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Strelchuk D, Wiles N, Turner K, Derrick C, Martin D, Davies J, Zammit S. Eye-movement desensitisation and reprocessing therapy (EMDR) to prevent transition to psychosis in people with an at-risk mental state (ARMS): mixed method feasibility study. BJPsych Open 2024; 10:e105. [PMID: 38721786 PMCID: PMC11094432 DOI: 10.1192/bjo.2024.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/28/2024] [Accepted: 02/18/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Trauma plays an important role in the development of psychosis, but no studies have investigated whether a trauma-focused therapy could prevent psychosis. AIMS This study aimed to establish whether it would be feasible to conduct a multicentre randomised controlled trial (RCT) to prevent psychosis in people with an at-risk mental state (ARMS), using eye-movement desensitisation and reprocessing therapy (EMDR). METHOD This started as a mixed-method randomised study comparing EMDR to treatment as usual but, as a result of low participant recruitment, was changed to a single-arm feasibility study. The proposed primary outcome for an RCT was transition to psychosis at 12-month follow-up. Data on secondary outcomes were also collected. Qualitative interviews were conducted with patients and therapists. RESULTS Fourteen participants were recruited from the Early Intervention teams. Most people who expressed an interest in taking part attended an assessment to determine eligibility. All those eligible consented to take part. A total of 64% (7 of 11) of participants who were offered EMDR were followed up at 12 months. Of the 11 participants offered EMDR, one (11%, 95% CI: 0.2%, 48%) transitioned to psychosis. Nine patients and three therapists were interviewed. Participants who completed therapy (n = 4; mean 10.5 sessions) found EMDR helpful, but those who discontinued (n = 6; mean 5.2 sessions) said it had not benefitted them overall. Therapists said EMDR could be effective, although not for all patients. CONCLUSIONS Future studies recruiting people with an ARMS to an RCT may need to extend recruitment beyond Early Intervention teams. Although some individuals found EMDR helpful, reasons for discontinuing need to be addressed in future studies.
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Affiliation(s)
- Daniela Strelchuk
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK; and National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - Katrina Turner
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK; and Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Catherine Derrick
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - David Martin
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK; and Medical Education, Avon Wiltshire Partnership NHS Mental Health Trust, Bath NHS House Combe Park, Bath, UK
| | - Jonathan Davies
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Stan Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK; and MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, UK
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Izon E, Berry K, Law H, French P. 'If he feels better I'll feel better' relationships with individuals at high-risk of developing psychosis. Early Interv Psychiatry 2022; 16:231-238. [PMID: 33761576 DOI: 10.1111/eip.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
AIM A large proportion of individuals with an at-risk mental state (ARMS) live at home and are supported by their families. Recommended treatment includes family intervention (FI), and therefore, understanding relationships between individuals with an ARMS and their family members is key. This study aimed to provide a more holistic exploration of relationships within families of individuals with an ARMS by reporting the perceived impact of the condition on other family members including sibling and romantic relationships. METHOD Fourteen semi-structured interviews with family members were analysed using thematic analysis. RESULTS Parents wanted to maintain a safe family environment for all family members. This can result in spending less time with siblings who impacted on siblings' relationships with the service user and other family members. Romantic relationships were negatively impacted when there was unclear communication between the couple, as well as the partner's response and understanding of the ARMS condition. Clear communication across sibling and romantic relationships facilitated helpful family/carer's behaviour and understanding of the individuals' mental distress. CONCLUSION FI should explore and support families with changes in sibling and romantic relationships. More research is needed to understand siblings' perspectives in families with individuals experiencing an ARMS and to develop resources to support partners and families in changes within their sexual and romantic relationships.
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Affiliation(s)
- Emma Izon
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK.,Department of Experimental Psychology, Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Complex Trauma Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Law
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- The Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Department of Psychology, Manchester Metropolitan University, Manchester, UK.,Department of Research and Innovation, Pennine Care NHS Foundation Trust, Lancashire, UK
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A qualitative systematic review of Early Intervention in Psychosis service user perspectives regarding valued aspects of treatment with a focus on cognitive behavioural therapy. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x2100026x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Despite the increasing evidence base and focus given to Early Intervention in Psychosis (EIP) services, qualitative literature remains sparse, particularly in relation to the ‘At Risk Mental State’ (ARMS) group. Although research has looked to service user experience within EIP, data have not been collated to understand valued aspects of treatment across both EIP groups: first episode psychosis (FEP) and ARMS, particularly regarding cognitive behavioural therapy (CBT).
Aims:
To conduct a systematic review of qualitative literature to examine service user perspectives on support provided in EIP treatment with a focus on CBT.
Method:
This was a thematic synthesis of qualitative studies. Nine studies were included in the analysis identified through a systematic database search and citation tracking. Studies were critically appraised using the critical appraisal skills programme tool.
Results:
Nine studies were identified for inclusion. Six analytical themes and 20 descriptive categories were identified.
Conclusions:
User perspectives confirm previous findings highlighting importance of therapeutic relationships for treatment success. Normalisation, learning and understanding were valued across both groups, which increased coping, and can be facilitated throughout the EIP journey. Harnessing the support of those involved in users’ care and understanding these relationships further enhances interventions utilised. Understanding the stage the individual is at regarding their experiences is essential in relation to targeting support. Transdiagnostic aspects of CBT were valued across both groups. ARMS referred to more specific strategies and there were some differences regarding coping styles and flexibility preferences; however, this may be due to group differences in problem trajectory and care provision.
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Hinojosa-Marqués L, Domínguez-Martínez T, Barrantes-Vidal N. Family environmental factors in at-risk mental states for psychosis. Clin Psychol Psychother 2021; 29:424-454. [PMID: 34260123 DOI: 10.1002/cpp.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/07/2022]
Abstract
The family environment represents an important psychosocial factor that impacts psychosis prognosis, but little is known about its effect on the at-risk stages of psychosis. This study presents a comprehensive review and summarizes the state of the art of study on the wide range of family factors related to family functioning in the At-Risk Mental State (ARMS) for psychosis, as well as family interventions in ARMS individuals. Publications were retrieved by an extensive search on MEDLINE, PsycINFO and SCOPUS (1990-2020). Expressed Emotion is the most studied variable in ARMS literature, but there is scarce evidence of the role of other significant family factors at the ARMS stage. Overall, high Expressed Emotion did not appear to be reactive to ARMS patients' poor clinical status. However, initial evidence has suggested that relatives' beliefs about the disorder may play a significant role, either as mediators of these relationships or as predictors of Expressed Emotion. Available literature yet to yield a consistent pattern of findings on the association between Expressed Emotion or other family functioning indicators and negative outcomes, but some longitudinal studies highlight the greater potential for the protective effects of positive family environments at the ARMS stage. Family-based interventions have demonstrated benefits for both ARMS individuals and family dynamics. An increased focus on the impact of the at-risk stage of illness on relatives' mental well-being is required to provide family support based on their needs and to clarify the mechanisms leading to dysfunctional family dynamics during the critical ARMS period.
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Affiliation(s)
- Lídia Hinojosa-Marqués
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tecelli Domínguez-Martínez
- Global Mental Health Research Center, Directorate of Epidemiological and Psychosocial Research, 'Ramón de la Fuente Muñiz' National Institute of Psychiatry, Ministry of Health, Mexico City, Mexico
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.,Departament de Salut Mental, Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Stewart AL, Nápoles AM, Piawah S, Santoyo-Olsson J, Teresi JA. Guidelines for Evaluating the Feasibility of Recruitment in Pilot Studies of Diverse Populations: An Overlooked but Important Component. Ethn Dis 2020; 30:745-754. [PMID: 33250621 PMCID: PMC7683033 DOI: 10.18865/ed.30.s2.745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In health disparities research, studies often fall short of their recruitment goals. Conducting a pilot feasibility study of recruitment in which data are collected systematically on recruitment processes can help investigators refine methods for the larger study. However, there are few guidelines for conducting pilot feasibility studies, and recruitment methods are seldom the focus. Feasibility indicators differ from traditional reports of recruitment results by focusing on the extent to which recruitment goals are met. Methods We present an organizing framework for assessing the feasibility of recruitment that includes eight steps, briefly: 1) specify recruitment goals; 2) specify recruitment processes; 3) establish a tracking system for each individual; 4) establish a tracking database for monitoring processes and results; 5) implement recruitment and track each individual's progress; 6) summarize recruitment results; 7) calculate and interpret feasibility measures - were goals met; and 8) if goals were not met, utilize tracking data to modify methods for the larger study. We describe methods within each step, with added details for steps 2-5 (the specific processes). The framework draws from a small literature on recruitment feasibility with a focus on health disparities populations. The guidelines blend well-known methods of recruitment with additional information on calculating feasibility indicators. Conclusions These guidelines provide a first step in thinking systematically about recruitment feasibility, to advance the field of measuring feasibility. Feasibility indicators also can be used to track the effectiveness of innovative recruitment strategies as part of building the science of recruitment, especially in disparities populations.
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Affiliation(s)
- Anita L. Stewart
- Center for Aging in Diverse Communities, Institute for Health & Aging, University of California San Francisco, CA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Sorbarikor Piawah
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, CA
| | - Jasmine Santoyo-Olsson
- Department of Medicine, Division of Internal Medicine, University of California San Francisco, and School of Public Health, University of California Berkeley, CA
| | - Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute and Columbia Center for Interdisciplinary Research on Alzheimer’s Disease Disparities (CIRAD), New York, NY
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