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Evaluation of a positive psychotherapy group intervention for people with psychosis: pilot randomised controlled trial

Published online by Cambridge University Press:  20 February 2015

Beate Schrank ,
Tamsin Brownell ,
Zivile Jakaite ,
Charley Larkin ,
Francesca Pesola ,
Simon Riches ,
Andre Tylee  and
Mike Slade
Beate Schrank*
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Tamsin Brownell
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Zivile Jakaite
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Charley Larkin
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Francesca Pesola
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Simon Riches
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Andre Tylee
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Mike Slade
Affiliation:
Institure of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
*
*Address for correspondence: B. Schrank, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria (Email: [email protected], [email protected])
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Abstract

Aims.

Third-wave psychological interventions have gained relevance in mental health service provision but their application to people with psychosis is in its infancy and interventions targeting wellbeing in psychosis are scarce. This study tested the feasibility and preliminary effectiveness of positive psychotherapy adapted for people with psychosis (WELLFOCUS PPT) to improve wellbeing.

Methods.

WELLFOCUS PPT was tested as an 11-week group intervention in a convenience sample of people with psychosis in a single centre randomised controlled trial (ISRCTN04199273) involving 94 people with psychosis. Patients were individually randomised in blocks to receive either WELLFOCUS PPT in addition to treatment as usual (TAU), or TAU only. Assessments took place before randomisation and after the therapy. The primary outcome was wellbeing (Warwick-Edinburgh Mental Well-Being Scale, WEMWBS). Secondary outcomes included symptoms (Brief Psychiatric Rating Scale), depression (Short Depression-Happiness Scale), self-esteem, empowerment, hope, sense of coherence, savouring beliefs and functioning, as well as two alternative measures of wellbeing (the Positive Psychotherapy Inventory and Quality of Life). Intention-to-treat analysis was performed. This involved calculating crude changes and paired-sample t-tests for all variables, as well as ANCOVA and Complier Average Causal Effect (CACE) Analysis to estimate the main effect of group on all outcomes.

Results.

The intervention and trial procedures proved feasible and well accepted. Crude changes between baseline and follow-up showed a significant improvement in the intervention group for wellbeing according to all three concepts assessed (i.e., WEMWBS, Positive Psychotherapy Inventory and Quality of Life), as well as for symptoms, depression, hope, self-esteem and sense of coherence. No significant changes were observed in the control group. ANCOVA showed no main effect on wellbeing according to the primary outcome scale (WEMWBS) but significant effects on symptoms (p = 0.006, ES = 0.42), depression (p = 0.03, ES = 0.38) and wellbeing according to the Positive Psychotherapy Inventory (p = 0.02, ES = 0.30). Secondary analysis adapting for therapy group further improved the results for symptom reduction (p = 0.004, ES = 0.43) and depression (p = 0.03, ES = 0.41) but did not lead to any more outcomes falling below the p = 0.05 significance level. CACE analysis showed a non-significant positive association between the intervention and WEMWBS scores at follow-up (b = 0.21, z = 0.9, p = 0.4).

Conclusions.

This study provides initial evidence on the feasibility of WELLFOCUS PPT in people with psychosis, positively affecting symptoms and depression. However, more work is needed to optimise its effectiveness. Future research might evaluate positive psychotherapy as a treatment for comorbid depression in psychosis, and consider alternative measurements of wellbeing.

Keywords

Positive psychologypsychosispsychotherapyrandomised controlled trialschizophreniawellbeing
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 3 , June 2016 , pp. 235 - 246
Copyright
Copyright © Cambridge University Press 2015 

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References

Akhtar, M, Boniwell, I (2010). Applying positive psychology to alcohol-misusing adolescents: a group intervention. Groupwork 20, 6–31.Google Scholar
Bellg, AJ, Borrelli, B, Resnick, B, Hecht, J, Minicucci, DS, Ory, M, Ogedegbe, G, Orwig, D, Ernst, D, Czajkowski, S, Treatment Fidelity Workgroup of the NIHBCC (2004). Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychology 23, 443–451.Google Scholar
Blaskovich, J, Tomaka, J (1991). Measures of self-esteem. In Measures of Personality and Social psychological Attitudes. Volume 1: Measures of Psychological Attitudes (ed. Robinson, JP, Shaver, PR and Lawrence, S), pp. 121–123, Wrightsman Academic Pr Inc, St Louis, Missouri, U.S.A. Google Scholar
Bolier, L, Haverman, M, Westerhof, G, Riper, H, Smit, F, Bohlmeijer, E (2013). Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health 13, 119.Google Scholar
Brownell, T, Schrank, B, Jakaite, Z, Larkin, C, Slade, M (2014). Mental health service user experience of positive psychotherapy. Journal of Clinical Psychology 71, 85–92.Google Scholar
Bryant, F (2003). Savoring Beliefs Inventory (SBI): a scale for measuring beliefs about savouring. Journal of Mental Health 12, 175–196.Google Scholar
Buckley, PF, Miller, BJ, Lehrer, DS, Castle, DJ (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin 35, 383–402.Google Scholar
Burns, AM, Erickson, DH, Brenner, CA (2014). Cognitive-behavioral therapy for medication-resistant psychosis: a meta-analytic review. Psychiatric Services Apr 1 [Epub ahead of print] doi: 10.1176/appi.ps.201300213 Google Scholar
Chadwick, P (2014). Mindfulness for psychosis. British Journal of Psychiatry 204, 333–334.Google Scholar
Clarke, A, Friede, T, Putz, R, Ashdown, J, Martin, S, Blake, A, Adi, Y, Parkinson, J, Flynn, P, Platt, S, Stewart-Brown, S (2011). Warwick-Edinburgh Mental Well-being Scale (WEMWBS): validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health 11, 487.Google Scholar
Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I, Petticrew, M, Medical Research Council (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal 337, a1655.Google Scholar
Department of Health (1999). Effective care co-ordination in mental health services. HMSO, Catalogue number 16736. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009221 Google Scholar
Dunn, G (2013). Pragmatic trials of complex psychosocial interventions: methodological challenges. Epidemiology and Psychiatric Sciences 22, 105–109.Google Scholar
Eriksson, M, Lindstrom, B (2006). Antonovsky's sense of coherence scale and the relation with health: a systematic review. Journal of Epidemiology and Community Health 60, 376–381.Google Scholar
Guney, S (2011). The positive psychotherapy inventory (PPTI): reliability and validity study in Turkish population. Social and Behavioral Science 29, 81–86.Google Scholar
Jauhar, S, McKenna, PJ, Radua, J, Fung, E, Salvador, R, Laws, KR (2014). Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry 204, 20–29.Google Scholar
Joseph, S, McCollam, P (1993). A bipolar happiness and depression scale. Journal of Genetic Psychology 154, 127–129.Google Scholar
Joseph, S, Linley, PA, Harwood, J, Lewis, CA, McCollam, P (2004). Rapid assessment of well-being: the Short Depression-Happiness Scale (SDHS). Psychology and Psychotherapy 77, 463–478.Google Scholar
Juni, P, Altman, DG, Egger, M (2001). Systematic reviews in health care: assessing the quality of controlled clinical trials. British Medical Journal 323, 42–46.Google Scholar
Kahl, KG, Winter, L, Schweiger, U (2012). The third wave of cognitive behavioural therapies: what is new and what is effective? Current Opinion in Psychiatry 25, 522–528.Google Scholar
Lancaster, GA, Dodd, S, Williamson, PR (2004). Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice 10, 307–312.Google Scholar
Margrove, KL, SE-SURG, Heydinrych, K, Secker, J (2012). Waiting list-controlled evaluation of a participatory arts course for people experiencing mental health problems. Perspectives in Public Health 133, 28–35.Google Scholar
Meyer, PS, Johnson, DP, Parks, A, Iwanski, C, Penn, DL (2012). Positive living: a pilot study of group positive psychotherapy for people with schizophrenia. Journal of Positive Psychology 7, 239–248.CrossRefGoogle Scholar
Miyamoto, S, Jarskog, LF, Fleischhacker, WW (2014). New therapeutic approaches for treatment-resistant schizophrenia: a look to the future. Journal of Psychiatric Research 58, 1–6.Google Scholar
Neuendorf, KA (2002). The Content Analysis Guidebook. SAGE Publication: Thousand Oaks, CA.Google Scholar
NICE (National Institute of Clinical Excellence) (2009). Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. Quick reference guide. NICE clinical guideline No. 82.Google Scholar
Ouweneel, E, Le Blanc, PM, Schaufeli, WB (2013). Do-it-yourself: an online positive psychology intervention to promote positive emotions, self-efficacy, and engagement at work. Career Development International 18, 173–195.Google Scholar
Overall, JE, Gorham, DR (1988). The brief psychiatric rating scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacology Bulletin 24, 97–99.Google Scholar
Parks-Sheiner, AC (2009). Positive psychotherapy: building a model of empirically supported self-help. Department of Psychology, University of Pennsylvania. Dissertation available from ProQuest. Paper AAI3363580. http://repository.upenn.edu/dissertations/AAI3363580 Google Scholar
Pirkis, J, Burgess, P, Kirk, P, Dodson, S, Coombs, T, Williamson, M (2005). A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health and Quality of Life Outcomes 3, 76.Google Scholar
Priebe, S, Huxley, P, Knight, S, Evans, S (1999). Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry 45, 7–12.Google Scholar
Rashid, T, Seligman, ME (2013). Positive psychotherapy. In Current Psychotherapies (ed. Wedding, D and Corsini, R), pp. 461–498. Cengage: Belmont, CA.Google Scholar
Riches, S, Schrank, B, Rashid, T, Slade, M (2014). WELLFOCUS PPT: modifying positive psychotherapy into a manualised intervention to improve well-being for people with psychosis. Psychotherapy, accepted for publication.Google Scholar
Rogers, ES, Ralph, RO, Salzer, MS (2010). Validating the empowerment scale with a multisite sample of consumers of Mental Health Services. Psychiatric Services 61, 933–936.Google Scholar
Ruggeri, M, Tansella, M (2011). New perspectives in the psychotherapy of psychoses at onset: evidence, effectiveness, flexibility, and fidelity. Epidemiology and Psychiatric Sciences 20, 107–111.Google Scholar
Ruggeri, M, Lasalvia, A, Bonetto, C (2013). A new generation of pragmatic trials of psychosocial interventions is needed. Epidemiology and Psychiatric Sciences 22, 111–117.Google Scholar
Schrank, B, Woppmann, A, Grant Hay, A, Sibitz, I, Zehetmayer, S, Lauber, C (2012). Validation of the Integrative Hope Scale in people with psychosis. Psychiatry Research 198, 395–399.Google Scholar
Schrank, B, Bird, V, Tylee, A, Coggins, T, Rashid, T, Slade, M (2013 a). Conceptualising and measuring the well-being of people with psychosis: systematic review and narrative synthesis. Social Science and Medicine 92, 9–21.Google Scholar
Schrank, B, Riches, S, Bird, V, Murray, J, Tylee, A, Slade, M (2013 b). A conceptual framework for improving well-being in people with a diagnosis of psychosis. Epidemiology and Psychiatric Sciences Aug 20, 1–11 [Epub ahead of print]Google Scholar
Schrank, B, Riches, S, Coggins, T, Rashid, T, Tylee, A, Slade, M (2013 c). WELLFOCUS PPT – modified Positive Psychotherapy to improve well-being in psychosis: study protocol for pilot randomised controlled trial. Trials Jun 3, 15, 203.CrossRefGoogle Scholar
Schrank, B, Riches, S, Coggins, T, Tylee, A, Slade, M (2013 d). From objectivity to subjectivity: conceptualisation and measurement of well-being in mental health. Neuropsychiatry 3, 525–534.Google Scholar
Schrank, B, Brownell, T, Tylee, A, Slade, M (2014). Positive psychology: an approach to supporting recovery in mental illness. East Asian Archives of Psychiatry 24, 95–103.Google Scholar
Seligman, M, Steen, T, Park, N, Peterson, C (2005). Positive psychology progress: empirical validation of interventions. American Psychologist 60, 410–421.Google Scholar
Shepherd, A (2014). Avoiding surrogate measures and incorporating subjective experience into clinical research. Psychotherapy and Psychosomatics 83, 119.Google Scholar
Sin, N, Lyubomirsky, S (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: a practice-friendly meta-analysis. Journal of Clinical Psychology 65, 467–487.Google Scholar
Slade, M, Bird, V, Le Boutillier, C, Williams, J, McCrone, P, Leamy, M (2011). REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams. BMC Psychiatry 11, 185.Google Scholar
Slade, M, Leamy, M, Bacon, F, Janosik, M, Le Boutillier, C, Williams, J, Bird, V (2012) International differences in understanding recovery: systematic review. Epidemiology and Psychiatric Sciences 21, 353–364.Google Scholar
Steel, C, Tarrier, N, Stahl, D, Wykes, T (2012). Cognitive behaviour therapy for psychosis: the impact of therapist training and supervision. Psychotherapy and Psychosomatics 81, 194–195.Google Scholar
Tennant, R, Hiller, L, Fishwick, R, Platt, S, Joseph, S, Weich, S, Parkinson, J, Secker, J, Stewart-Brown, S (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcomes 5, 63.Google Scholar
Thabane, L, Ma, J, Chu, R, Cheng, J, Ismaila, A, Rios, LP, Robson, R, Thabane, M, Giangregorio, L, Goldsmith, CH (2010). A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology 10, 1.Google Scholar
Zipursky, RB, Reilly, TJ, Murray, RM (2013). The myth of schizophrenia as a progressive brain disease. Schizophrenia Bulletin 39, 1363–1372.Google Scholar