tentatively to not undermine the potential suffering caused by trauma. Participants effectively used various strategies to deal with their traumas, including some typically considered maladaptive by clinicians (e.g., avoidance and self-harm). Conclusion: When working with trauma in the context of psychosis, mental health professionals should formulate behaviours in terms of whether or not they are functional to a specific moment and environment, rather than routinely consider methods of coping as adaptive or maladaptive. Our findings also highlight the importance of assessing and supporting recovery from trauma rather than just from psychotic symptoms and suggest that clinicians should offer interventions for fostering PTG in psychosis, such as supporting access to a diverse range of narratives about adapting to life beyond trauma.