Popular trauma-focused talking therapies can help people challenge false beliefs and distorted thinking patterns but do little to stop them hearing voices or seeing things that aren’t there, according to a major review led by the University of Hertfordshire.
The review, which involved 36 studies with more than 1,300 patients, found these psychological interventions can significantly reduce symptoms of delusion—distressing beliefs that feel completely real to the person experiencing them, even when there is strong evidence to the contrary. But they do very little to treat hallucinations, sensory experiences such as hearing voices or seeing figures that do not exist.
Researchers said the analysis, published in the journal Psychological Medicine, shows there is no one-size-fits-all solution to treat psychosis symptoms and patients may need additional approaches alongside trauma-informed care.
Keith Laws, Professor of Cognitive Neuropsychology at the University of Hertfordshire, said, “Our findings challenge the common practice of treating all symptoms of psychosis as a single outcome. Different symptoms appear to respond to different therapeutic mechanisms.”
Traumatic experiences during childhood are a well-established risk factor for developing psychotic symptoms, such as delusions and hallucinations, later in life. Early trauma—including emotional, physical, or sexual abuse—is thought to shape how individuals interpret the world, often heightening perceptions of threat or mistrust.
This understanding has fueled growing interest in trauma-focused psychological therapies for psychosis, which aim to help patients process traumatic experiences, reduce related symptoms, and improve overall mental health.
In the U.K., trauma-focused approaches are already recommended as treatments for post-traumatic stress disorder (PTSD), a condition triggered by intensely distressing events. However, these therapies are not yet considered standard care for treating psychotic symptoms in most clinical settings, despite increasing recognition that they are safe and may have benefits.
This has prompted calls for trauma-focused interventions (TFIs) to be made routinely available for people with psychosis, with figures showing about 1 in every 100 people in England will experience a psychotic episode in their lifetime.
Results from the review, involving more than 1,300 participants aged between 16 and 97 who experienced symptoms of psychosis regardless of diagnosis, also revealed TFIs had little effect on other symptoms such as depression, anxiety, or quality of life.
Findings showed while many participants reported feeling emotionally supported or better understood through therapy, controlled studies showed little to no measurable reduction in the frequency or intensity of hallucinations. This was consistent across different types of sensory experiences, including auditory hallucinations (hearing voices) and visual experiences (such as seeing shadows or figures).
Trauma-focused therapies also appeared to be more effective in younger participants, suggesting that earlier intervention may be associated with greater symptom improvement.
While TFIs can help people re-evaluate threat-based beliefs (delusions), it may not directly address the brain and perceptual processes involved in hallucinations, researchers say.
The review also examined so-called “negative” symptoms, such as social withdrawal, emotional numbing, and reduced motivation. These symptoms are often particularly disabling and are widely recognized as difficult to treat.
The team found no clear improvements immediately after treatment, but at longer-term follow-up, a small but statistically significant reduction in negative symptoms emerged.
However, the authors stress that this finding should be interpreted cautiously, as it is based on a relatively small number of studies (six comparisons) and larger, more robust studies are needed to determine whether trauma-focused therapy offers longer-term benefit for social engagement and motivation.
Dr. Diamantis Toutountzidis, Chartered Psychologist and Visiting Lecturer in Psychology at the University of Hertfordshire, said, “Our findings highlight the importance of symptom-specific psychological approaches, rather than assuming one therapy will work equally well for everyone.”
The authors suggest that future research should clearly distinguish between delusions and hallucinations in clinical trials and develop and test approaches that are specifically designed to address the processes underlying hallucinations.
Dr. Toutountzidis added, “Trauma-focused psychological therapies are safe and effective for reducing delusional beliefs, particularly in younger people, but they are not a one-size-fits-all solution for psychosis.
“Many people—especially those who hear voices, experience visual hallucinations, or struggle with long-term social withdrawal—are likely to benefit from additional, specialized therapeutic approaches alongside trauma-informed care.”
Publication details
Diamantis Toutountzidis et al, Trauma-focused psychological interventions for psychosis: Meta-analytic evidence of differential effects on delusions and hallucinations, Psychological Medicine (2026). DOI: 10.1017/s0033291725103036
Journal information:
Psychological Medicine
Clinical categories
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