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Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

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Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder : a mixed-methods approach. / Morrison, Anthony; Law, Heather; Barrowclough, Christine; Bentall, Richard; Haddock, Gillian; Jones, Steven Huntley; Kilbride, Martina; Pitt, Elizabeth; Shryane, Nicholas; Tarrier, Nicholas; Welford, Mary ; Dunn, Graham.

In: Programme Grants for Applied Research, Vol. 4, No. 5, 31.05.2016, p. 1-304.

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Harvard

Morrison, A, Law, H, Barrowclough, C, Bentall, R, Haddock, G, Jones, SH, Kilbride, M, Pitt, E, Shryane, N, Tarrier, N, Welford, M & Dunn, G 2016, 'Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach', Programme Grants for Applied Research, vol. 4, no. 5, pp. 1-304. https://doi.org/10.3310/pgfar04050

APA

Morrison, A., Law, H., Barrowclough, C., Bentall, R., Haddock, G., Jones, S. H., Kilbride, M., Pitt, E., Shryane, N., Tarrier, N., Welford, M., & Dunn, G. (2016). Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. Programme Grants for Applied Research, 4(5), 1-304. https://doi.org/10.3310/pgfar04050

Vancouver

Morrison A, Law H, Barrowclough C, Bentall R, Haddock G, Jones SH et al. Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach. Programme Grants for Applied Research. 2016 May 31;4(5):1-304. https://doi.org/10.3310/pgfar04050

Author

Morrison, Anthony ; Law, Heather ; Barrowclough, Christine ; Bentall, Richard ; Haddock, Gillian ; Jones, Steven Huntley ; Kilbride, Martina ; Pitt, Elizabeth ; Shryane, Nicholas ; Tarrier, Nicholas ; Welford, Mary ; Dunn, Graham. / Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder : a mixed-methods approach. In: Programme Grants for Applied Research. 2016 ; Vol. 4, No. 5. pp. 1-304.

Bibtex

@article{5cbea73a99f7409b87e34d97edd5bd83,
title = "Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach",
abstract = "BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total; p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78; p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.",
author = "Anthony Morrison and Heather Law and Christine Barrowclough and Richard Bentall and Gillian Haddock and Jones, {Steven Huntley} and Martina Kilbride and Elizabeth Pitt and Nicholas Shryane and Nicholas Tarrier and Mary Welford and Graham Dunn",
year = "2016",
month = may,
day = "31",
doi = "10.3310/pgfar04050",
language = "English",
volume = "4",
pages = "1--304",
journal = "Programme Grants for Applied Research",
issn = "2050-4322",
publisher = "NIHR Journals Library",
number = "5",

}

RIS

TY - JOUR

T1 - Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder

T2 - a mixed-methods approach

AU - Morrison, Anthony

AU - Law, Heather

AU - Barrowclough, Christine

AU - Bentall, Richard

AU - Haddock, Gillian

AU - Jones, Steven Huntley

AU - Kilbride, Martina

AU - Pitt, Elizabeth

AU - Shryane, Nicholas

AU - Tarrier, Nicholas

AU - Welford, Mary

AU - Dunn, Graham

PY - 2016/5/31

Y1 - 2016/5/31

N2 - BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total; p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78; p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

AB - BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total; p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78; p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

U2 - 10.3310/pgfar04050

DO - 10.3310/pgfar04050

M3 - Journal article

VL - 4

SP - 1

EP - 304

JO - Programme Grants for Applied Research

JF - Programme Grants for Applied Research

SN - 2050-4322

IS - 5

ER -