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Loizou S, Fowler D, Hayward M. Measuring the longitudinal course of voice hearing under psychological interventions: A systematic review. Clin Psychol Rev 2022; 97:102191. [PMID: 35995024 DOI: 10.1016/j.cpr.2022.102191] [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: 11/23/2021] [Revised: 06/10/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Trials of psychological interventions targeting distressing voices have used a range of variables to measure outcomes. This has complicated attempts to compare outcomes across trials and to evaluate the effectiveness of these interventions. Therefore, this review aimed to identify the variables that have been used to measure the longitudinal course and impact of voice hearing under these interventions and to evaluate how these variables change over time. Inclusion and exclusion criteria were applied, resulting in a total of 66 articles. Of these, 60 studies (28 RCTs, 23 uncontrolled, 9 non-randomised) were published in peer-reviewed journals, whilst 6 were recently completed or currently ongoing. The findings of this review suggest that a range of variables that are not directly relevant to psychological interventions have been used (e.g., depression, characteristics of voice hearing experience), whilst those directly impacted by psychological interventions (e.g., voice-related distress), broader concepts of outcome (e.g., functioning) and specific associated processes (e.g., self-schema) have received less attention. Findings also showed that the majority of variables demonstrated improvements, but effect sizes varied considerably across trials. This may be attributed to methodological differences such as statistical power, blinding, control groups and different methods of measurement. Our review highlights the importance of determining a set of outcomes that are directly targeted and should change under psychological interventions. Recommendations include the use of voice-related distress as a primary outcome. This can ultimately facilitate comparisons across studies and inform the development of psychological interventions.
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Affiliation(s)
- Sofia Loizou
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK; Research & Development Department, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN7 3HZ, UK
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Kendall T, Whittington CJ, Kuipers E, Johnson S, Birchwood MJ, Marshall M, Morrison AP. NICE v. SIGN on psychosis and schizophrenia: same roots, similar guidelines, different interpretations. Br J Psychiatry 2016; 208:316-9. [PMID: 27036696 DOI: 10.1192/bjp.bp.115.170324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
Abstract
A recent editorial claimed that the 2014 National Institute for Health and Care Excellence (NICE) guideline on psychosis and schizophrenia, unlike its equivalent 2013 Scottish Intercollegiate Guidelines Network (SIGN) guideline, is biased towards psychosocial treatments and against drug treatments. In this paper we underline that the NICE and SIGN guidelines recommend similar interventions, but that the NICE guideline has more rigorous methodology. Our analysis suggests that the authors of the editorial appear to have succumbed to bias themselves.
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Affiliation(s)
- Tim Kendall
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Craig J Whittington
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Elizabeth Kuipers
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Sonia Johnson
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Max J Birchwood
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Max Marshall
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - Anthony P Morrison
- Tim Kendall, FRCPsych, National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, and Sheffield Health and Social Care NHS Foundation Trust; Craig J. Whittington, PhD, Doctor Evidence; Elizabeth Kuipers, FBPsS, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London; Sonia Johnson, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, and Camden and Islington NHS Foundation Trust, London; Max J. Birchwood, FBPsS, Warwick Medical School, University of Warwick, Coventry; Max Marshall, FRCPsych, Lancashire Care NHS Foundation Trust and School of Medicine, Manchester University, Manchester; Anthony P. Morrison, FBPsS, University of Manchester and Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, UK
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Peters E, Crombie T, Agbedjro D, Johns LC, Stahl D, Greenwood K, Keen N, Onwumere J, Hunter E, Smith L, Kuipers E. The long-term effectiveness of cognitive behavior therapy for psychosis within a routine psychological therapies service. Front Psychol 2015; 6:1658. [PMID: 26579041 PMCID: PMC4625031 DOI: 10.3389/fpsyg.2015.01658] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022] Open
Abstract
Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have considered its long-term effectiveness in routine services. This study reports the outcomes of clients seen in a psychological therapies clinic, set up following positive results obtained from an RCT (Peters et al., 2010). The aims were to evaluate the effectiveness of CBTp, using data from the service’s routine assessments for consecutive referrals over a 12 years period, and assess whether gains were maintained at a 6+ months’ follow-up. Of the 476 consenting referrals, all clients (N = 358) who received ≥5 therapy sessions were offered an assessment at four time points (baseline, pre-, mid-, and end of therapy) on measures assessing current psychosis symptoms, emotional problems, general well-being and life satisfaction. A sub-set (N = 113) was assessed at a median of 12 months after finishing therapy. Following the waiting list (median of 3 months) clients received individualized, formulation-based CBTp for a median number of 19 sessions from 121 therapists with a range of experience receiving regular supervision. Clients showed no meaningful change on any measure while on the waiting list (Cohen’s d <= 0.23). In contrast, highly significant improvements following therapy, all of which were significantly greater than changes during the waiting list, were found on all domains assessed (Cohen’s d: 0.44–0.75). All gains were maintained at follow-up (Cohen’s d: 0.29–0.82), with little change between end of therapy and follow-up (Cohen’s d <= 0.18). Drop-out rate from therapy was low (13%). These results demonstrate the positive and potentially enduring impact of psychological therapy on a range of meaningful outcomes for clients with psychosis. The follow-up assessments were conducted on only a sub-set, which may not generalize to the full sample. Nevertheless this study is the largest of its kind in psychosis, and has important implications for the practice of CBTp in clinical services.
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Affiliation(s)
- Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK ; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, King's College London London, UK
| | - Tessa Crombie
- Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Deborah Agbedjro
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Louise C Johns
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Kathryn Greenwood
- Department of Psychology, Sussex University Sussex, UK ; Sussex Partnership NHS Foundation Trust Sussex, UK
| | - Nadine Keen
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Elaine Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Laura Smith
- Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK ; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, King's College London London, UK
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Bucci S, Barrowclough C, Ainsworth J, Morris R, Berry K, Machin M, Emsley R, Lewis S, Edge D, Buchan I, Haddock G. Using mobile technology to deliver a cognitive behaviour therapy-informed intervention in early psychosis (Actissist): study protocol for a randomised controlled trial. Trials 2015; 16:404. [PMID: 26357943 PMCID: PMC4566519 DOI: 10.1186/s13063-015-0943-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022] Open
Abstract
Background Cognitive behaviour therapy (CBT) is recommended for the treatment of psychosis; however, only a small proportion of service users have access to this intervention. Smartphone technology using software applications (apps) could increase access to psychological approaches for psychosis. This paper reports the protocol development for a clinical trial of smartphone-based CBT. Methods/Design We present a study protocol that describes a single-blind randomised controlled trial comparing a cognitive behaviour therapy-informed software application (Actissist) plus Treatment As Usual (TAU) with a symptom monitoring software application (ClinTouch) plus TAU in early psychosis. The study consists of a 12-week intervention period. We aim to recruit and randomly assign 36 participants registered with early intervention services (EIS) across the North West of England, UK in a 2:1 ratio to each arm of the trial. Our primary objective is to determine whether in people with early psychosis the Actissist app is feasible to deliver and acceptable to use. Secondary aims are to determine whether Actissist impacts on predictors of first episode psychosis (FEP) relapse and enhances user empowerment, functioning and quality of life. Assessments will take place at baseline, 12 weeks (post-treatment) and 22-weeks (10 weeks post-treatment) by assessors blind to treatment condition. The trial will report on the feasibility and acceptability of Actissist and compare outcomes between the randomised arms. The study also incorporates semi-structured interviews about the experience of participating in the Actissist trial that will be qualitatively analysed to inform future developments of the Actissist protocol and app. Discussion To our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake, attrition and potential efficacy of a CBT-informed smartphone app for early psychosis. Mobile applications designed to deliver a psychologically-informed intervention offer new possibilities to extend the reach of traditional mental health service delivery across a range of serious mental health problems and provide choice about available care. Trial registration ISRCTN34966555. Date of first registration: 12 June 2014.
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Affiliation(s)
- Sandra Bucci
- School of Psychological Sciences, The University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
| | - Christine Barrowclough
- School of Psychological Sciences, The University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
| | - John Ainsworth
- Centre for Health Informatics, Institute of Population Health, University of Manchester, M13 9PL, Manchester, UK. .,Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, M13 9PL, Manchester, UK.
| | - Rohan Morris
- School of Psychological Sciences, The University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
| | - Katherine Berry
- School of Psychological Sciences, The University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
| | - Matthew Machin
- Centre for Health Informatics, Institute of Population Health, University of Manchester, M13 9PL, Manchester, UK. .,Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, M13 9PL, Manchester, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester & Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, M13 9PL, Manchester, UK.
| | - Shon Lewis
- Institute of Brain, Behaviour and Mental Health, Manchester Academic Health Sciences Centre and Manchester Mental Health and Social Care Trust, Manchester, M13 9PL, UK.
| | - Dawn Edge
- School of Psychological Sciences, The University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
| | - Iain Buchan
- Centre for Health Informatics, Institute of Population Health, University of Manchester, M13 9PL, Manchester, UK. .,Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, M13 9PL, Manchester, UK.
| | - Gillian Haddock
- School of Psychological Sciences, The University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
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