Interruptions to therapy sessions on acute psychiatric wards; how frequent are they, and who does the interrupting?

Aim:To find out how often therapy sessions conducted on acute psychiatric wards are interrupted and who by.Methods:Interruptions or early endings to therapy sessions were recorded as part of a trial of a brief talking therapy for psychosis delivered on acute psychiatric wards.Results:Only a minority of therapy sessions were interrupted (19/146; 13%) or ended early (5/146; 3%). Interruptions most commonly came from staff (15/19; 79%) rather from other patients on the ward (4/19; 21%). Conclusions: These data show most inpatient therapy sessions can be completed as planned, and provide further support to the feasibility of delivering psychological therapies within these challenging clinical settings.<br/

Risk of contamination when planning psychological therapy trials can be assessed using a simple framework

Objectives: The objective of this study was to develop and pilot a standard framework that could be used to assess risk of contamination in psychological therapy trials, at the protocol development stage. Study Design and Setting: We developed and piloted a risk of contamination framework on a sample of 100 psychological therapy trial protocols registered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry (www.isrctn.com). We assessed all protocols as being low or high risk via three possible sources of contamination: 1) participants in the control arm, 2) participants in the intervention arm, 3) therapists in the intervention arm. Results: Overall, we found that the risk of contamination across all three sources was low for most studies (86 of 100 trial protocols; 86%). We identified 14 studies that had a potentially high risk for contamination. Most of these (N = 10) were identified as risk of contamination arising from a therapist in the intervention arm. Conclusion: The risk of contamination framework we piloted in this study could be a helpful tool for researchers aiming to identify and manage risk of contamination in their trial protocol development. We found that the risk of contamination was relatively low in the psychological therapy trials we sampled for this study, as measured by our framework, and could usually be mitigated through reasonable adjustments to the study design.</p

Risk of contamination when planning psychological therapy trials can be assessed using a simple framework

Objectives: The objective of this study was to develop and pilot a standard framework that could be used to assess risk of contamination in psychological therapy trials, at the protocol development stage. Study Design and Setting: We developed and piloted a risk of contamination framework on a sample of 100 psychological therapy trial protocols registered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry (www.isrctn.com). We assessed all protocols as being low or high risk via three possible sources of contamination: 1) participants in the control arm, 2) participants in the intervention arm, 3) therapists in the intervention arm. Results: Overall, we found that the risk of contamination across all three sources was low for most studies (86 of 100 trial protocols; 86%). We identified 14 studies that had a potentially high risk for contamination. Most of these (N = 10) were identified as risk of contamination arising from a therapist in the intervention arm. Conclusion: The risk of contamination framework we piloted in this study could be a helpful tool for researchers aiming to identify and manage risk of contamination in their trial protocol development. We found that the risk of contamination was relatively low in the psychological therapy trials we sampled for this study, as measured by our framework, and could usually be mitigated through reasonable adjustments to the study design

Piloting a ‘Timeline of Crisis Tool’ with service users on admission to an acute psychiatric ward

Objective: Being admitted to a psychiatric ward can be a distressing and confusing experience. Our objective was to develop and pilot a Timeline Tool as a way of supporting service users in developing a narrative of their experiences in the run up to admission. Method: We designed and piloted a ‘Timeline of Crisis Tool’ with 50 service users, incorporating a card sort exercise, comprising eight factors relevant to people’s experiences in the run up to a crisis admission. We asked service users for feedback on the experience of completing the Timeline Tool. Results: Service user feedback indicated advantages of completing the Timeline Tool in terms of feeling listened to and respected, reflecting and making sense of experiences. Discussion: Collaborative completion of the Timeline Tool on admission could help foster good service user-staff relationships. Information arising from the completed tool could be used to increase shared decision-making in the development of care plans during inpatient admissions.</p

Mindfulness for Psychosis Groups; Description and preliminary evaluation of a novel routine care pathway in Hong Kong

Background: There is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to 1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and 2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes.Methods: A new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation ‘taster’ session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions.Results: A high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation ‘taster’ session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group.Conclusions: Offering service users with psychosis the opportunity to attend a Mindfulness for Psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning.<br/

Mindfulness-Based Crisis Interventions (MBCI) for psychosis within acute inpatient psychiatric settings; A feasibility randomised controlled trial

Background: Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. People often need to go into hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings. Objectives: The primary objective of the study was to find out whether it was possible to carry out this kind of trial successfully within UK inpatient settings in terms of successfully recruiting and retaining patients in the trial. The secondary objective was to collect pilot data on clinical outcome measures, including re-admission rates at 6-month follow-up. Method: The amBITION study (BrIef Talking therapIes ON wards; ISRCTN376253384) was a parallel groups, feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention; MBCI). Inpatients on acute psychiatric wards were eligible for the study if they reported at least one positive psychotic symptom, and were willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants were randomly allocated to receive either MBCI or a control intervention (Social Activity Therapy; SAT) which involved doing activities on the ward with the therapist. Results: Fifty participants were recruited to the trial (26 MBCI; 24 TAU). No participants dropped-out during the therapy phase, and everyone in the trial received at least one therapy session. The average number of sessions per participant was 3 in both arms of the trial. Retention in the trial was excellent, and exceeded the pre-set benchmark of no more than 20% loss to follow-up at trial end-point (6-month follow-up after discharge). The follow-up rate at 6-month follow-up was 98% for service use data extracted from clinical notes, and 86% for self-report questionnaire measures. Three participants experienced adverse events, but none of these were considered to be related to their participation in the trial. Conclusions: It is feasible to recruit and retain participants in the trial. The therapy was acceptable to patients, and satisfaction ratings with therapy was high. Progression to a further trial is warranted based on these encouraging feasibility outcomes

A systematic review and meta-analysis of the association between emotional stress reactivity and psychosis

AimEmotional stress reactivity may be a mediating factor in the association between trauma and psychosis. This review aimed to (i) identify, summarise and critically evaluate the link between emotional stress reactivity and psychotic experiences (ii) examine evidence for a 'dose–response' relationship between stress reactivity and psychosis in the wider psychosis phenotype (i.e., sub-clinical symptoms).MethodsElectronic database searches (PsychINFO, MEDLINE, EMBASE) were conducted for studies which investigated the link between stress reactivity and psychosis, psychotic symptoms, or a vulnerability to developing psychosis (wider phenotype). Cross-sectional, experimental and experience sampling method study designs were eligible for inclusion.ResultsFourty five eligible articles were identified (N participants = 8830). Narrative synthesis showed that increased emotional stress reactivity was associated with psychosis and subclinical psychotic experiences across all study designs, however, findings were inconsistent across studies. The preliminary meta-analysis (k = 4, n = 383) showed increases in emotional stress reactivity was associated with higher negative affect in response to event-related stress, in those with psychosis compared to controls (mean difference in beta coefficients = 0.05, 95% CI 0.02–0.08, p = .004). However, this difference was small with a considerable degree of heterogeneity (p = .001, I2 = 81%) so results should be interpreted with caution.ConclusionsOverall, the evidence suggests that there is a link between emotional stress reactivity and psychosis in those with psychosis, those at high risk of developing psychosis and in relation to subclinical psychotic-like experiences in the general population

Key competencies for the delivery of cognitive behavioural therapies for psychosis in acute psychiatric inpatient settings: A Delphi study of therapists’ views

Cognitive Behaviour Therapy for psychosis (CBTp) is the psychological therapy recommended for people with psychosis and can start in the acute phase. However, there is not consensus on how CBTp should be delivered in an acute mental health inpatient setting. This study aimed to gain consensus from therapists on how CBTp should be delivered in this context. A two stage Delphi study was conducted to establish consensus on what the core components are of inpatient CBTp from the perspective of therapists who are experts in the field. Forty-five therapists took part in two rounds of rating statements on the areas of engagement and feedback, assessment and model, formulation, change strategies, homework and principles and values. A final list of 114 statements were included, which were rated as essential or important by ≥80% of respondents. The delivery of inpatient CBTp is dependent on several adaptations to traditional CBTp including indirect work, being more flexible with session content and delivery, and making adaptations to the restrictive environment. These recommendations could inform training, competency frameworks, and delivery of CBTp in inpatient settings

Dataset for "What Should Inpatient Psychological Therapies be for? Qualitative Views of Service Users on Outcomes"

This data outlines the views of 14 participants who had an inpatient admission within the last year, on what outcomes they think are important to measure in psychological therapy trials in acute mental health inpatient wards. This data includes the 14 transcripts of the qualitative semi-structured interviews.The interview schedule was piloted with a Person with Personal Experience Researcher (LC) and included questions adapted from a previous Core Outcome Set study (Tyler et al., 2020). The semi-structured interviews were conducted remotely by either video call or telephone and audio-recorded for transcription.The transcripts were anonymised and demographic details were removed. The data includes the transcription from the first question to the final question.The transcripts are in Microsoft Word format.Transcription was completed following the Transcription Notation System for Orthographic Transcription (revised from Braun & Clarke, 2013)