Impact of a brief worry-based cognitive therapy group in psychosis: a study of feasibility and acceptability

Previous research suggests that CBT focusing on worry in those with persecutory delusions reduces paranoia, severity of delusions and associated distress. This preliminary case series aimed to see whether it is feasible and acceptable to deliver worry-focused CBT in a group setting to those with psychosis. A secondary aim was to examine possible clinical changes. Two groups totalling 11 participants were run for seven sessions using the Worry Intervention Trial manual. Qualitative and quantitative data about the experience of being in the group was also collected via questionnaires, as was data on number of sessions attended. Measures were delivered pre- and post-group and at 3-month follow-up. These included a worry scale, a measure of delusional belief and associated distress and quality of life measures. Of the 11 participants who started the group, nine completed the group. Qualitative and quantitative feedback indicated that most of the participants found it acceptable and helpful, and that discussing these issues in a group setting was not only tolerable but often beneficial. Reliable Change Index indicated that 6/7 of the group members showed reliable reductions in their levels of worry post-group and 5/7 at follow-up. There were positive changes on other measures, which appeared to be more pronounced at follow-up. Delivering a worry intervention in a group format appears to be acceptable and feasible. Further research with a larger sample and control group is indicated to test the clinical effectiveness of this intervention

Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: a retrospective evaluation

Objectives:  to evaluate whether demographic and clinical variables are related to disengagement rates in cognitive behavioural therapy (CBT) for psychosis in a clinical setting.Methods:  the medical records and symptom severity data (from Health of the Nation Outcome Scales) were analysed retrospectively for 103 referrals for CBT for psychosis in a National Health Service secondary care and Early Intervention in Psychosis team.Results:  overall, 42.7% (n = 44) disengaged from CBT. There was no impact of gender or ethnicity, and no impact of clinical variables such as risk history and comorbid diagnosis. However, risk of disengagement was significantly higher for those who were younger, F = 6.89, partial η2 = .064, p = &lt;.05; those with greater total HoNOS scores, F = 4.22, partial η2 = .04, p &lt; .05; more severe symptoms on the HoNOS items of overactive, aggressive, disruptive, or agitated behaviour, χ2 = 6.13, p &lt; .01; problem drinking or drug taking, χ2 = 7.65, p &lt; .05; depressed mood, χ2 = 7.0, p &lt; .01; and problems with occupation and activities: χ2 = 3.68, p &lt; .05. There was a non‐significant trend for shorter waiting times to be associated with greater levels of disengagement.Conclusions:  these results indicate that it may not be psychosis per se that disrupts engagement in CBT, but linked behavioural and emotional factors. A more assertive approach to these factors – overactive, aggressive, disruptive, or agitated behaviour, problem drinking or drug taking, depressed mood, and problems with occupation and activities, particularly in younger people – may be valuable prior to or early on in therapy as a means of increasing engagement in CBT for psychosis.</p