Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): A single-blind, randomised controlled trial
Open accessAbstract
BACKGROUND: Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early intervention services would lead to improvements in social recovery. METHODS: We did this single-blind, phase 2, randomised controlled trial (SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16-35 years, had non-affective psychosis, had been clients of early intervention services for 12-30 months, and had persistent and severe social disability, defined as engagement in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone. Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. FINDINGS: Between Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8·1 h (95% CI 2·5-13·6; p=0·0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. INTERPRETATION: Our findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who have comorbid difficulties preventing them from doing so. FUNDING: National Institute for Health Research.
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In two studies, cut-off scores for social disability (≤30 hours per week in structured activities) and isolation (< 1 hour per day in recreational or social activities) were applied to determine participants' eligibility for the intervention, although neither reported how the cut-off scores were determined.
“In two studies, cut-off scores for social disability (≤30 hours per week in structured activities) (53) and isolation (< 1 hour per day in recreational or social activities) (56) were applied to determine participants’ eligibility for the intervention, although neither reported how the cut-off scores were determined.”
From Contributions of a time use perspective in community mental health practice: a scoping review (2024) · cites this paper as [53]
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Experimental — accuracy not yet measuredFowler et al. found that the SRT was effective in improving engagement in structured and economic activities.
“Fowler et al. (53, 54) found that the SRT was effective in improving engagement in structured and economic activities.”
From Contributions of a time use perspective in community mental health practice: a scoping review (2024) · cites this paper as [53]
The Results report that social recovery therapy plus early intervention services increased structured activity by 8.1 hours per week at 9 months compared with early intervention services alone. The Results provide only conditional, model-based evidence of a difference in constructive economic activity at 15 months; the completer analysis found no systematic difference. Thus the claim overstates the evidence for improved economic activity. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe TUS has been used to measure time spent in structured activities (excluding resting and sleep) as an indicator of overall functioning.
“To date, the TUS has been variously used to measure time spent in structured activities (excluding resting and sleep) as an indicator of overall functioning (50, 52, 53); economic and structured activity participation (55); social participation (e.g. places visited and people with whom activities were completed) (56); and time use as an indicator of social recovery (54).”
From Contributions of a time use perspective in community mental health practice: a scoping review (2024) · cites this paper as [53]
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- Authors
- Fowler, D., Hodgekins, J., French, P., Marshall, M., Freemantle, N., McCrone, P., Everard, L., Lavis, A., Jones, P. B., Amos, T., Singh, S., Sharma, V., & Birchwood, M.
- Affiliations
- University of Sussex (GB)
- University of Liverpool (GB)
- Lancashire Care NHS Foundation Trust (GB)
- University College London (GB)
- King's College London (GB)
- Birmingham and Solihull Mental Health NHS Foundation Trust (GB)
- University of Birmingham (GB)
- University of Cambridge (GB)
- University of Bristol (GB)
- University of Warwick (GB)
- University of Chester (GB)
- Corresponding author
- Fowler, David
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 5
- Issue
- 1
- Pages
- 41-50
- ISSN
- 2215-0366 (ISSN-L)
- PMC
- PMC5818038
- OpenAlex
- W2771218756
- Cited by
- 95
- References
- 41
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 12 · 2023: 8 · 2022: 10 · 2021: 17 · 2020: 8 · 2019: 20 · 2018: 8 · 2017: 3
- FWCI
- 8.76
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- ChesterRep (University of Chester) (submittedVersion, cc-by-nc-nd)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- National Institute for Health and Care Research (RP-PG-0109-10074, 10/104/501)
- Programme Grants for Applied Research
- Collaboration for Leadership in Applied Health Research and Care - Greater Manchester
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Keywords
- early intervention services, first-episode psychosis, social recovery, social functioning, structured activities, social dysfunction, non-affective psychosis, young adults, functional recovery, time use survey, community mental health services, peer support
- MeSH terms
- Psychiatric Rehabilitation, Adolescent, Adult, Female, Humans, Interpersonal Relations, Male, Mental Health Services, Psychotic Disorders, Single-Blind Method, Treatment Outcome, Early Medical Intervention, Social Skills
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