A training model for relatives and friends in cognitive behaviour therapy (CBT) informed care for psychosis

Figures & data

Figure 1. Psychosis REACH (Recovery by Enabling Adult Carers at Home): A model for training relatives and friends in CBT-informed care for psychosis.

Table 1. Content of CBT-informed care for psychosis workshops

Topic	Components
Psychoeducation	Recovery, relapse and schizophrenia Knowledge of CBT principles
Key caring principles	Befriending Emotional neutrality Activating self-care
Normalising	The antidote to self-stigma How common are psychotic symptoms? Famous and successful voice hearers. Normalizing explanations
Making sense of psychosis	Questioning styles A-B-C of voice hearing and delusions What maintains psychotic symptoms?
Working with medication	Pros and cons of using medicines Automatic thoughts about medicines Linking medication to behaviors Beliefs about medicines
Coping—good and bad	Distraction and focusing Coping styles that make things worse Mindfulness and acceptance styles
Negative symptoms	What are they? Recognising secondary causes Key approaches Graded mastery and pleasure
Working with voices	Type and content Voice diaries Writing the voices down Setting boundaries for the voice Working with explanations and emotions Testing the voices out
Red Flags	Recognising high risk situations Psychosis first aid What to do next? Who to call?
Relapse Prevention	Relapse signature Recognising early warning signs Action plan Working with the care team

Table 2. HADS and WEMWBS, expressed as continuous variables, at baseline and post-training

	All available data				Data available for both baseline and post-training (Paired Sample t-test)
	N	Baseline (m, sd)	N	Post (m, sd)	N	Baseline (m, sd)	Post m (sd)	Difference (m, sd)	p	Cohen’s d*
HADS depression (0–21, higher scores more depression)	81	6.7 (4.7)	65	5.2 (4.9)	60	6.4 (5.0)	5.1 (5.0)	1.3 (3.4)	p = 0.004	0.4
HADS anxiety (0–21, higher scores more anxiety)	76	8.6 (4.0)	67	6.67 (4.4)	60	8.3 (4.1)	6.6 (4.4)	1.7 (4.4)	p = 0.005	0.4
WEMBWBS (14–70, higher scores better well-being)	77	51 (10.4)	72	54 (10.5)	64	52.4 (9.8)	54.5 (10.2)	−2.1 (10.4)	p = 0.001	0.2

m = mean, sd = standard deviation

* d = mean difference/standard deviation of the difference in scores

Table 3. HADS and WEMWBS, expressed as categorical variables, at baseline and post-training

	All available data				Data available for both baseline and post-training (McNemar-Bowker Test)
	N	Baseline	N	Post	N	Baseline	N	Post	p
HADS depression									p = 0.042
No depression (0–7)	43	53%	46	71%	33	55%	42	70%
Mild (8–10)	22	27%	11	17%	14	23%	10	17%
Moderate (11–14)	9	11%	1	2%	7	12%	1	2%
Severe (15–21)	7	9%	7	11%	6	10%	7	12%
Total N	81		65		60		60
HADS anxiety									p = 0.02
No anxiety (0–7)	24	32%	34	51%	20	33%	31	52%
Mild (8–10)	30	39%	20	30%	22	37%	20	33%
Moderate (11–14)	17	22%	11	16%	15	25%	7	12%
Severe (15–21)	5	7%	2	3%	3	5%	2	3%
Total N	76		67		60	100%	60
WEMBWBS									p = 1
Total	77		72		64	100%	64	100%
Low well-being (= < 43)	18	23%	13	18%	11	17%	10	16%
High well-being (> 43)	59	77%	59	82%	53	83%	54	84%