Background and objectives
The dissemination and delivery of psychological therapies for people with psychosis has been limited by workforce and organisational factors. ‘Low Intensity’ (LI) delivery, whereby staff are trained to deliver brief, focused, manualised interventions, may be one way of improving access. In this study, we piloted a new LI intervention specifically for people with psychosis, aimed at helping people to reach a personal recovery goal, whilst targeting anxious avoidance or depression-related inactivity. Frontline mental health workers were trained to deliver the intervention. We report here on the impact of the intervention on therapeutic outcomes.
Methods
Twelve people with psychosis and either anxious avoidance or low mood, who wanted to work towards a personal goal, completed the intervention and a battery of assessments of mood, functioning and psychotic symptoms.
Results
Eleven out of the twelve participants achieved their personal goals. The results of a series of Friedman K related sample tests revealed significant improvements in depression, clinical distress, activity levels, negative symptoms and delusions across the three time points, and no change in hallucinations, or anxious avoidance. Staff and participant satisfaction was high.
Limitations
The study is a small uncontrolled pilot study. Outcomes should therefore be interpreted with caution, pending replication.
Conclusions
The new LI intervention shows preliminary evidence of effectiveness and is a feasible model of therapy delivery for people with psychosis. The results suggest that frontline mental health workers can be trained relatively easily to deliver the intervention. A larger, randomised controlled trial is warranted to determine the effectiveness of the intervention and training programme
It is estimated that over half a million people in the UK alone suffer from psychosis. For many, recovery is impeded by high levels of distress, often resulting from persisting psychotic symptoms, stigma and social exclusion (Garety, Kuipers, Fowler, Freeman, & Bebbington, 2001; Slade, 2009a). UK and international clinical guidelines recommend that patients with schizophrenia are offered cognitive behavioural therapy for psychosis (CBTp) as part of routine clinical practice (National Institute for Health and Clinical Excellence (NICE) 2002; Update 2009; US Schizophrenia Patient Outcomes Research Team (PORT), Kreyenbuhl, Buchanan, Dickerson, & Dixon, 2010). There is evidence that CBTp reduces symptom severity, reduces the number and duration of hospital admissions, improves social functioning, and is cost-effective (NICE, Update 2009). However, despite its efficacy, people with schizophrenia and other psychoses still have ‘poor access’ to talking therapies (Berry & Haddock, 2008; Kuipers, 2011; Rethink, 2010; Tarrier, Barrowclough, Haddock, & McGovern, 1999). Identified barriers to implementation include lack of staff time to consider appropriate referrals, ‘pessimistic views of recovery of psychosis’ and a lack of skilled therapists able to work therapeutically with clients with psychoses (Pilling & Price, 2006; Prytys, Garety, Jolley, Onwumere, & Craig, 2011). Fig. 1
Overall, the intervention shows promise as a way of improving access to psychological therapy for people with psychosis who wish to work towards particular recovery-related goals. Further, the intervention was viewed as acceptable to both service users and members of staff. The results of this small study suggest that the LI intervention can be successfully delivered by frontline mental health staff following brief training and weekly supervision. As described earlier, this may be one way of providing a cost-effective service in the NHS. A larger, randomised controlled trial of the intervention with clients with psychosis is warranted.
