Behavioural Therapy For Psychosis Research Articles

Multisite randomised controlled trial of trauma-focused cognitive behaviour therapy for psychosis to reduce post-traumatic stress symptoms in people with co-morbid post-traumatic stress disorder and psychosis, compared to treatment as usual: study protocol for the STAR (Study of Trauma And Recovery) trial

BackgroundPeople with psychosis have high rates of trauma, with a post-traumatic stress disorder (PTSD) prevalence rate of approximately 15%, which exacerbates psychotic symptoms such as delusions and hallucinations. Pilot studies have shown that trauma-focused (TF) psychological therapies can be safe and effective in such individuals. This trial, the largest to date, will evaluate the clinical effectiveness of a TF therapy integrated with cognitive behaviour therapy for psychosis (TF-CBTp) on post-traumatic stress symptoms in people with psychosis. The secondary aims are to compare groups on cost-effectiveness; ascertain whether TF-CBTp impacts on a range of other meaningful outcomes; determine whether therapy effects endure; and determine acceptability of the therapy in participants and therapists.MethodsRater-blind, parallel arm, pragmatic randomised controlled trial comparing TF-CBTp + treatment as usual (TAU) to TAU only. Adults (N = 300) with distressing post-traumatic stress and psychosis symptoms from five mental health Trusts (60 per site) will be randomised to the two groups. Therapy will be manualised, lasting 9 months (m) with trained therapists. We will assess PTSD symptom severity (primary outcome); percentage who show loss of PTSD diagnosis and clinically significant change; psychosis symptoms; emotional well-being; substance use; suicidal ideation; psychological recovery; social functioning; health-related quality of life; service use, a total of four times: before randomisation; 4 m (mid-therapy); 9 m (end of therapy; primary end point); 24 m (15 m after end of therapy) post-randomisation. Four 3-monthly phone calls will be made between 9 m and 24 m assessment points, to collect service use over the previous 3 months. Therapy acceptability will be assessed through qualitative interviews with participants (N = 35) and therapists (N = 5–10). An internal pilot will ensure integrity of trial recruitment and outcome data, as well as therapy protocol safety and adherence. Data will be analysed following intention-to-treat principles using generalised linear mixed models and reported according to Consolidated Standards of Reporting Trials-Social and Psychological Interventions Statement.DiscussionThe proposed intervention has the potential to provide significant patient benefit in terms of reductions in distressing symptoms of post-traumatic stress, psychosis, and emotional problems; enable clinicians to implement trauma-focused therapy confidently in this population; and be cost-effective compared to TAU through reduced service use.Trial registrationISRCTN93382525 (03/08/20)

Mindfulness on Daily Life Coping in People Experiencing Psychosis: A Randomized Controlled Trial

Background/ObjectiveCognitive Behavior Therapy for psychosis (CBTp) is a recommended treatment for psychoses whose effect is mediated by coping. Mindfulness (MBI) have shown positive effects in psychosis. This study examines the hypothesis that combining CBTp+MBI could improve coping with day-to-day life in psychosis better than CBTp alone in people attending a public community rehabilitation center. MethodFifty-six outpatients were recruited and randomly allocated either to CBTp or CBTp+MBI. Measures comprised PANSS interview and COPE Inventory. Data were analyzed using a repeated measures ANOVA and RCI calculation. ResultsThere were no statistical differences between groups at pre-treatment. Significant statistical differences were found for the interaction Treatment x Time in Mental disengagement (F = 5.65, p = .021, η2 = .102), Acceptance (F = 7.69, p = .008, η2 = .133), and Suppressing competing activities (F = 4.62, p = .037, η2 = .085). ConclusionsMBI promotes specific coping styles in people who experience psychosis that otherwise are not improved with CBTp. Only the MBI group improved acceptance of the presence of the stressor and reduced mental disengagement from the context. The intervention is feasible and effective for public healthcare settings.

What do trainee cognitive behavioural therapists need from clinical supervision to develop their skills in working with people with psychosis? A qualitative analysis

ABSTRACT Background Clinical supervision is assumed to be essential to the development of competent psychological therapists. While the evidence for effective psychological therapy training remains sparse, there is some support for the role of supervision and the experiential learning cycle in trainees’ progression. Despite a growing demand for cognitive behavioural therapy for psychosis (CBTp), no research has investigated the components of CBTp supervision necessary for skilful therapeutic practice. Methods We completed a qualitative thematic analysis of 385 supervision questions from 11 trainee CBTp therapists. Results The analysis yielded three main themes – knowledge/content (What?) questions; procedure/process (How?) questions; and course requirements/assessment methods (Training) questions. What? questions decreased over the 20 weeks of supervision, How? questions were raised throughout, and Training questions increased prior to academic deadlines. The thematic analysis also showed that active experimentation (the final stage of the experiential learning cycle) may be omitted from supervisory practice. Discussion These results indicate that CBTp supervision should prioritise knowledge, procedural learning and active experimentation, in training therapists to deliver high quality CBT for people with psychosis.

Training inpatient psychiatric nurses and staff to utilize CBTp informed skills in an acute inpatient psychiatric setting

ABSTRACT Background The aim of this study was to investigate the impact of a novel, brief CBTp-informed skills training, called Positive Practices for working with Psychosis (PPP), on recovery-orientation of frontline inpatient psychiatric staff, and on staff knowledge of and confidence using skills informed by Cognitive Behavior Therapy for psychosis. Methods Twenty five providers participated in 12 hours of PPP training. We examined changes in providers’ skills in delivering recovery-oriented care (focusing on skills advocacy, evidence based practice, stigma, optimism, and client preference), and providers’ knowledge of, and confidence in using CBTp informed skills, using the Competency Assessment Instrument (CAI) and the Knowledge and Confidence Using CBTp Skills Scale (KC-CBTp). Results were analyzed using paired-sample t-tests. Results: Significant gains (p < .001) in self-rated knowledge and confidence using CBTp skills were seen on 8 of 9 domains measured. On the CAI, significant gain in optimism was seen (p = .004). Discussion Brief CBTp informed PPP training is a potential intervention for frontline staff, associated with significant gains in knowledge of, and confidence in using, evidence based CBTp-informed skills, and increased optimism in attitudes towards recovery. Limited change on recovery based competencies of staff was seen in other domains and requires further investigation.

Commentary: Schizophrenia prevention and prodromal psychosis in children and adolescents.

Catalan and colleagues aggregated findings related to detection, prognosis, and intervention in Clinical High Risk for Psychosis (CHR-P) children and adolescents through October 7, 2019 (Catalan et al., 2020). While a sufficient number of studies were available to meta-analytically summarize evidence on detection and prognosis, the authors highlight the need for more studies on interventions, including cognitive behavioral therapy for psychosis, in CHR-P youth. Further research on the biological and neural correlates of CHR-P in children and adolescents is also needed. Though results from the few existing biomarker studies in CHR-P youth were included in the systematic review, disparate study methodologies and outcomes prohibited biomarker study meta-analysis.

“A blank canvas of me”: an interpretive phenomenological analysis study of the experience of client self-disclosure in cognitive behavioural therapy for psychosis

ABSTRACT Background: Client disclosure of emotionally salient information to a therapist may be an important factor in the effectiveness of Cognitive Behavioural Therapy for Psychosis (CBTp). The present study explores how people engaging with CBTp make sense of sharing emotionally salient information with a therapist and considers how mental health stigma may influence how participants decide whether to share information. Methods: Eight participants were recruited for semi-structured interviews lasting 30–75 minutes. Interpretive Phenomenological Analysis was used. Results: Two main themes were identified. I am responsible for controlling the negative impact of disclosure refers to participants’ awareness that sharing distressing experiences may have negative consequences. Participants worried about being judged, such as being seen as abnormal or having the potential to harm others. They also worried about feeling shamed or distressed. Non-disclosure may be a way of avoiding these fears. The second theme, Therapy makes me feel normal, describes how participants viewed themselves more positively from their therapist validating and understanding their experiences. Conclusions: Internalized stigma-based beliefs may influence self-disclosure, and the therapeutic relationship may provide alternative, positive beliefs about the self as normal. Further research can explore beliefs about self-disclosure and consider micro-affirmations as a therapeutic process.

Cognitive Behavior Therapy for Psychosis (CBT-p) as an Adjunct to Competency Restoration

ABSTRACT Adjudicative competence evaluations are the most common forensic evaluation to occur in the United States. As a result of these evaluations, pretrial defendants are often found to be incompetent to stand trial and ordered for competency restoration, with psychotic symptoms as a major barrier to competency. Traditional competency restoration services are sometimes insufficient for restoring such defendants to competency within a reasonable period of time. This can lead to a finding that a defendant is unrestorably incompetent to stand trial and potentially a dismissal of charges. However, if not all available interventions are attempted during the course of competency restoration, this may be perceived as a miscarriage of justice for victims. In other cases, defendants with psychotic symptoms may lack insight into their mental illness, and after being successfully restored to competency, become non-adherent with their prescribed medication regimens and decompensate before their cases are resolved. The authors contend that use of Cognitive Behavior Therapy for psychosis (CBT-p) as an adjunct to traditional competency restoration services may be a means of restoring more defendants to competency, and also strengthening the durability of restored competency, when psychotic symptoms are identified as a barrier to adjudicative competence. This makes use of the skill sets of many clinically trained treatment providers working in forensic settings, and is consistent with recent trends of applying empirically-based interventions designed for use with non-forensic patients in forensic contexts. A case example is included to demonstrate the potential application of CBT-p to competency restoration during the course of individualized intervention.

Mindfulness for psychosis groups; description and preliminary evaluation of a novel routine care pathway in Hong Kong

BackgroundThere is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to (1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and (2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes.MethodsA new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation ‘taster’ session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions.ResultsA high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation ‘taster’ session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group.ConclusionsOffering service users with psychosis the opportunity to attend a mindfulness for psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning.

Increasing access to CBT for psychosis patients: a feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2)

BackgroundThe National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (clinical psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of assistant psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised controlled trial (RCT).MethodsThis is a feasibility study for a pragmatic, three-arm, parallel-group, superiority 1:1:1 RCT comparing a Guided self-help CBT intervention for voices and treatment as usual (GiVE) to Supportive Counselling and treatment as usual (SC) to treatment as usual alone (TAU), recruiting across two sites, with blinded post-treatment and follow-up assessments. A process evaluation will quantitatively and qualitatively explore stakeholder experience.DiscussionExpected outcomes will include an assessment of the feasibility of conducting a definitive RCT, and data to inform the calculation of its sample size. If evidence from a subsequent, fully powered RCT suggests that GiVE is clinically and cost-effective when delivered by briefly trained assistant psychologists, CBTp offered in these less resource-intensive forms has the potential to generate benefits for individual patients (reduced distress, enhanced recovery and enhanced quality of life), service-level patient benefit (increased access to evidence-based psychological therapies) and economic benefits to the NHS (in terms of the reduced use of mental health inpatient services).Trial registrationCurrent Controlled Trials, ISRCTN registration number: 16166070. Registered on 5 February 2019.

Do Attitudes Matter? Evaluating the Influence of Training in CBT-p-Informed Strategies on Attitudes About Working with People Who Experience Psychosis.

Attitudes of mental health providers are an important consideration in training and delivering evidence-based practices. Treatment approaches for individuals who experience schizophrenia consistently endorse the importance of a recovery perspective. At the same time, a review of the literature suggests that the attitudes of many providers and many policies of community health care settings serving individuals who experience schizophrenia, may not align with the recovery perspective. This brief report provides a summary of the program evaluation outcomes of a wide range of mental health providers who participated in a 2-day intensive training to learn strategies informed by Cognitive Behavioral Therapy for Psychosis (CBT-p). This intensive training emphasizes engagement strategies and person-centered approaches inherent in the recovery perspective. Consistent with the aims of the training, participants' attitudes about working with people who experience psychosis appeared to be positively influenced by training.

Identifying psychological resistances to using logic in cognitive-behavioral therapy for psychosis (CBTp) that limit successful outcomes for patients

ABSTRACTThe small to modest effect sizes of cognitive behavioral therapy for psychosis (CBTp) invite the question, do some treatments not succeed because patients mobilize psychological resistances to treatment that limit outcomes? This paper identifies 10 psychological resistances to CBTp, 7 that undermine the use of logic when examining delusional beliefs, and 3 best considered from a psychodynamic viewpoint. Resistances to progress in CBTp defined in the paper include logic evasion, logic monopolizing, logic blinding, logic partitioning, equivocation, reactive reassertion, feeling-percept fusion, mind-guarding, peripheral preoccupation, and external expectancy. When therapists recognize the operation of these defenses, they may aim to diminish their impact on the treatment. Ways the therapist might address these resistances in psychotherapy are suggested.

Implementation of Cognitive Behavioural Therapy for Psychosis (CBTp) in a forensic setting

In this Letter to the Editor, the authors comment on the implementation of a cognitive behavioural therapy for psychosis program for individuals admitted to a forensic psychiatry program. They highlight their experience and how they adapted the sessions to fit the needs of the patient in this context.

Cognitive Restructuring and Graded Behavioral Exposure for Persecutory Paranoia and Agoraphobic Anxiety in Complex Psychosis

Cognitive behavioral models of psychosis assert the notion of cognitive mediation, in which threat-oriented subjective misinterpretations of anomalous experiences lead to increased levels of emotional distress. Thus, paranoid appraisals of auditory hallucinations often result in hypervigilance and associated anxiety. The prevalence of diagnostic comorbidity between psychosis and anxiety disorders has been shown to be considerable. Among the evidence-based psychological treatments for complex mental ill-health, Cognitive Behavioral Therapy for psychosis (CBTp) has been supported with particularly promising research outcomes. Yet, despite such encouraging empirical data, the treatment provision often remains insufficient, predominantly among individuals with more acute presentations. Likewise, literature demonstrating the actual utilization of CBTp with complex psychoses appears above all relevant to the daily clinical practice in the specialism of severe mental ill-health. This methodologically rigorous case study describes a successful implementation of CBTp undertaken with a socially withdrawn individual diagnosed with paranoid schizophrenia and comorbid agoraphobic anxiety disorder. The intervention focused on cognitive restructuring of paranoid appraisals of voices and graded behavioral exposure to anxiety-inducing stimuli. Standardized measurement, behavior frequency sampling, and subjective data were utilized to evaluate the outcomes, indicating a considerable reduction in both paranoia and associated anxiety, and an overall improvement in the client’s behavioral and interpersonal functioning. The article highlights the importance of direct intellectual engagement with the content of paranoia, alongside methodically facilitated graded behavioral exposure and response prevention in the treatment of severe, socially debilitating psychoses with comorbid mood disorders.

Increasing subjective wellbeing with strengths-based cognitive behavioural psychotherapy in first episode psychosis

Despite a marked interest of psychosocial sciences in psychosis, there remains a scarcity of academic literature describing experiences of subjective wellbeing (SWB) among individuals with such condition. A recently published model of strengths-based cognitive behavioural therapy for psychosis (sbCBTp) explicitly recognises individual SWB as a central target in individual recovery. As such, sbCBTp integrates applied positive psychology interventions within the realms of an evidence-based psychotherapy to help individuals with psychosis recover beyond the point of symptom reduction. To date, no single subject research has been published describing a systematic implementation of sbCBTp undertaken within a clinical environment. This rigorous case study addresses such a gap in empirical literature. Standardised measurements, behaviour frequency sampling, and subjective data were utilised to evaluate the outcomes, indicating a considerable improvement in the client's SWB. The paper highlights the applicability of strengths-based psychotherapeutic strategies in helping individuals with complex mental ill-health achieve reasonable levels of life satisfaction.

Psychosis: Cognitive Behavioral Treatment Strategies

Cognitive behavioral therapy (CBT) is an established treatment for the patients with psychosis including schizophrenia. The evidence for the efficacy of CBT is proved by randomized clinical trials and meta-analyses. Evidence-based treatment guidelines recommend CBT for routine treatment. The aim of this paper is to give a short practical guideline for different cognitive behavioral treatment strategies. Cognitive Behavior Therapy for psychosis (CBTp) is an adaptation of general principles of CBT modified for patients with psychotic disorders. Basis of CBT are cognitive models of symptoms to identify treatment targets. The major goal is to foster every-day functioning by realizing a self-management approach. A caring, genuine and real-life oriented therapeutic attitude can help to establish a therapeutic alliance. An individualized functional analysis should be the core for every intervention. Basic strategies like psychoeducation and crisis plans are briefly described. Relatives and close friends of patients should be involved in order to improve crisis management and problem solving. Behavioral and cognitive treatment strategies for delusions, hallucinations and negative symptoms are outlined. Metacognitive treatment as well as social competence training is presented.

Cognitive Behavioral Therapy for Psychosis (CBTp): Multicenter Randomized Clinical Trial on Specific Efficacy

Background: Cognitive behavioral therapy for psychosis (CBTp) is a specific form of psychotherapy recommended in evidence-based treatment guidelines for patients with psychosis. However, it remains unclear whether CBTp is more efficacious than unspecific psychotherapies such as supportive therapy (ST). Methods: This multicenter, single blind, randomized clinical trial used a parallel group design to compare CBTp and ST. In total, 330 patients with persistent positive symptoms were included. Participants received 20 sessions of CBTp or ST over a 9-month period. Therapy was provided in six outpatient clinics at university psychiatry departments. The primary endpoint was the severity of positive symptoms (Positive and Negative Syndrome Scale-positive) until post-treatment at 9 months after inclusion. Analysis was carried out by intention to treat with multilevel linear modeling. Findings: There was a between group effect size of g=0·33 (0·11-0·55) in favor of CBTp for positive symptoms, with pre-post effect sizes of g=0·93 (0·70-1·15) for CBTp and g=0·62 (0·40-0·84) for ST. CBTp showed favorable effects for hallucinations and social functioning, but not for negative symptoms and readmission rates. Ratings of the therapeutic relationship, number of adverse events, and antipsychotic medication did not differ between the groups. Positive symptoms decreased in both groups until the 24 month follow-up, with a between group difference of g=0·09 (-0·23-0·39). Interpretation: CBTp is more efficacious than ST in patients with persistent positive symptoms. CBTp effects cannot be explained by therapeutic attention alone. This indicates CBTp has specific mechanisms of action, and further supports the unrestricted recommendation of CBTp for the treatment of psychosis. Trial Registration Number: ISRCTN29242879 Funding Statement: The study was funded by the German ministry of education and research (grant no. 01GV0618). Declaration of Interests: All authors declare that there is no conflict of interest. Ethics Approval Statement: The study protocol was reviewed without objections by the ethics committee of the coordinating study center and the local ethics committees of all participating centers. Patients were included in the study after written informed consent was obtained, which was assured by external monitoring.

M-RESIST, a modular intervention programme addressed to patients with treatment-resistant schizoprenia

In European Union, between 0.2 and 2.6% of the population suffer from psychotic disorders (Wittchen et al., 2011). The largest group is patients with schizophrenia, and around 40% can be considered resistant to pharmacological treatment (Essock et al., 1996; Kennedy et al., 2014). Standard intervention in patients with treatment-resistant schizophrenia (TRS) is difficult due to the persistence of positive symptoms, extensive periods of hospitalization, and higher risk of comorbidities. The full scope of this scenario generates a financial burden on society because of frequent emergency visits, hospitalizations and chronic use of polytherapy (de Silva et al., 2012), as well as a huge impact in the humanistic burden. This concerns patients and caregivers, and involves several dimensions such as quality of life, treatment side effects, caregiver burden, social impairment, suicide, violence, and healthy lifestyle among the most important (Millier et al., 2014 ) In this sense, we have developed the m-RESIST, an intervention programme based on m-Health that offer to TRS patients an holistic approach to: i) integrate psychiatric and psychosocial assistance with other medical health-carers; ii) better monitorization of symptoms through a personalised and optimised therapeutic process; iii) promote acceptance and self-management of disease and co-morbidities; and iv) potentiate involvement of patients and their caregivers in the therapeutic process. Moreover, there are no studies in TRS patients that collect real-time information from patients that allow monitoring, evaluation and intervention in the main areas of the disease, as well as in situations of risk. In this regard, m-RESIST brings an excellent opportunity to access this information, as well as permit an immediate and tailored intervention. This program will have integrated a mobile application that will deliver three possible intervention packages: treatment adherence, healthy lifestyle and symptoms management that include training strategies based on cognitive behaviour therapy for psychosis. Clinical algorithms have been created for each intervention package in order to deliver tailored recommendations to patients, caregivers and clinicians, which will be based on clinical and real-time sensor data. Moreover, a risk level ranking system will be used in order to prioritize actions in risk situations. On-going challenges include a pilot test to assess acceptability, usability and satisfaction of patients, caregivers and clinicians with the m-RESIST intervention program. m-RESIST project is founded by Horizon 2020 Framework Programme of the European Union. PHC26 2014 m-RESIST “Mobile Therapeutic Attention for patients with Treatment Resistant Schizophrenia”. The authors listed in this abstract are only a part of the m-RESIST Group.

Brain connectivity changes occurring following cognitive behavioural therapy for psychosis predict long-term recovery

Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.

Understanding clinician attitudes towards implementation of guided self-help cognitive behaviour therapy for those who hear distressing voices: using factor analysis to test normalisation process theory

BackgroundThe Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions. The current study aims to apply the NPT model to a secondary mental health context, and test the model using exploratory factor analysis. This study will consider the implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention.MethodsMental health clinicians were asked to complete a NPT-based questionnaire on the implementation of a brief CBTp intervention. All clinicians had experience of either working with the target client group or were able to deliver psychological therapies. In total, 201 clinicians completed the questionnaire.ResultsThe results of the exploratory factor analysis found partial support for the NPT model, as three of the NPT factors were extracted: (1) coherence, (2) cognitive participation, and (3) reflexive monitoring. We did not find support for the fourth NPT factor (collective action). All scales showed strong internal consistency. Secondary analysis of these factors showed clinicians to generally support the implementation of the brief CBTp intervention.ConclusionsThis study provides strong evidence for the validity of the three NPT factors extracted. Further research is needed to determine whether participants’ level of seniority moderates factor extraction, whether this factor structure can be generalised to other healthcare settings, and whether pre-implementation attitudes predict actual implementation outcomes.

Service users' perceptions of cognitive behavioural therapy for psychosis: A review

This aim of this literature review was to throw light on the perceptions of service users with psychosis with regard to their experiences of cognitive behavioural therapy for psychosis (CBTp). CBTp is recommended by the National Institute for Clinical Excellence for service users with psychosis at every stage of their illness, but provision of this intervention is not widespread. This narrative literature review critically appraised six primary studies, all of which view CBTp through the eyes of service users, revealing their perceptions of CBTp experiences and of their therapists. The thematic analysis revealed much positivity among service users towards CBTp, their perceptions often contrasting with those of their therapists. It also emerged that therapist characteristics may have a significant impact on the efficacy of CBTp. Implications for the greater involvement of mental health nurses in the delivery of CBTp are considered, and recommendations made for how this might be achieved in order to extend the access of service-users with psychosis to this effective intervention.