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Improving treatment decision-making capacity in psychosis

The current focus of our research unit is to test and refine our theoretical model of impaired treatment decision-making capacity in psychosis and, in doing so, develop a range of intervention components that can then be combined into an overall intervention package. Our focus is on examining whether the mechanisms we have proposed are causally linked to impaired capacity, therefore our approach will consist primarily of interventionist-causal trials, preceded by case series to establish feasibility. At the end of this process we will test the safety and effectiveness of the overall intervention package in randomised controlled efficacy and effectiveness trials.

We are in the early stages of this model-testing process, but we have already conducted the first randomised controlled trial of a psychological intervention to improve capacity in psychosis, and the first case series of collaborative assessment and formulation with this group. For details of these projects, see below.

To continue this work, we are working with clinical psychology colleagues in the North West of England, including researchers from the University of Manchester and Greater Manchester NHS Foundation Trusts' Psychosis Research Unit, colleagues from the Mental Welfare Commission, and colleagues from psychiatry, Support in Mind Scotland, and the Centre for Mental Health and Incapacity Law.

Turner, Larkin, MacBeth, Moritz, Livingstone, Campbell & Hutton, (under review)


  • This was the first randomised controlled ‘interventionist-causal trial’ (N=37) of a psychological intervention to improve treatment decision-making capacity in psychosis.

  • This non-blind trial found that people with psychosis who received a 1-session intervention designed to reduce the 'jumping to conclusions' bias demonstrated not only improvements in this bias, but also improved overall capacity and improved appreciation, when compared to those who received an attention control intervention.

  • The relationship between receiving the intervention and having improved capacity appeared to be accounted for by improvements in the jumping to conclusions bias. This suggests the effect of the intervention on capacity was indeed caused by improvements in this cognitive bias.

Murphy, O’Rourke, McRitchie, Allan & Hutton (in prep)


  • We did the first case series of psychological assessment and formulation of impaired treatment decision-making capacity in psychosis. We were able to engage five patients receiving forensic psychiatric inpatient care in this study, and 13 of their clinicians also participated.

  • The results suggest it is feasible to work collaboratively with patients with psychosis to develop a shared understanding of the processes that may lead to their capacity being judged to be impaired. The intervention was acceptable to patients and their clinicians, and was associated with a notable increase in the richness of the explanations offered by patients and clinicians for the patients not having capacity, as judged by blind raters.

As we continue trying to understand and improve treatment decision-making capacity in psychosis, we are also researching the causes of psychotic symptoms, and developing and testing psychological interventions to reduce the suffering associated with these.

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