Increasing Access to CBT for Psychosis: Development, Feasibility, and Acceptability of a Specialized Outpatient Service.

Despite the increasing demand for cognitive behavioural therapy for psychosis (CBTp), the existing literature is lacking in terms of models for sustainable implementation. The aims of this study were to: (a) describe the development of a specialized CBTp Service; (b) report demographic characteristics and referral patterns over 1 year to examine feasibility; and (c) review feedback from participants in group-based CBTp to examine acceptability. Data were analyzed from 126 referrals (M = 35.52, SD = 13.06, 59.5% men) to an outpatient CBTp Service at the Centre for Addiction and Mental Health (Toronto, Ontario) between January 2019 to January 2020. Anonymous feedback was obtained from 54 individuals who completed group-based CBTp. Positive symptoms and distressing emotions were the main reasons for referral. Over half of eligible referrals scheduled an intake assessment and 70% of individuals who completed this assessment attended further treatment. Primary reasons for service refusal were scheduling conflicts and illness-related barriers. The total service wait-time was two months, with the longest delay between dates of referral and initial contact. Satisfaction with the quality of CBTp and its components was rated high among group members. Although variable wait-times and engagement levels were identified across stages of the referral process, the CBTp Service demonstrates preliminary feasibility and acceptability, and provides a model of service delivery to incorporate within future CBTp implementation efforts in Canada.

Emotion regulation relates to clinical characteristics and quality of life but not daily functioning in psychosis spectrum outpatients.

Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention.

Extending motivational interviewing to the treatment of major mental health problems: current directions and evidence.

Motivational interviewing (MI) was originally developed for the treatment of substance abuse but is rapidly expanding to other major mental health populations beyond addictions. This brief review considers the use of MI and related motivational enhancement therapies (METs) in the treatment of anxiety, depression, and eating disorders, and concurrent psychosis and substance use disorders. MI-MET has been added and (or) integrated into treatment for these problems in a wide variety of ways, most commonly as a pretreatment to other therapies (psychosocial treatments and pharmacotherapy) or integrated into standard assessment procedures. In each problem domain, the bulk of the current evidence supports the value of adding MI to existing therapies in increasing engagement with treatment and in improving clinical outcomes. This is particularly encouraging in that many of the populations included in these investigations represent severe and treatment-recalcitrant populations. However, research on the application of MI to other major mental health problems beyond addictions is in the early stages, with existing studies having numerous limitations (for example, small uncontrolled studies or lack of adequate control groups, and failure to establish both MI treatment integrity and the unique contribution of MI in integrated treatments). In short, the substantial body of promising preliminary findings strongly support the continued investigation of MI and related methods for these populations in well-designed clinical trials that examine not only the additive value of MI but also mechanisms underlying these effects and individual differences (moderators) indicating the need for MI.

Systemic-constructivist couple therapy (SCCT): Description of approach, theoretical advances, and published longitudinal evidence.

The systemic-constructivist approach to studying and benefiting couples was derived from qualitative and quantitative research on distressed couples over the past 10 years. Systemic-constructivist couple therapy (SCCT) is the clinical intervention that accompanies the approach. SCCT guides the therapist to work with both the intrapersonal and the interpersonal aspects of marriage while also integrating the social-environmental context of the couple. The theory that underlies SCCT is explained, including concepts such as we-ness and interpersonal processing. The primary components of the therapy are described. Findings described previously in an inaugural monograph containing extensive research demonstrating the long-term utility of SCCT are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Therapeutically induced changes in couple identity: the role of we-ness and interpersonal processing in relationship satisfaction.

Changes in partners' sense of self-in-relationship, which a systemic-constructivist couple therapy (SCCT) induced, led to robust improvement in satisfaction in 2 studies and a follow-up study. In each study, 13 referred couples completed measures of satisfaction, mutuality, similarities, and other-in-self construal pre-post 12 hours of SCCT. The authors reliably coded transcripts of 1st and final sessions for each partner's we-ness, the identity that each partner establishes in relationship to the other. Having met the criteria for the rigorous study of change in single group process-outcome design, changes in we-ness accompanied large posttherapy dyadic increments on all variables in each study. Therapeutic gains appeared at follow-up and correlated with increased we-ness obtained at end of therapy 2 years earlier. The authors raise theoretical implications for all types of couple therapies and explain clinical techniques.