A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials

Abstract

NICE guidelines recommend use of treatment protocols that have trial-based evidence of efficacy to guide the delivery of CBT for psychosis. The rationale for using such an approach, and a manual that has been used to ensure fidelity and adherence within six clinical trials, is described. The protocol emphasises principles and values, such as collaborative teamwork, active participation involving between session tasks for service users and therapists and a normalising philosophy, as well as specific milestones such as early agreement of a shared goal, maintenance formulations and use of defined change strategies. Challenges to implementation and methods for promoting good practice are considered and implications for future research and practice are discussed.

Keywords:

• Cognitive behaviour therapy
• Schizophrenia
• Treatment guidelines
• Treatment outcome research

Acknowledgements

This protocol has evolved over two decades with input from trial supervisors (including Paul French, Samantha Bowe, Paul Hutton), trial therapists (including Julia Renton, Steve Williams, Hazel Dunn, Sophie Parker, Vicky Brooks, Nicola Chapman, Liz Murphy, Lisa Wood, Natasha Holden, Rachel MacLeod, Jane Hutton, Ann Steele, Jasper Palmier-Claus), principal investigators at other sites (including Max Birchwood, Alison Brabban, Rob Dudley, David Fowler, Andrew Gumley, David Kingdon, Matthias Schwannauer, Douglas Turkington), user-researchers (Rory Byrne, Martina Kilbride, Eleanor Longden, Liz Pitt), participants from our trials (via qualitative interviews) and service user consultants (our Service User Reference Group).