Delivery of cognitive-behaviour therapy for psychosis: a service user preference trial

Abstract

Background: Clinical guidelines recommend cognitive behaviour therapy (CBT) for people with psychosis, however, implementation is poor and not everyone wishes to engage with therapy. Understanding service user (SU) preferences for receiving such treatments is a priority for services.

Aims: To explore SU preferences and outcomes of different methods of delivering CBT for psychosis.

Method: SUs experiencing psychosis could choose between treatment as usual (TAU); TAU plus telephone-delivered CBT with self-help, CBT recovery manual (TS); high support CBT (HS – TAU plus TS plus group sessions) or randomisation. Participants received their option of choice and were followed-up on several outcomes over 9 and 15 months.

Results: Of 89 people recruited, three chose to be randomised and 86 expressed a treatment preference (32 chose TAU, 34 chose TS, 23 chose HS). There were few differences between those who chose therapy compared to those who chose TAU. Those who had more positive impacts from their symptoms were significantly more likely to choose TAU.

Conclusions: Most people had strong preferences about treatment delivery and a substantial number did not wish to receive additional therapy. These findings have to be considered when planning and allocating resources for people with psychosis.

Keywords:

• Schizophrenia
• CBT
• treatment preference
• psychosis
• preference trial

Acknowledgements

Authors acknowledge the support of Service User Consultants, (named alphabetically) and individual members of the Service User Reference Group, Yvonne Awenat, Rory Byrne, Ellen Hodson, Sam Omar, Liz Pitt, Jason Price, Tim Rawcliffe and Yvonne Thomas, for their work on this study. We also acknowledge the Mental Health Research Network, the NHS trusts where the study took place (Manchester Mental Health and Social Care Trust, Greater Manchester West NHS Trust, Five Boroughs NHS Trust) and the significant contribution made in the early stages of the project by Martina Kilbride. Ethical approval for the study was provided by NRES Committee North West – Greater Manchester North, reference 09/H1011/81. Trial Identifier: ISRCTN50487713.

Declaration of interest

The authors wish to recognise that the terms and language used in this article such as service user/client/psychosis are not universally endorsed by all. Where differences of opinion arose in preparation of this work, the authors decided to use the term that was agreed by the majority, while also respecting the views of others.

We also wish to acknowledge the role of the National Institute for Health Research (NIHR) for funding this study. This report/article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1086). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.