Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

Jackson, Christopher; Trower, Peter; Reid, Imogen; Smith, Jo; Hall, Mandra L. Rasmussen; Townend, Michael; Barton, Karen; Jones, J.; Ross, Kerry; Russell, Roger A.; Newton, Elizabeth; Dunn, Graham; Birchwood, Max

doi:10.1016/j.brat.2009.02.009

Cited by 66 publications

(81 citation statements)

References 48 publications

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“…Two reports were found that did not meet inclusion criteria for the systematic review, but referred to trials that targeted affective disturbance specifically in people with psychosis (White et al, 2011;Jackson et al, 2009), which most of the psychological therapy trials above had not set out explicitly to achieve. One further paper (Lecomte et al, 1999) reported on a trial of a self esteem therapy intervention that was similar to the four reviewed above (Hall & Tarrier, 2003;Knight, Wykes, & Hayward, 2006;Laithwaite et al, 2007;Laithwaite et al, 2009).…”

Section: Three Excluded Studies With Some Relevancementioning

confidence: 99%

“…Only one of the psychological therapy trials included in the review set out specifically to target depression in people with psychosis (Laithwaite et al, 2009), although two more were found that targeted depression but did not meet review criteria (Jackson et al, 2009;White et al, 2011 (Birchwood, 2003), which carried the implication that by manipulating the meaning of the psychotic experience to the individual, reducing the degree of defeat and entrapment experienced, depression and its associated negative effects could be prevented. Depression showed no benefit from this intervention compared to TAU, and this was not attributable to a floor effect: baseline CDSS scores had indicated that 67% of the participants were "significantly" depressed.…”

Section: Targeting Depressionmentioning

confidence: 99%

“…Self esteem has received some attention as such a factor, and trials have reported that treatments targeting self esteem can have beneficial effects on positive symptoms. Appraisals of shame, loss and entrapment have not yet proved to be a beneficial therapeutic target for ameliorating depression (Jackson et al, 2009). …”

Section: Limitations and Indications For Future Researchmentioning

confidence: 99%

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Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.

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Section: Three Excluded Studies With Some Relevancementioning

confidence: 99%

Section: Targeting Depressionmentioning

confidence: 99%

Section: Limitations and Indications For Future Researchmentioning

confidence: 99%

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Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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“…49 The gold standard in research investigating therapies, treatments and medications would be large clinical studies such as randomised controlled trials (RCTs), which aim to reduce frequency of symptoms. The primary outcome measure in RCTs investigating CBT [50][51][52] and medication 53,54 has been symptom change scores using standardised psychiatric interviews. Similarly, mental health services often use the criteria of symptom alleviation as a benchmark for demonstrating effective practice, adopting the benchmark from RCTs.…”

Section: Introductionmentioning

confidence: 99%

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…2 This definition has been widely adopted in clinical and randomised controlled trials (RCTs) of psychological therapies (e.g. cognitive-behavioural therapy) [8][9][10] and medication. 11,12 As RCTs are used as the benchmark for effective treatments for psychosis in National Health Service (NHS) and Department of Health policies and guidelines, symptom alleviation is clearly an important factor in relation to defining recovery in current services.…”

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confidence: 99%

Conceptualisation of recovery from psychosis: a service-user perspective

et al. 2010

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Aims and methodThere has been much uncertainty about the concept of recovery in psychosis. The aim of this paper is to conceptualise recovery, through service users' descriptions of their recovery stories. A qualitative approach (interpretive phenomenological analysis) was used to guide interviews and analysis of data.ResultsEight service users were interviewed about their recovery from psychosis. Data analysis revealed four superordinate themes: ‘impacts on mental health’, ‘self-change and adaptation’, ‘social redefinition’ and ‘individualised coping mechanisms’.Clinical implicationsData indicates that multiple dimensions of recovery are all important to individuals when considering their subjective experiences of recovery from psychosis. Recovery can only be conceptualised by the person making the recovery journey and treatment outcome measures must reflect this individuality.

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Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

Cited by 66 publications

References 48 publications

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Conceptualisation of recovery from psychosis: a service-user perspective

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