Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder:randomised controlled pilot trial

Background Despite evidence for the effectiveness of structured psychological therapies for bipolar disorder no psychological interventions have been specifically designed to enhance personal recovery for individuals with recent-onset bipolar disorder. Aims A pilot study to assess the feasibility and effectiveness of a new intervention, recovery-focused cognitive-behavioural therapy (CBT), designed in collaboration with individuals with recent-onset bipolar disorder intended to improve clinical and personal recovery outcomes. Method A single, blind randomised controlled trial compared treatment as usual (TAU) with recovery-focused CBT plus TAU (n = 67). Results Recruitment and follow-up rates within 10% of pre-planned targets to 12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of recovery-focused CBT were attended out of a potential maximum of 18 h. Compared with TAU, recovery-focused CBT significantly improved personal recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean score 310.87, 95% CI 75.00-546.74 (s.e. = 120.34), P = 0.010, d = 0.62) and increased time to any mood relapse during up to 15 months follow-up (χ(2) = 7.64, P<0.006, estimated hazard ratio (HR) = 0.38, 95% CI 0.18-0.78). Groups did not differ with respect to medication adherence. Conclusions Recovery-focused CBT seems promising with respect to feasibility and potential clinical effectiveness. Clinical- and cost-effectiveness now need to be reliably estimated in a definitive trial

Evaluation of a compassionate mind training intervention with school teachers and support staff

Teacher retention is a key issue facing schools, with stress, student behavior, current competitive policies and practices resulting in many leaving within the first five years of qualification. Consequently, recent in-school research initiatives have focused on resilience training, although the quality of such conducted studies is debated. Drawn from Compassion Focused Therapy (CFT), this study set out to explore a six module Compassionate Mind Training (CMT) programme with school staff to improve well-being. As part of their continued professional development, over 70 teachers and support staff took part in the CMT, with a mixed-measures AAB quantitative and qualitative design employed. This enabled us to explore both implementation effectiveness and outcome effectiveness in terms of parameters of well-being. The initiative was well-received with the majority of staff reporting positively on their experiences of the curriculum and practices. Additionally, exercise practice was associated with significant increases in self compassion (p<0.01) and significant decreases in self-criticism (p<0.05). Thematic analyses further revealed benefits of CMT for dealing with emotional difficulties. As a feasibility study, our results demonstrate many benefits of CMT in educational settings. CMT may hold promise as a way of helping those in education counteract the current competition-based nature of education, especially that which contributes to negative changes in well-being. Given this, future research should employ a control group design, a larger sample size and a range of wellbeing measures at follow-up, to fully evaluate the utility of CMT in educational settings.N/

Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial

We aimed to evaluate the feasibility of Cognitive Therapy (CT) as an intervention for internalised stigma in people with psychosis. We conducted a single-blind randomised controlled pilot trial comparing CT plus treatment as usual (TAU) with TAU only. Participants were assessed at end of treatment (4 months) and follow-up (7 months). Twenty-nine participants with schizophrenia spectrum disorders were randomised. CT incorporated up to 12 sessions over 4 months (mean sessions=9.3). Primary outcome was the Internalised Stigma of Mental Illness Scale – Revised (ISMI-R) total score, which provides a continuous measure of internalised stigma associated with mental health problems. Secondary outcomes included self-rated recovery, internalised shame, emotional problems, hopelessness and self-esteem. Recruitment rates and retention for this trial were good. Changes in outcomes were analysed following the intention-to-treat principle, using ANCOVAs adjusted for baseline symptoms. There was no effect on our primary outcome, with a sizable reduction observed in both groups, but several secondary outcomes were significantly improved in the group assigned to CT, in comparison with TAU, including internalised shame, hopelessness and self-rated recovery. Stigma-focused CT appears feasible and acceptable in people with psychosis who have high levels of internalised stigma. A larger, definitive trial is required

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

Emotional response to a therapeutic technique:The social Broad Minded Affective Coping

Objectives It has been suggested that savouring positive memories can generate positive emotions. Increasing positive emotion can have a range of benefits including reducing attention to and experiences of threat. This study investigated individuals' emotional reactions to a guided mental imagery task focussing on positive social memory called the ‘social Broad Minded Affective Coping (BMAC)’ technique. The study examined possible predictors of individuals’ responses to this intervention. Method An internet‐based, within‐group, repeated‐measures design was used. One hundred and twenty‐three participants completed self‐report measures of self‐attacking and social safeness/pleasure. They were then guided through the social BMAC. Participants completed state measures of positive and negative affect and social safeness/pleasure before and after the intervention. Forty‐nine participants took part in a 2‐week follow‐up. Results It was found that safe/warm positive affect, relaxed positive affect and feelings of social safeness increased following the social BMAC, whilst negative affect decreased. In addition, it was found that people scoring higher on inadequate self‐attacking benefited most from this intervention. Changes in affect were not maintained at the 2‐week follow‐up. Conclusion The results provide preliminary support for the efficacy of the social BMAC in activating specific types of mood (those associated with safeness rather than drive/reward). This task has potential as part of therapeutic interventions directed at clinical groups, but further evaluation is needed. Practitioner points The social Broad Minded Affective Coping (BMAC) was related to improvements in forms of positive affect linked to the affiliative system. This task may be helpful in inducing these positive mood states within therapy. Further evaluation comparing the BMAC to a control task is needed. Individuals with a greater fear of compassion or more hated‐self‐criticism may gain less from the task, although effects were small