Exploring service users' perceptions of cognitive behavioural therapy for psychosis: a user led study.

BACKGROUND AND AIMS: This study explored individuals' subjective experiences of Cognitive Behavioural Therapy for psychosis (CBTp) with the aim of identifying coherent themes consistent across individual accounts and any potential barriers to CBTp effectiveness. METHOD: Semi-structured interviews were conducted with nine individuals with experience of CBTp. A qualitative Interpretive Phenomenological Analysis was used to analyze the data collected to identify common themes. RESULTS: Five super-ordinate themes emerged from our analyses: CBT as a process of person-centred engagement; CBT as an active process of structured learning; CBT helping to improve personal understanding; CBT is hard work; Recovery and outcomes of CBT for psychosis. CONCLUSIONS: The theoretical and clinical implications are discussed.

A preliminary exploration of predictors of outcome and cognitive mechanisms of change in cognitive behaviour therapy for psychosis in people not taking antipsychotic medication.

BACKGROUND: Cognitive behaviour therapy (CBT) has been shown to be effective in an open trial for people with psychotic disorders who have not been taking antipsychotic medication. There is little known about predictors of outcome in CBT for psychosis and even less about hypothesised mechanisms of change. METHOD: 20 participants with schizophrenia spectrum disorders received CBT in an exploratory trial. Our primary outcome was psychiatric symptoms measured using the PANSS. Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning, and hypothesised mechanisms of change included appraisals of psychotic experiences, dysfunctional attitudes and cognitive insight. We also measured patient characteristics that may be associated with outcome. RESULTS: T-tests revealed that several of the hypothesised mechanisms did significantly change over the treatment and follow-up periods. Correlational analyses showed that reductions in negative appraisals of psychotic experiences were related to improvements on outcome measures and that shorter duration of psychosis and younger age were associated with greater changes in symptoms. CONCLUSIONS: CBT based on a specific cognitive model appears to change the hypothesised cognitive mechanisms, and these changes are associated with good outcomes. CBT may be more effective for those who are younger with shorter histories of psychosis.

What are the components of CBT for psychosis? A Delphi study.

There is strong evidence supporting the implementation of cognitive behavior therapy (CBT) for people with psychosis. However, there are a variety of approaches to the delivery and conceptual underpinnings within different research groups, and the degree of consensus or disagreement regarding what are the intrinsic components has not been explored. This study uses the Delphi method to try to establish what a group of experts in CBT for psychosis view as important. Experts were invited to participate in 3 rounds of producing and rating statements that addressed areas such as principles, assessment, models, formulation, change strategies, homework, and therapists' assumptions in order to consolidate consensus of opinion. Seventy-seven items were endorsed as important or essential for CBT for psychosis by >80% of the panel. These recommendations should ensure greater fidelity in clinical practice, allow greater evaluation of adherence within clinical trials, facilitate the development of competency frameworks, and be of value in relation to training and dissemination of CBT for psychosis.