Improving psychosis

Psychological interventions for psychosis

It is essential that we develop more effective psychological interventions for psychosis, and that the field increases its efforts to measure and report serious and common potential adverse effects. We also need to fully understand the safety and effectiveness of existing approaches, using the most rigorous methodology. A key goal of the Psychosis, Autonomy & Recovery Research Unit is to contribute to these efforts, thus increasing the range of psychological interventions available, and increasing knowledge about effectiveness and safety.

To this end, we have led or supported a number of clinical trials and meta-analyses of interventions for psychosis, a number of which are ongoing. These projects are outlined below:

Whittington, Morrison, Taylor, Wood, Sellars, Kuipers, Kendall, Hutton & Hutton (ongoing)

This is a systematic review and meta-analysis of the safety and effectiveness of cognitive behavioural therapy (CBT) for psychosis.
Searches and extractions are largely complete, and we are now in the analysis and writing stage.
The protocol for this review is available here and here.

Hutton & Taylor (2014)

We did a systematic review and meta-analysis to examine whether CBT was effective and safe at preventing the onset of psychosis in people at high risk of developing this condition.
The synthesis of data from randomised controlled trials (RCTs) suggested CBT reduced the risk of developing psychosis by over 50% and there was no evidence of adverse effects, although this was poorly reported.
The paper is available here.

Morrison, Turkington, Pyle, Spencer, Brabban, Dunn, Christodoulides, Dudley, Chapman, Callcott, Grace, Lumley, Drage, Tully, Irving, Cummings, Byrne, Davies, Hutton (2014)

This is the first RCT of CBT for people with psychosis not taking antipsychotic medication, and was funded by the NIHR Research for Patient Benefit (RfPB) scheme.
The results suggested CBT was acceptable, safe and effective at reducing psychotic symptoms for this group.
The paper is available here.

Morrison, Hutton, Wardle, Spencer, Barratt, Brabban, Callcott, Christodoulides, Dudley, French, Lumley, Tai, & Turkington (2012)

This is the first uncontrolled trial of CBT for people with psychosis not taking antipsychotic medication.
The results suggested CBT was acceptable and safe and and associated with significant improvements in psychotic symptoms.
The paper is available here.

Hutton, Morrison, Pyle & Wells (2014)

This study investigated the use of Metacognitive Therapy (MCT) for people with treatment-resistant psychosis.
This case series suggested MCT was associated with improvements in a number of domains, however modifications may be required for this group.
The paper is available here.

Taylor, Perry, Hutton, Tan, Fisher, Focone, Griffiths & Seddon (under review)

This study investigated the use of Cognitive Analytic Therapy (CAT) for people with psychosis.
This case series suggested CAT was associated with improvements in a number of domains, however modifications may be required for this group.

Morrison, Burke, Murphy, Pyle, Bowe, Varese, Dunn, Chapman, Hutton, Welford, & Wood (2016)

This pilot RCT investigated the use of CBT to reduce self-stigma in psychosis.
The results suggested CBT showed promise for reducing internalised shame and hopelessness and improving self-rated recovery.
The paper is available here.

Bordon, O'Rourke & Hutton (2017)

This systematic review and meta-analysis of RCTs demonstrated that a simple intervention can markedly improve the ability of people with psychosis to recognise emotional expressions in others, and that this is associated with improvements in social functioning, but not psychotic symptoms.
The paper is available here.

Pyle, Norrie, Schwannauer, Kingdon, Gumley, Turkington, Byrne, Syrett, MacLennan, Dudley, McLeod, Griffiths, Bowe, Barnes, French, Hutton, Davies, & Morrison (2016)

This is a large 5-year RCT of CBT for people with clozapine-resistant psychotic symptoms, funded by the NIHR Health Technology Appraisal (HTA) scheme.
The results of this definitive trial have been submitted for publication.
The Psychosis, Autonomy and Recovery Research Unit was involved in the supervision of the therapists.
The Unit also led the design of the adverse effects measurement protocol, and will be analysing the data for a separate publication.
The paper detailing the protocol for the main trial is here.

McGlanaghy, Turner, Morris, Dougall, Davis & Hutton (ongoing)

This is a systematic review and network meta-analysis of psychological interventions for psychosis.
The advantage of a network meta-analysis is the ability to draw inferences about the relative efficacy of interventions that have yet to be directly compared in an RCT.
Searches are complete and data extraction and analysis is underway.
The protocol is available here.

McGlanaghy, Morris, Dougall & Hutton (ongoing)

The aim of this study is to develop a comprehensive, reliable and valid measure of the potential adverse effects of psychological therapy.
Delphi survey methodology is being used to reach a consensus amongst therapy-users and therapy-providers as to the most important adverse effects that require inclusions.
The various rounds of the survey have been completed, and the results are being written up for publication.
The website for the study is available here.

Woodrow, Karatzias, Harper, Fleming & Hutton (ongoing)

This randomised controlled trial will use 'ecological interventionist-causal' methodology to examine whether a therapeutic approach designed to improve emotion regulation will reduce paranoia in people with psychosis. This novel experimental approach to understanding the causes of psychosis will employ 'real-time' experience sampling to examine the effects of the intervention and the relationship between emotion regulation improvements and paranoia.