Psychological interventions for psychosis; a meta-analysis of social skills training followed by a randomised controlled experimental study assessing the impact of meta-cognitive training addressing the jumping-to-conclusions bias on capacity
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Date
03/07/2017Item status
Restricted AccessEmbargo end date
31/12/2100Author
Turner, David T.
Metadata
Abstract
Background
There now exist a range of efficacious options for the treatment of psychosis in
mental healthcare. The importance of recovery, empowerment, dignity and
choice among patients with severe mental health diagnoses are important
topics in contemporary research and practice. This thesis presents a meta-analytic
review followed by a randomised controlled experimental study. These
address distinct but related questions which aim to further our understanding
of the choices available for intervention in psychosis and whether intervention
may improve the ability of psychosis patients to make those choices.
Aims
The first objective aimed to offer a comprehensive review of the effectiveness of
social skills training (SST), which is a psychological intervention for psychosis.
SST has fallen out of favour in the UK and is not widely implemented in practice.
We hypothesised that SST would demonstrate superiority for the negative
symptoms of psychosis. The second objective was to determine whether
decision-making capacity regarding treatment among psychosis patients could
be improved by the application of a brief psycho-educational intervention
targeting the jumping-to-conclusions (JTC) bias, which is a commonly observed
cognitive bias in psychosis. We hypothesised that the intervention would
improve decision-making capacity.
Methods
Firstly, a series of 70 meta-analyses are presented in a systematic review
assessing the efficacy of social skills training across a number of psychosis
outcome domains: positive symptoms, negative symptoms, general symptoms,
overall symptoms and social functioning outcomes. Secondly, a randomised
controlled experimental study is presented in which 36 psychosis patients in
NHS Lanarkshire and 1 in NHS Dumfries & Galloway were allocated to receive
either a brief meta-cognitive training (MCT) intervention or an non-specific
control presentation lecture. Capacity was assessed at baseline and post-treatment
while the impact of the intervention upon capacity was estimated by
ANCOVA. Mediation analyses assessed whether changes in the JTC bias
mediated outcome.
Findings
In the meta-analytic review, SST demonstrated superiority over treatment as
usual (TAU. g=0.3), active controls (g=0.2-0.3) and comparators pooled (g=0.2-
0.3) for negative symptoms; and over TAU (g=0.4) and comparators pooled
(g=0.3) for general psychopathology. In the randomised controlled study, MCT
demonstrated large effects on two capacity outcomes; overall capacity (d=0.96,
p<.05) and appreciation (d=0.87, p<.05). Exploratory analyses suggested a
mediating effect of JTC (d=0.64, p<.05).
Interpretation
SST demonstrates a magnitude of effect for negative symptoms similar to those
commonly reported for CBT for positive symptoms and may have potential for
wider implementation in mental healthcare settings. The randomised
controlled study suggests that psycho-educational interventions targeting
capacity have clinical utility and may be developed for implementation.
Limitations included lack of blinding, no fidelity checks and inclusion based on
clinical diagnosis therefore a larger randomised controlled trial addressing
these limitations is warranted.