Title: Adapting Cognitive Behavioural Therapy for psychosis (CBTp) for an acute psychiatric inpatient setting to reduce readmission
Funder: Health Education England

Abstract: Background: Psychosis has been defined as 'the group of psychotic disorders that includes schizophrenia, schizoaffective disorder, schizophreniform disorder and delusional disorder' (NICE, 2014). Psychosis incorporates experiences such as hearing voices, paranoid beliefs and visual hallucinations (positive symptoms) and blunted affect and social withdrawal (negative symptoms). As a result of such distressing symptoms, patients with psychosis can present a risk to themselves (e.g. through self-harm and suicide) and/or to others (e.g. through violence and aggression), which can result in psychiatric inpatient admission. Cognitive Behavioural Therapy for psychosis (CBTp) is a psychological therapy which should be offered during psychiatric inpatient care (NICE, 2014). Problematically, few research studies have examined the efficacy of CBTp suitably adapted for the psychiatric hospital context, and the current NICE recommendations are largely based on research with community populations. Therefore the suitability of CBTp for acute psychiatric inpatient settings has not been determined. The aim of this clinical lectureship is to adapt the current CBTp approach and develop a CBTp therapy manual suitable for the psychiatric inpatient setting. A feasibility randomised controlled trial (RCT) will then be conducted to examine the feasibility and acceptability of the CBTp intervention. As part of the applicant's current fellowship, a number of preparatory studies have already been conducted to inform the manual development including: a systematic review and meta-analysis of CBTp interventions for acute psychiatric inpatients, and qualitative interviews with patients, psychological practitioners, and the Multi-Disciplinary Team (MDT) to examine the therapeutic needs of psychiatric inpatients with psychosis. Proposed Research:Aim 1. To develop an adapted CBTp intervention for an acute psychiatric inpatient setting to reduce readmission.A CBTp theory stipulates that it is primarily the negative appraisal of an anomalous experience and consequent unhelpful coping behaviours, which are the cause and maintenance of experiences of psychosis (Morrison, 2001). CBTp is a talking therapy delivered by an appropriately trained therapist and aims to target negative appraisals and unhelpful coping behaviours in order to treat psychosis. The proposed study will aim to adapt this approach and develop a CBTp intervention manual suitable for a psychiatric inpatient setting. The intervention will be developed by drawing upon preparatory study data (outlined above), and through regular meetings with a coproduction panel. The intervention will include a patient therapy manual, self-help resources and a therapist training package, and aim to target the causal and maintaining factors which have led to the patients' admission in order to reduce readmission. Aim 2. To conduct a feasibility RCT of the adapted CBTp acute psychiatric inpatient intervention.A small feasibility RCT will be conducted to examine the feasibility and acceptability of the adapted CBTp intervention. Thirty participants with experiences of psychosis and hospital admission will be recruited and randomised to either treatment as usual (TAU; n=15) or CBTp plus TAU (n=15). The feasibility and acceptability of the intervention will be assessed against pre-determined objective measures of feasibility. Qualitative interviews with therapists and patients will be conducted to gather feedback regarding the acceptability of the therapy manual and broader research process.

Lay abstract: Background: Psychosis is a mental health problem where people can have unusual experiences such as hearing voices, feeling very unsafe, and seeing things which are not there. Experiencing psychosis can be very upsetting and make it hard for people to cope with day to day life. When people go to a mental health hospital for help with their experiences of psychosis, they tend to be very upset, and can often be a risk to themselves (due to self-harming or wanting to end their own life) or even to other people. Stays in hospital are very costly for the NHS, and both patients and hospital staff say there should be more treatment options. They would like mental health hospitals to provide talking therapies to patients, so they can find ways of coping with a mental health crisis. Talking therapies can be helpful as they give people the chance to talk openly about their problems, help them make sense of what is going on, and help them find ways of coping. Cognitive Behavioural Therapy for psychosis (CBTp) is a type of talking therapy which works well when offered over long periods (16 - 24 weekly sessions). CBTp is recommended to be offered in mental health hospitals, but no study has been done before to check that it useful in current hospital settings. This study will adapt CBTp so that it can be used during a hospital stay. It will then find out whether patients and staff find it useful and helpful. I recently carried out some research to inform this study. I have looked in detail at research studies on CBTp for patients in mental health hospitals who also have psychosis. I have also spoken to mental health hospital staff and patients to find out what is important when caring for people with psychosis in hospital. I used this research to develop two important aims for this study, which are: Aim 1. To develop a new CBTp approach for the mental health hospital setting. The first aim will be to develop a new CBTp approach and write a therapy guide for the mental health hospital setting. The therapy will aim to help mental health hospital patients with psychosis cope with their mental health crisis. I will have regular discussions with patients and staff to make sure they can help write the guide. The therapy guide will include a part about training for the therapists. Aim 2. To see if the new CBTp approach for mental health hospital is useful and acceptable. A type of research process called a research trial will be used to see if the new CBTp approach is helpful. A research trial compares two groups of patients, one that has been given the new therapy and one that has not. This is to see if the therapy is helpful. Thirty patients will take part in this phase and will be chosen at random to either have the therapy or not. Patients will be asked to complete surveys and will be asked questions about their experience of the therapy. Therapists will also be asked how they found the training and therapy. How will patients and the public be involved? Mental health hospital staff and patients have already given feedback on this study and have helped produce the final Plain English Summary and design the research process. An expert group of mental health hospital staff and patients will be set up for this project to steer how the research will be done

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH