Although group cognitive-behavioural therapy may not be the optimum treatment method for reducing hallucinations and delusions, it may have important benefits, including feeling less negative about oneself and less hopeless for the future.

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BackgroundWeb-based interventions to support people to manage long-term health conditions are available and effective but rarely used in clinical services. The aim of this study is to identify critical factors impacting on the implementation of an online supported self-management intervention for relatives of people with recent onset psychosis or bipolar disorder into routine clinical care and to use this information to inform an implementation plan to facilitate widespread use and inform wider implementation of digital health interventions.MethodsA multiple case study design within six early intervention in psychosis (EIP) services in England, will be used to test and refine theory-driven hypotheses about factors impacting on implementation of the Relatives’ Education And Coping Toolkit (REACT). Qualitative data including behavioural observation, document analysis, and in-depth interviews collected in the first two EIP services (wave 1) and analysed using framework analysis, combined with quantitative data describing levels of use by staff and relatives and impact on relatives’ distress and wellbeing, will be used to identify factors impacting on implementation. Consultation via stakeholder workshops with staff and relatives and co-facilitated by relatives in the research team will inform development of an implementation plan to address these factors, which will be evaluated and refined in the four subsequent EIP services in waves 2 and 3. Transferability of the implementation plan to non-participating services will be explored.DiscussionObservation of implementation in a real world clinical setting, across carefully sampled services, in real time provides a unique opportunity to understand factors impacting on implementation likely to be generalizable to other web-based interventions, as well as informing further development of implementation theories. However, there are inherent challenges in investigating implementation without influencing the process under observation. We outline our strategies to ensure our design is transparent, flexible, and responsive to the timescales and activities happening within each service whilst also meeting the aims of the project.Trial registrationISCTRN 16267685 (09/03/2016).

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• Written specifically with sufferers and carers in mind, to help them understand and apply the basic concepts of cognitive therapy for psychosis. • Illustrates what it is like to have common psychosis and how people's lives can be restored using therapy. • Increases understanding of how the psychosis started, and the factors that worsen symptoms or increase the likelihood of relapse. • Helps the sufferer learn how to control symptoms and delay or prevent relapse. • Includes features and exercises to help sufferers explore their own beliefs and feelings to reflect on the way they cope. • Helps carers know what to say and what to do. • Provides a resource for mental health professionals working with patients, to introduce the approach, support ongoing therapy and make the most efficient use of appointment time.