Staying Well After Psychosis

link to book on Amazon UK
6 February 2016: This is a new page devoted to the study of 'Staying Well After Psychosis: A Cognitive Interpersonal Approach to Recovery and Relapse Prevention' by Andrew Gumley and Matthias Schwannauer, 2006, John Wiley & Sons.

[thanks to Matthias for lending me a copy]



link to University of Glasgow website page

link to Edinburgh University website research page


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Tweeting 17 April 2017:
 






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resuming #StayingWellAfterPsychosis Ch7 Paranoia; maintaining strength & resilience [27 January 2017]

QTime 26Jan17
Getting back to Staying Well After Psychosis book after a bit of a hiatus.  

Question Time on BBC One and talk of Brexit, Trump and Scottish Independence via Angus Robertson MP.











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#StayingWellAfterPsychosis Ch5 "sealing over" [7 June 2016]








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#StayingWellAfterPsychosis secure base, safe haven, roots, wings, striking a balance [28 April 2016]








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#StayingWellAfterPsychosis: it's all about the story [20 April 2016]









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#StayingWellAfterPsychosis tweets 1st April: compassionate mind preference [11 April 2016]







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The Glasgow ESTEEM early intervention service #Psychosis #Recovery [7 April 2016]



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.

Underpinning research

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

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Promoting recovery for people experiencing psychosis: University of Glasgow article, 18 March 2016



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Cognitive Interpersonal Therapy #StayingWellAfterPsychosis: shared formulation, alliance, mutuality [28 March 2016

Studying a few more pages of Chapter 4: Overview of Principles and Procedures, Staying Well After Psychosis, A Cognitive Interpersonal Approach to Recovery and Relapse Prevention by Professors Andrew Gumley and Matthias Schwannauer.  Alongside some knitting, gardening, reading Podvoll's Seduction of Madness and other everyday home stuff.

What stood out for me was the length and focus of cognitive interpersonal therapy, the level of commitment and collaborative approach, the willingness to adapt the therapy to suit the person, and the containment within a safe space or "safe interpersonal context".

I also noticed a tweet by Prof Gumley on 'Review of clinical and educational psychology training arrangements' and had a quick look through.










Then I noticed a tweet by Prof Gumley about the 'Review of clinical and educational psychology training arrangements', retweeted and commented:




link to Review

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Psychological factors in vulnerability #StayingWellAfterPsychosis: Benefits of conversing with a "close other" [17 March 2016]

Studying the book Staying Well After Psychosis by Professors Andrew Gumley and Matthias Schwannauer on bus to and from Glenrothes today.  Chapter 3 and beginning of next one.  

Points which stood out for me: significance of life events, the impact of trauma whether prior to or in a psychosis or because of the psychiatric treatment, confiding therapeutic relationships, "specific personal meanings attached to psychotic experiences", emotional recovery.





















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"After his second episode (psychosis) Alan sought individual psychological therapy to explore his experiences" [15 March 2016]

Reading Chapter 3 of Staying Well After Psychosis in Cupar Library yesterday while waiting for the x42 bus to Dundee:









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Contents pages link


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Dipping in to Staying Well After Psychosis Ch3 on bus to Dundee 7Mar16 [8 March 2016]















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#StayingWellAfterPsychosis: book aim; getting to grips with Attachment Theory [1 March 2016]

From last paragraph of Chapter 1, page 33, Staying Well After Psychosis by Andrew Gumley and Matthias Schwannauer:



"The aim of this book ... to engage individuals who are at risk of relapse, to support the emotional recovery and adjustment after psychosis, to reduce psychological vulnerability to relapse, and to provide prompt and immediate support to individuals with at-risk mental states for relapse."

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Starting Chapter 2 and getting to grips with Attachment Theory which I am not a big fan of, because of the implications that there is a direct causal relationship between psychosis and childhood neglect or abuse.  Which wasn't the case with my family.  However I want to keep an open mind (as much as possible anyway) to this "regulatory theory" and "some of the challenges associated with engagement, help-seeking and recovery following psychosis" p35.

It was my family's experience that the main challenges were to do with psychiatric treatment, the coercion and lack of person-centred care when a psychiatric inpatient, and the lack of support for tapering psychiatric drugs so as to make a full recovery.  Despite this I did make a full recovery after 3 episodes of psychoses and coercive psychiatric drug treatment, in 1978, 1984 and 2002.  And so did other family members.  

p 35 Attachment Theory case scenario

Contents pages, Staying Well After Psychosis



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Staying Well After Psychosis: avoiding the research evidence [18 February 2016]

I had sent an Email to the authors of Staying Well After Psychosis, Professors Gumley and Schwannauer, saying:

"I'm sceptical of research, tend to think there is a lot of bias and agenda, particularly among academics who have a point to prove.  I prefer action research undertaken by independent folk although this is hard to find.  It requires the researchers to be truth seekers, I think, rather than paid pipers.  So I will probably skim your research bits and only stop to look if something catches my eye."

Then it dawned on me that the research in their 2006 book would be out-of-date anyway.  Phew.  That's fine then.  Makes it a lot easier to read, for me.

Starting on Chapter One and this paragraph caught my eye on page 6:



I think this may still be true today, 10 years later: "CBT studies seem to have been concerned with symptomatic improvement ... psychiatric ratings of outcome ... less concerned with emotional recovery, quality of life, social functioning and staying well.". 

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'What's really wrong with cognitive behavioral therapy for psychosis?' Neil Thomas, 27 March 2015, Frontiers in Psychology

"However, what does CBTp actually offer? CBTp mainly provides a framework for adapting existing cognitive and behavioral methods to psychosis, thereby primarily being suited to delivery by practitioners with advanced levels of cognitive-behavioral skill, typically clinical psychologists. Indeed, the competency framework described for CBTp (Roth and Pilling, 2013) indicates a high and exclusive bar for delivery. In practice, the CBTp intervention we have validated as evidence-based practice within RCTs outlines a treatment protocol requiring such high prerequisite skill that it can only be used by a small—and expensive—segment of the mental health workforce."

 Concluding paragraph:



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Staying Well After Psychosis: Contents trajectory; fear of relapse; professional belief system #Podvoll [13 February 2016]

This post takes a brief look at the Contents of 'Staying Well After Psychosis: A Cognitive Interpersonal Approach to Recovery and Relapse Prevention' by Andrew Gumley and Matthias Schwannauer.  To see what stands out and the order of topics.

And the first thing I notice is that it begins and ends with "relapse".  Other main themes are attachment theory, paranoia, trauma, the interpersonal and beliefs.  A section on antipsychotic medication and relapse (I would have written a chapter or more on this, from my own personal and family's experience).

Sections that I would go to first because the strapline sounds useful:

  • Ch7: The paranoid mind is strategically deployed.
  • Ch8: Psychosis as a traumatic event.
  • Ch11: Phenomenology of relapse
  • Ch11: Decatastrophising relapse.

I didn't see much about Recovery in the Contents headings.  In fact the word recovery is hardly ever mentioned, just in Part III, which is interesting.  I think this book would benefit from psychiatric survivor co-authoring, an experiential perspective to back up the theory, from someone who has resisted relapse and lifelong mental illness prognoses.  To put flesh on the bones.

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Here's a screenshot from 'The Seduction of Madness: A revolutionary approach to recovery at home', Dr Edward M Podvoll, 1990, Random Century Ltd, one of the books I'm dipping in to while studying Staying Well:

p37, Parables of Madness, Perceval's Courage





























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some books for referencing when reading 'Staying Well After Psychosis' [11 February 2016]

Here are some books I have collected which I'll use as a reference when studying 'Staying Well After Psychosis' by Professors Andrew Gumley and Matthias Schwannauer:


It's not a comprehensive list as I couldn't afford to buy all the books I might have liked to read.  However I am hoping these will be useful in my attempts to learn more about the clinical psychologists' work with individuals "targeting emotional recovery and relapse prevention".  

back cover Staying Well After Psychosis



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Reading the Preface and Foreword [7 February 2016]:

I started with the Foreword (of 'Staying Well After Psychosis'), having heard Professor Max Birchwood speak at an SMHRN (Scottish Mental Health Research Network) event in Glasgow, Dec13, Perspectives on Psychosis Research, and not being impressed.  So I was prepared not to like what was written, and I didn't.  The language was flowery and full of hyperbole eg "magnificent book"  "renaissance of psychotherapy"  "Thus CBTp won approval" which I found off-putting. 

I then began to read the Preface and liked the style of writing, the content and context, finding it easy to understand and accessible to a "layperson" like me.  Which isn't always the case with academic research articles on psychosis which seem to be full of statistical jargon and distancing from the person.  

[not sure why the book is priced so high on Amazon at £37 for a Kindle edition and £38.99 paperback, it should be far cheaper so that the ordinary person in the street could pick up a copy, learn about the advantages of CBT for psychosis, and then request it in their localities and for their family members]

Here is an excerpt from an Email I wrote to the authors last night, not expecting a response, more of a soliloquy:

"The comments about family therapy which I agree with.  Didn't like Open Dialogue for this reason, also for the "blaming the mother" which came out.  You use the word "individual" repeatedly in the 2nd paragraph and I like this.  For each of us experience psychosis individually and differently, uniquely to our self and personhood, I think.  We are no two of us the same.  I like that you are not going to portray anyone in particular, ... You say psychosis is "a normal human experience" and again I agree.

You mention readers accessing specific chapters according to need.  That's useful.  Mary MacCallum Sullivan's book ... Cradling the Chrysalis, I could dip into at different parts and make sense of it.  I notice you mention a few women attachment theorists in the Preface.  That makes a change!  I've never heard of them so will check them out: Mary Main, Mary Dozier and Christine Barrowclough. 

I can see from this Preface why there is a need to talk of relapse and to prepare for it.  Or to guard against it.  Psychosis: "an adaptive and meaningful response to personal life experiences".  Yes.  And I think it is more healthy in the long run than internalising distress which can lead to depression and physical health issues like cancer, ulcers etc, or that's my take on it.  The problem was psychiatric treatment, in my family's experience.  The coercion and one size fits all regime.  Take the pills or else.  Some of my family remaining in the system on the drugs.  The disabling side effects.  Shortened lives.  Stigma and discrimination.  "Family history of" leading to targeting. ...


"psychosis an integrative and collective term ... a range of human experiences"
Preface p1 family-based interventions, individuals
Preface p2 para 1 "a normal human experience"
Preface p3 para 2 re women attachment theorists
Psychosis: "an adaptive and meaningful response to personal life experiences"
Preface ... and finally ...

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"Represents a giant step forward in the treatment of schizophrenia.  A must for all mental health professionals dealing with this condition."  Aaron T. Beck, University Professor of Psychiatry, University of Pennsylvania, USA 

Contents pages


 










































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[I was in the Monkees fan club, bought their LPs, this song a favourite in 1966, the year my youngest sister was born]