Group therapies for schizophrenia: initial group climate predicts changes in negative symptoms

Effectiveness of group arts therapies (art therapy, dance movement therapy and music therapy) compared to group counselling for diagnostically heterogeneous psychiatric community patients: study protocol for a randomised controlled trial in mental health services (the ERA study)

BACKGROUND

Arts therapies are widely but inconsistently provided in community mental health. Whilst they are appealing to patients, evidence for their effectiveness is mixed. Trials to date have been limited to one art-form or diagnosis. Patients may hold strong preferences for or against an art-form whilst group therapies rely on heterogeneity to provide a range of learning experiences. This study will test whether manualised group arts therapies (art therapy, dance movement therapy and music therapy) are effective in reducing psychological distress for diagnostically heterogeneous patients in community mental health compared to active group counselling control.

METHODS

A pragmatic multi-centre 2-arm randomised controlled superiority trial with health economic evaluation and nested process evaluation. Adults aged ≥ 18, living in the community with a primary diagnosis of psychosis, mood, or anxiety disorder will be invited to participate and provide written informed consent. Participants are eligible if they score ≥ 1.65 on the Global Severity Index of the Brief Symptom Inventory. Those eligible will view videos of arts therapies and be asked for their preference. Participants are randomised to either their preferred type of group arts therapy or counselling. Groups will run twice per week in a community venue for 20 weeks. Our primary outcome is symptom distress at the end of intervention. Secondary outcomes include observer-rated symptoms, social situation and quality of life. Data will be collected at baseline, post-intervention and 6 and 12 months post-intervention. Outcome assessors and trial statisticians will be blinded. Analysis will be intention-to-treat. Economic evaluation will assess the cost-effectiveness of group arts therapies. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of group process measures and qualitative interviews with participants and therapists.

DISCUSSION

This will be the first trial to account for patient preferences and diagnostic heterogeneity in group arts therapies. As with all group therapies, there are a number of logistical challenges to which we have had to further adapt due to the COVID-19 pandemic. Overall, the study will provide evidence as to whether there is an additive benefit or not to the use of the arts in group therapy in community mental health care.

TRIAL REGISTRATION

ISRCTN, ISRCTN88805048 . Registered on 12 September 2018.

Group music therapy with songwriting for adult patients with long-term depression (SYNCHRONY study): a feasibility and acceptability study of the intervention and parallel randomised controlled trial design with wait-list control and nested process evaluation

BACKGROUND

Despite effective treatments, one fifth of patients develop chronic depression. Music therapy may offer a different approach. This study aimed to assess feasibility and acceptability of a music therapy intervention and trial methodology.

METHODS

A parallel two-arm randomised controlled trial with wait-list control, mixed feasibility/acceptability measures and nested process evaluation. Adults with long-term depression (symptom duration > 1 year) were recruited from community mental health services and computer randomised to 42 sessions of group music therapy with songwriting three times per week or wait-list control. Depression, social functioning, distress, quality of life, satisfaction and service use were assessed by blinded researchers at enrolment, 1 week and 3 and 6 months post-therapy. Outcomes were analysed descriptively, controlling for baseline covariates. Recruitment (number eligible, participation and retention rates) and intervention (fidelity, adherence) feasibility were assessed using pre-defined stop-go criteria. Attendance, adverse events, mood, relationship satisfaction and semi-structured interviews were analysed in a nested process evaluation.

RESULTS

Recruitment processes were feasible with 421 eligible, 12.7% participation and 60% (18/30) retention. Thirty participants were randomised to intervention (N = 20) and control (N = 10). Session attendance was low (mean 10.5) with four withdrawals. Music therapist adherence was good but changes to session frequency were suggested. Outcomes were available for 10/20 treatment and 9/10 wait-list participants. Depression increased in both arms post-therapy. Treatment depression scores fell below baseline 3 and 6 months post-therapy indicating improvement. Wait-list depression scores increased from baseline 3 and 6 months post-therapy. At 3 months, the treatment arm improved from baseline on all measures except satisfaction and functioning. At 6 months, quality of life, distress and functioning improved with reduction in health service contacts. High-attending participants improved more than low-attending. Seven adverse events (one serious) were reported.

LIMITATIONS

As this was a feasibility study, clinical outcomes should be interpreted cautiously.

CONCLUSION

A randomised controlled trial of group music therapy using songwriting is feasible with inclusion criteria and session frequency modifications, but further intervention development is required.

TRIAL REGISTRATION

ISRCTN18164037 on 26.09.2016.

Splitting Things Apart to Put Them Back Together Again: A Targeted Review and Analysis of Psychological Therapy RCTs Addressing Recovery From Negative Symptoms

Negative symptoms have attracted growing attention as a psychological treatment target and the past 10 years has seen an expansion of mechanistic studies and clinical trials aimed at improving treatment options for this frequently neglected sub-group of people diagnosed with schizophrenia. The recent publication of several randomized controlled trials of psychological treatments that pre-specified negative symptoms as a primary outcome warrants a carefully targeted review and analysis, not least because these treatments have generally returned disappointing therapeutic benefits. This mini-review dissects these trials and offers an account of why we continue to have significant gaps in our understanding of how to support recovery in people troubled by persistent negative symptoms. Possible explanations for mixed trial results include a failure to separate the negative symptom phenotype into the clinically relevant sub-types that will respond to mechanistically targeted treatments. For example, the distinction between experiential and expressive deficits as separate components of the wider negative symptom construct points to potentially different treatment needs and techniques. The 10 negative symptom-focused RCTs chosen for analysis in this mini-review present over 16 different categories of treatment techniques spanning a range of cognitive, emotional, behavioral, interpersonal, and metacognitive domains of functioning. The argument is made that treatment development will advance more rapidly with the use of more precisely targeted psychological treatments that match interventions to a focused range of negative symptom maintenance processes.

I know what I like, and I like what I know: Patient preferences and expectations when choosing an arts therapies group

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Past experiences and capability in the art forms informed choices.

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Participants had mixed expectations of the social interactions in the groups.

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Participants considered the ways in which the arts therapies would be helpful for them.

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These aspects should be considered during collaborative decision-making for the arts therapies.

Patient preferences deserve consideration as they play a role in engagement with psychosocial interventions. This study sought to understand more about preferences and expectations of the arts therapies, in order to support informed decision-making.

Semi-structured interviews were conducted with 17 participants in a trial of group music therapy, art therapy and dance-movement therapy. Audio recordings were transcribed. Data relating to the process of choosing their preferred arts therapies groups, expectations and experiences of the groups were analysed using framework analysis.

Three overarching themes were found relating to the experience of choosing an arts therapies group and subsequently attending it: past experiences of the art forms, social interactions in the groups and expectations of helpfulness. Familiarity and perceived capability were important factors for the therapy experiences.

Although each participant had a unique decision-making process, the themes offer understanding of common considerations when making a choice about engagement with the arts therapies. Clinicians should guide discussions around past experiences of the art forms, group dynamics and therapy aims during shared decision making for the arts therapies.

The effects of acceptance and commitment therapy in psychosis treatment: A systematic review of randomized controlled trials

PURPOSE

To identify, evaluate, and synthesize existing randomized controlled trials (RCTs) that examine the effect of acceptance and commitment therapy (ACT) in the treatment of psychotic disorders and to integrate this knowledge and experience into the nursing literature.

DESIGN AND METHODS

This systematic review is based on the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

FINDINGS

This study was completed with 11 RCTs meeting the research criteria. It has been determined that the vast majority (82%) of the assessed studies were published after 2010. There is evidence that ACT is effective on depression, anxiety, and hallucinations seen in psychotic disorders.

PRACTICE IMPLICATIONS

ACT is seen as a reasonable approach to be used and tested by nurses and other clinicians because it provides an explanatory and pragmatic approach to psychotic disorders.