Emily Gray - A thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: young people
psychosis
thematic analysis
meta-analysis
clinical Psychology
carers
substance use
CBT for psychosis
digital interventions
case series

Critical Review of the Literature: How effective are family therapies for the treatment of substance abuse in young people? A systematic review and meta-analysis:
Family therapies have been proposed as efficacious at reducing substance abuse in young people. There are no NICE guidelines for psychological interventions in this population. Previous reviews have generally focused on substance abuse as the only outcome for this research rather than looking at other outcomes. This review consists of meta-analyses and a systematic review of the literature for family therapies for substance abuse in young people. Outcome measures used include, in addition to use of substances, internalising behaviours, externalising behaviours and measures of family functioning. The quality of the literature is assessed and a narrative overview of the state of the literature provided. The review concludes that there is evidence that family therapies outperform other treatments at reducing use of substance, but do not appear to perform significantly better at improving internalising behaviours, externalising behaviours or family functioning. Recommendations for future research and policy are made.
Service Improvement Project: Understanding dropout from CBT for first episode psychosis:
Psychosis is a mental health problem that has a lifetime prevalence of 0.7%. Cognitive behavioural therapy for psychosis (CBTp) is one of the NICE recommended psychological therapies for first episode psychosis. It should be offered to clients as part of the NHS Access and Waiting Time standards. NICE guidelines recommend at least 16 sessions of CBTp for maximum benefit. This study aimed to understand the reasons for dropout from CBTp in two early intervention for psychosis services and to make service recommendations for reducing dropout.
Two studies were conducted. The first investigated whether demographic and clinical variables from routinely collected service data predicted dropout from CBTp. The second used thematic analysis of semi-structured interviews with therapists and clients to obtain their views of why dropout occurs. The quantitive analysis indicated that gender significantly predicted dropout, with males being twice as likely as females to drop out of therapy. No other variable was predictive. A number of themes of why people dropout from treatment were extracted by the thematic analysis, broadly grouped under therapy and personal factors.
In conclusion, dropout appears to be influenced by different factors, including client gender, timing of therapy, and understanding of therapy. Recommendations include increasing flexibility of treatment delivery, increasing client’s understanding of CBTp prior to the beginning of treatment, and improving how routine feedback is sought from those who have dropped out of CBTp.
Main Research Project: Modifying appraisals of control in relatives of people with a first episode of psychosis: development and piloting of a digital intervention:
Appraisals of psychosis in carers of people with first episode psychosis have been linked to a number of health outcomes. Appraisals of control, how much a carer can affect the mental health of the person with psychosis, have been associated with positive outcomes, however no study thus far has attempted to demonstrate this link causally.
This study aimed to develop and test an online module to modify appraisals of control in carers of people experiencing a first episode of psychosis. This pilot study focused on the development and initial testing of the module, ahead of potential future studies to investigate causal links between changing appraisals and positive psychological outcomes.
An online module was developed alongside carer representatives. This was piloted on 3 participants and then tested on a sample of 10 participants using a consecutive, phasic case series design, taking daily measures of illness perceptions.
The results showed that the module was broadly acceptable to participants, but that it is likely to be more useful to individuals earlier in their experience of caring for someone with psychosis. The module did not lead to a significant shift in any measure of illness perceptions. Further testing is needed on this module in order to understand how it impacts illness appraisals. Testing in a larger sample, closer to the onset of psychosis is likely to be a useful next step.