Heather Law

Recovery in Psychosis: A Delphi Study With Experts by Experience

This study aimed to establish consensus about the meaning of recovery among individuals with experience of psychosis. A Delphi approach was utilized to allow a large sample of service users to be anonymously consulted about their views on recovery. Service users were invited to take part in a 3-stage consultation process. A total of 381 participants gave their views on recovery in the main stage of this study, with 100 of these taking part in the final review stage. The final list of statements about recovery included 94 items, which were rated as essential or important by >80% of respondents. These statements covered items which define recovery, factors which help recovery, factors which hinder recovery, and factors which show that someone is recovering. As far as we are aware, it is the first study to identify areas of consensus in relation to definitions of recovery from a service user perspective, which are typically reported to be an idiosyncratic process. Implications and recommendations for clinical practice and future research are discussed.

Recovery from psychosis: a user informed review of self-report instruments for measuring recovery

Background Mental health services are being encouraged to adopt a recovery approach, creating a requirement for standardised measures of recovery to be developed and embedded within services. Measurement of this unique concept is inherently difficult, but it is feasible and valid provided that service users and clinicians work collaboratively. Aims To evaluate which measures of recovery have clinical utility and are acceptable to service users. Method Instruments included in this review are (1) quantitative self-report measures, (2) published in a peer reviewed English language journal and (3) designed to measure personal recovery. The review team included two service-user researchers to allow evaluation of acceptability to service users. Results Twenty-five measures of recovery were identified; six of these met the inclusion criteria. A summary table of the measures is included to enable readers to make an informed choice of measure for their specific needs, along with an overview of each measure. Conclusions The Recovery Assessment Scale appears to be the most acceptable and valid measure currently available. No “gold-standard” measure of recovery has been developed to date. Further research is required to examine the longitudinal reliability of existing tools, and their utility within clinical services and as outcome measures.

Recovery-focused cognitive–behavioural therapy for recent-onset bipolar disorder: randomised controlled pilot trial

BACKGROUNDnDespite evidence for the effectiveness of structured psychological therapies for bipolar disorder no psychological interventions have been specifically designed to enhance personal recovery for individuals with recent-onset bipolar disorder.nnnAIMSnA pilot study to assess the feasibility and effectiveness of a new intervention, recovery-focused cognitive-behavioural therapy (CBT), designed in collaboration with individuals with recent-onset bipolar disorder intended to improve clinical and personal recovery outcomes.nnnMETHODnA single, blind randomised controlled trial compared treatment as usual (TAU) with recovery-focused CBT plus TAU (n = 67).nnnRESULTSnRecruitment and follow-up rates within 10% of pre-planned targets to 12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of recovery-focused CBT were attended out of a potential maximum of 18 h. Compared with TAU, recovery-focused CBT significantly improved personal recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean score 310.87, 95% CI 75.00-546.74 (s.e. = 120.34), P = 0.010, d = 0.62) and increased time to any mood relapse during up to 15 months follow-up (χ2 = 7.64, P<0.006, estimated hazard ratio (HR) = 0.38, 95% CI 0.18-0.78). Groups did not differ with respect to medication adherence.nnnCONCLUSIONSnRecovery-focused CBT seems promising with respect to feasibility and potential clinical effectiveness. Clinical- and cost-effectiveness now need to be reliably estimated in a definitive trial.

The cognitive behavioural prevention of suicide in psychosis: a clinical trial.

BACKGROUNDnSuicide behaviour in psychosis is a significant clinical and social problem. There is a dearth of evidence for psychological interventions designed to reduce suicide risk in this population.nnnAIMSnTo evaluate a novel, manualised, cognitive behavioural treatment protocol (CBSPp) based upon an empirically validated theoretical model.nnnMETHODSnA randomly controlled trial with independent and masked allocated and assessment of CBSPp with TAU (n=25, 24 sessions) compared to TAU alone (n=24) using standardised assessments. Measures of suicide probability, and suicidal ideation were the primary outcomes and measures of hopelessness, depression, psychotic symptoms, functioning, and self-esteem were the secondary outcomes, assessed at 4 and 6 months follow-up.nnnRESULTSnThe CBSPp group improved differentially to the TAU group on two out of three primary outcome measures of suicidal ideation and suicide probability, and on secondary outcomes of hopelessness related to suicide probability, depression, some psychotic symptoms and self-esteem.nnnCONCLUSIONSnCBSPp is a feasible intervention which has the potential to reduce proxy measures of suicide in psychotic patients.

Psychometric properties of the Questionnaire about the Process of Recovery (QPR)

The latent structure, reliability and validity of the Questionnaire about the Process of Recovery (QPR) (Neil et al., 2009) were examined in a sample of participants with experience of psychosis (N=335). The original two factor model proposed by Neil et al. (2009) was examined using exploratory factor analysis followed by a further independent exploratory factor analysis to test revised solutions. Model fit statistics indicated that the most interpretable solution was a one factor model using 15 items from the original measure. Internal consistency, test re-test reliability and convergent validity of this new 15 item version were found to be high. Recommendations for the utility of the QPR in routine clinical practice along with suggestions for future research are discussed.

Child and adolescent females who present with sexually abusive behaviours: A 10-year UK prevalence study

Abstract Relatively few studies have investigated the prevalence of young females with sexually abusive behaviours, and there is a lack of research comparing females with sexually abusive behaviours to a sample of non-sexually abusive delinquent females. The current pilot study explored the prevalence of sexually abusive behaviours in a sample of delinquent females referred to an outpatient Forensic Adolescent Consultation and Treatment Service (FACTS). A retrospective casenote study was conducted to compare the characteristics, offending behaviours and mental health of those with sexually abusive behaviours to their non-sexually abusive peers. Of the 258 females in the study, 31 (12%) presented with sexually abusive behaviours. Consistent with previous studies, females with sexually abusive behaviours were significantly more likely to have been victims of abuse themselves and to have learning disabilities/difficulties. They were less likely to engage in other antisocial behaviours, including aggression and violence, criminal damage, self-harm and substance misuse.

Psychosocial and neuropsychiatric predictors of subjective recovery from psychosis.

Research suggests that both psychosocial factors and neuropsychiatric factors are important predictors of outcome, but little research has examined their relative importance to self-rated recovery. We aim to investigate how such factors are associated with subjective judgements of recovery from psychosis. The participants comprised 122 individuals with experience of psychosis who completed measures of perceived recovery, as well as measures of psychological factors (including self-esteem, locus of control, and emotion) and psychiatric factors (including psychotic symptoms, neurocognition and insight). Measurement models developed using confirmatory factor analysis supported a hypothesis of separate recovery and negative emotion factors. Structural equation modelling showed that negative emotion and internal locus of control had a direct influence on self-rated recovery, and that positive symptoms and internal locus of control had an indirect effect on recovery, mediated via negative emotion. There did not appear to be any effect of insight, negative symptoms or neurocognitive functioning on either self-rated recovery or negative emotion. Psychosocial factors are more directly related to perceived recovery than neuropsychiatric factors. The implications of these findings are discussed.

How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences.

This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis.

A randomised controlled trial of recovery focused CBT for individuals with early bipolar disorder

BackgroundThere is increasing evidence for the effectiveness of structured psychological therapies for bipolar disorder. To date however there have been no psychological interventions specifically designed for individuals with early bipolar disorder. The primary objective of this trial is to establish the acceptability and feasibility of a new CBT based intervention (Recovery focused CBT; RfCBT) designed in collaboration with individuals with early bipolar disorder intended to improve clinical and personal recovery outcomes.Methods and designThis article describes a single blind randomised controlled trial to assess the feasibility and acceptability of RfCBT compared with treatment as usual. Participants will be recruited from across the North West of England from specialist mental health services and through primary care and self referral. The primary outcome of the study is the feasibility and acceptability of RfCBT as indicated by recruitment to target and retention to follow-up as well as absence of untoward incidents associated with RfCBT. We also intend to estimate the effect size of the impact of the intervention on recovery and mood outcomes and explore potential process measures (self appraisal, stigma, hope and self esteem).DiscussionThis is the first trial of recovery informed CBT for early bipolar disorder and will therefore be of interest to researchers in this area as well as indicating the wider potential for evaluating approaches to the recovery informed treatment of recent onset severe mental illness in general.Trial registration numberISRCTN43062149

Longitudinal predictors of subjective recovery in psychosis

BACKGROUNDnResearch has highlighted the importance of recovery as defined by the service user, and suggests a link to negative emotion, although little is known about the role of negative emotion in predicting subjective recovery.nnnAIMSnTo investigate longitudinal predictors of variability in recovery scores with a focus on the role of negative emotion.nnnMETHODnParticipants (n = 110) with experience of psychosis completed measures of psychiatric symptoms, social functioning, subjective recovery, depression, hopelessness and self-esteem at baseline and 6 months later. Path analysis was used to examine predictive factors for recovery and negative emotion.nnnRESULTSnSubjective recovery scores were predicted by negative emotion, positive self-esteem and hopelessness, and to a lesser extent by symptoms and functioning. Current recovery score was not predicted by past recovery score after accounting for past symptoms, current hopelessness and current positive self-esteem.nnnCONCLUSIONSnPsychosocial factors and negative emotion appear to be the strongest longitudinal predictors of variation in subjective recovery, rather than psychiatric symptoms.