Delivery of cognitive-behaviour therapy for psychosis:a service user preference trial

Background: Clinical guidelines recommend cognitive behaviour therapy (CBT) for people with psychosis, however, implementation is poor and not everyone wishes to engage with therapy. Understanding service user (SU) preferences for receiving such treatments is a priority for services. Aims: To explore SU preferences and outcomes of different methods of delivering CBT for psychosis. Method: SUs experiencing psychosis could choose between treatment as usual (TAU); TAU plus telephone-delivered CBT with self-help, CBT recovery manual (TS); high support CBT (HS – TAU plus TS plus group sessions) or randomisation. Participants received their option of choice and were followed-up on several outcomes over 9 and 15 months. Results: Of 89 people recruited, three chose to be randomised and 86 expressed a treatment preference (32 chose TAU, 34 chose TS, 23 chose HS). There were few differences between those who chose therapy compared to those who chose TAU. Those who had more positive impacts from their symptoms were significantly more likely to choose TAU. Conclusions: Most people had strong preferences about treatment delivery and a substantial number did not wish to receive additional therapy. These findings have to be considered when planning and allocating resources for people with psychosis

Psychological resilience to suicidal experiences in people with non-affective psychosis: A position paper

It is important to understand the psychological factors which underpin pathways to suicidal experiences. It is equally as important to understand how people develop and maintain resilience to such psychological factors implicated in suicidal experiences. Exploring optimal routes to gaining this understanding of resilience to suicidal thoughts and acts in people with severe mental health problems, specifically non-affective psychosis, was the overarching aim of this position paper. There are five central suggestions: 1. investigating resilience to suicidal experiences has been somewhat over-looked, especially in those with severe mental health problems such as schizophrenia; 2. it appears maximally enlightening to use convergent qualitative, quantitative and mixed research methods to develop a comprehensive understanding of resilience to suicide; 3. relatedly, involving experts-by-experience (consumers) in suicide research in general is vital, and this includes research endeavours with a focus on resilience to suicide; 4. evidence-based models of resilience which hold the most promise appear to be buffering, recovery and maintenance approaches; and 5. there is vast potential for contemporary psychological therapies to develop and scaffold work with clients centred on building and maintaining resilience to suicidal thoughts and acts based on different methodological and analytical approaches which involve both talking and non-talking approaches

Psychometric properties of the Suicidal Ideation Attributes Scale (SIDAS) in a longitudinal sample of people experiencing non-affective psychosis

BACKGROUND: Suicidal ideation is a key precursor for suicide attempts and suicide deaths. Performing routine screening of suicide precursors can help identify people who are at high risk of death by suicide. This is, arguably, an important suicide prevention effort. The aim of this study was to assess the validity, reliability, and factor structure of the Suicidal Ideation Attributes Scale (SIDAS) in a three-month longitudinal study with people with a diagnosis of schizophrenia or non-affective psychosis and experiences of suicidal ideation and/or behaviours. It was predicted that the SIDAS would have high internal consistency, test-retest reliability, convergent, discriminant and construct validity. METHODS: Ninety-nine participants experiencing psychosis completed the SIDAS at baseline and 89 participants completed it 3 months later. Additionally, participants completed a demographic questionnaire, the Beck Scale for Suicide Ideation, the Beck Hopelessness Scale, and the Defeat and Entrapment Scales. The internal consistency, test-retest reliability, convergent validity, and discriminant validity of the SIDAS were investigated in comparison to other constructs. Factor analysis was performed to examine the factor structure of the scale. RESULTS: Principal component analysis yielded a theoretically coherent one-dimensional factor structure of SIDAS, suggesting good construct validity (PCA = .71). The SIDAS had high internal consistency (α = .89) and good test-retest reliability (α = .73). It was highly correlated with other self-report measures, including the Beck Scale for Suicide Ideation, Beck Hopelessness Scale, Defeat and Entrapment scales, indicating excellent construct validity. CONCLUSION: The SIDAS is a valid and reliable self-report instrument for assessing the severity of suicidal ideation in a population of people with a diagnosis of schizophrenia or non-affective psychosis. Further research should test the psychometric properties of the scale in individuals experiencing different mental health problems in cross-cultural settings, in order to establish its broader validity, reliability, and clinical utility