Title: Low intensity intervention to promote recovery in psychosis: a pilot randomised controlled trial
Funder: Department of Health (England)

Abstract: Background: Promoting recovery is a new emphasis in mental health services. A core part of the recovery approach is facilitating service users to achieve valued personal goals, particularly goals which increase meaningful activity and social inclusion. However, for many with psychosis, the process of re-engaging with life goals is impeded by persisting symptoms, low mood, anxiety and stigma. The focus of recovery work to date has been on attitude change, but we lack effective interventions to promote re-engagement in activity, particularly when the recovery process stalls because of the particular problems faced by people with psychosis. The aim of our new intervention is to help service users and frontline mental health staff to overcome these obstacles to recovery, using a structured approach based on interventions which are readily disseminated. Aims: The aim of this study is to run a pilot RCT of the new intervention in comparison to a treatment as usual control group (TAU), to inform the further development of the intervention and training and provide information for a larger multicentre trial. Plan of Investigation: 65 adult outpatients with psychosis will be recruited from secondary care services (community mental health and early intervention teams) in the South London and Maudsley NHS Trust. Service users will be screened for eligibility by research workers and those who give consent will be randomised to receive either the intervention or TAU. Those allocated to the intervention will see a locally trained therapist 8 times, followed by a single booster session approximately one month post-treatment. Key outcomes, including a primary measure of activity levels, and secondary measures of wellbeing, quality of life, mood, and psychotic symptoms, will be completed blind by an independent research worker at pre- and post-intervention (2 months) and follow-up (4 months) Analysis will comprise a comparison of mean outcomes from the intervention and TAU groups across the three time-points. Costs of providing the intervention and of service use will be calculated. Additionally, a sub-sample of participants from each condition will be interviewed about their experiences of taking part in the study. This will be analysed qualitatively using thematic analysis. Summary of Potential Benefits: The intervention is designed to be recovery-focused. Service users allocated to the intervention group will be supported to work towards a personalised recovery-related goal, teaching skills which can be generalised to the completion of other desired goals. Behavioural Activation and Graded Exposure techniques have known efficacy in improving functioning and reducing symptoms of depression and anxious avoidance respectively. The intervention should therefore also improve mood and wellbeing for service users. This work is also designed to develop a cost-effective way of improving access to psychological therapy in the NHS, specifically for service users with a diagnosis of psychosis, who at present have limited access. The intervention method is ‘low intensity’ (brief, structured, manualised and delivered by frontline staff with brief training).There is evidence that low intensity methods improve access to psychological therapy in people with anxiety and depression, through allowing greater volume of delivery and more cost-effective practice (Clark et al., 2009), in comparison to higher intensity delivery to all. If successful, further funding will be sought to evaluate the intervention in a larger-scale RCT, which could result in better pathways to psychological therapy across the NHS. Frontline staff recruited for the feasibility case series reported high levels of satisfaction from completing the training and felt that they had learnt new skills, which had benefited their ongoing care. ‘Care co-ordinators’ of participating clients also felt that their work had been made easier following completion of the intervention (e.g. clients were able to travel more easily to meetings).


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