Early Intervention in the Real World
Pilot programme of modular symptom-specific group cognitive behaviour therapy in a ‘Real World’ early intervention in psychosis service
Corresponding author: Dr David Raune, Harrow and Hillingdon Early Intervention in Psychosis Service, Central and Northwest London Foundation NHS Trust, The Pembroke Centre, 90 Pembroke Road, Ruislip Manor HA4 8NQ, UK. Email: email@example.com
A modular symptom-specific (MSS) programme of early intervention group cognitive behaviour therapy for psychosis might confer additional therapeutic benefits and clinical and financial efficiency, but the approach is empirically untested. Therefore, we devised a novel MSS programme to test – in a culturally diverse ‘Real World’ early intervention service – its relevancy, feasibility, acceptability and safety.
The MSS programme comprised six different groups across 33 sessions: Psycho-Education (3), Mood-Management (5), Delusions (8), Auditory Hallucinations (8), Past Auditory Hallucinations (3) and Negative Symptoms (6). All patients were eligible for psycho-education, but other groups required a specific symptom.
Patients (n = 166, 37% White) showed wide heterogeneity in the activity, type and number of symptoms, and group-relevant symptoms were common. Eighteen groups have run so far, each type of group at least once, 58/166 (35%) of patients attended across 281/412 (68%) group sessions, 46/58 (79%) of patients re-attended, and the 58 patients attended groups a mean of 4.8 times. Patients were significantly (P < 0.05) more likely to attend the programme if they had a schizophrenia diagnosis, a longer psychotic illness length or one active group-relevant (psychotic/mood) symptom. Diagnostically uncertain psychosis patients were almost significantly (P = 0.05) less likely to attend the programme. duration of untreated psychosis and ethnicity were unrelated to attendance/re-attendance. No group-related risk incidents occurred.
A MSS programme approach is highly relevant to early intervention symptom heterogeneity and is feasible, culturally acceptable and safe; it also appears particularly efficient. Future research should now test its clinical efficacy.