|Operationalising psychological therapies in early intervention services for psychosis|
Development of early intervention services for psychosis
University of Glasgow
Summary of the impact
"Psychosis affects 3-4% of the UK population and is ranked as the third most disabling condition worldwide by the World Health Organisation. Research at the University of Glasgow has changed treatment and services for patients with psychosis by identifying therapies that improve emotional recovery and prevent psychosis relapse and by contributing to the development of early intervention services for individuals with a first episode of psychosis. This work has supported the inclusion of cognitive behaviour therapy (CBT) for psychosis in national clinical guidelines and the implementation of these guidelines via an expanded UK Department of Health programme. University of Glasgow research has also driven the development and expansion of local early intervention services for psychosis, the success of which has directly informed the current Scottish Government Mental Health Strategy.
Psychosis is a mental health problem characterised by a loss of contact with reality, with symptoms that include hallucinations and delusions. It often first presents in 16-35 year olds. Within 5 years of a first episode of psychosis, 80% of patients will have experienced a relapse. Most of the lifetime disability arising from psychosis is caused by relapse, which leads to more persistent and distressing psychotic experiences. Research at the University of Glasgow led by Professor Gumley (2001 — present) developed and refined therapies to prevent psychosis relapse and promote emotional recovery, and supported the design of service models that are responsive to the needs of service users (people accessing mental healthcare) who are at risk of relapse and poor outcomes.
Psychological therapies research
In 2003, Gumley conducted the first randomised controlled trial of CBT for psychosis relapse. CBT is an evidence-based form of psychotherapy that aims to educate patients about their condition and to provide them with the skills to manage it. Gumley's research showed that CBT leads to a reduction in relapse and hospital admissions (15.3% in CBT compared to 26.4% in the treatment as usual group; n=72 participants in each group), and improvements in day to day functioning.1 Gumley also showed that each subsequent relapse leads to increased emotional distress, especially feelings of shame and stigma about psychosis. However, users who received CBT experienced improved emotional outcomes.2
These studies demonstrated that relapse emerges from how service users' cope with the early signs and symptoms of a forthcoming relapse. By improving service users' abilities to recognise, tolerate and cope with distressing experiences through CBT, service users can develop greater control and choice in their recovery.1,2 The connection between emotional recovery and relapse prevention first identified at the University of Glasgow has led to a fundamental adaptation of CBT for psychosis. This adaptation focuses on the development of skills to improve emotional regulation, and is published in a treatment manual released in 2006 in collaboration with Matthias Schwannauer (University of Edinburgh).3
Between 2006 and 2010, a large UK, multi-site, randomised controlled trial (EDIE-2), with a substantial Glasgow contribution led by Gumley, provided further evidence that CBT can help to prevent relapses of psychosis.4 The trial showed that CBT reduces the severity of psychotic-like experiences, which are recognised risk factors for developing psychosis, and this finding had important implications for the design and development of services for the early detection of psychosis.
Service design research
Gumley's research has been developed in close collaboration with an NHS early intervention service in Glasgow (ESTEEM). Between 2005 and 2008, Gumley evaluated the outcomes of ESTEEM's comprehensive and dedicated early intervention service, which serves 16-35 year olds. The study, funded by the Chief Scientist Office, compared ESTEEM with adult community mental health services based in Edinburgh. Throughout this study, the duration of untreated psychosis was reduced in Glasgow compared with Edinburgh (13 versus 23 weeks), as was the delay before help-seekers were aided by the services (1 versus 3 weeks). Furthermore, the number of days spent as inpatients in Glasgow was fewer than half that seen in Edinburgh (33 versus 72 days) in the 12 months following a first episode of psychosis. This study demonstrated the value of a dedicated early intervention service over a community-level service.8
The University of Glasgow research has also explored the importance of attachment (the emotional tie between individuals that endures over time) and its role in recovery with service users and staff of the ESTEEM service. In 2011, Gumley's team used the `gold standard' measurement of attachment, The Adult Attachment Interview, to assess and understand an individual's capacity to form useful and productive relationships and thus engage with the therapies and supports offered by mental health services.5 The team also demonstrated that avoidance of attachment relationships was associated with specific problems in service users' ability to regulate their emotions and that such avoidance is therefore a core predictor of relapse and poor outcome.5
Key researchers (Glasgow): Professor Andrew Gumley (Honorary Clinical staff, 1998-2001; Senior Lecturer, 2001-2008; Professor of Psychological Therapy, 2008-present).
External collaborators: Matthias Schwannauer (Professor of Clinical Psychology, University of Edinburgh), Tony Morrison (Professor of Clinical Psychology, University of Manchester),
Max Birchwood (Professor of Youth Mental Health, University of Birmingham) ..."
Read complete case study
Promoting recovery for people experiencing psychosis: University of Glasgow article, 18 March 2016
Staying Well After Psychosis blog page