Cognitive behaviour therapy for improving social recovery in psychosis: A report from the ISREP MRC trial platform study (Improving Social Recovery in Early Psychosis)
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BACKGROUND: This study reports on a preliminary evaluation of a cognitive behavioural intervention to improve social recovery among young people in the early stages of psychosis showing persistent signs of poor social functioning and unemployment. The study was a single-blind randomized controlled trial (RCT) with two arms, 35 participants receiving cognitive behaviour therapy (CBT) plus treatment as usual (TAU), and 42 participants receiving TAU alone. Participants were assessed at baseline and post-treatment. METHOD: Seventy-seven participants were recruited from secondary mental health teams after presenting with a history of unemployment and poor social outcome. The cognitive behavioural intervention was delivered over a 9-month period with a mean of 12 sessions. The primary outcomes were weekly hours spent in constructive economic and structured activity. A range of secondary and tertiary outcomes were also assessed. RESULTS: Intention-to-treat analysis on the combined affective and non-affective psychosis sample showed no significant impact of treatment on primary or secondary outcomes. However, analysis of interactions by diagnostic subgroup was significant for secondary symptomatic outcomes on the Positive and Negative Syndrome Scale (PANSS) [F(1, 69)=3.99, p=0.05]. Subsequent exploratory analyses within diagnostic subgroups revealed clinically important and significant improvements in weekly hours in constructive and structured activity and PANSS scores among people with non-affective psychosis. CONCLUSIONS: The primary study comparison provided no clear evidence for the benefit of CBT in a combined sample of patients. However, planned analyses with diagnostic subgroups showed important benefits for CBT among people with non-affective psychosis who have social recovery problems. These promising results need to be independently replicated in a larger, multi-centre RCT.
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The 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 [52]
In Fowler et al.'s trial of CBTsr, compared to TAU, CBTsr was associated with improved economic activity (increase of 4.4 hours versus 3.2 hours) and improved structured activity (12.0 hours versus 4.1 hours).
“The pilot study data showed signals suggesting that compared to TAU CBTsr was associated with improved economic activity (increase of 4.4 hours versus 3.2 hours) and improved structured activity (12.0 hours versus 4.1 hours).”
From A parallel group randomised open blinded evaluation of A cceptance and Commitment Therapy for d epression a fter p sychosis: Pilot t rial outcomes (ADAPT) (2017) · cites this paper as Fowler et al. (2009)
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“Social and occupational engagement are emphasized by a number of exisiting interventions, for example Social Recovery Focused Cognitive Therapy (Fowler et al., 2009), Acceptance and Commitment Therapy (Gaudiano et al., 2010) and Person Based Cognitive Therapy (Chadwick, 2006), and may be…”
BackgroundCowman, M., Godfrey, E., Walsh, T., Frawley, E., Fowler, D. G., Álvarez‐Jiménez, M., O’Connor, K., Wykes, T., Birchwood, M. J., & Donohoe, G. J. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad062 · Cited by 14 · see citing works
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Bases Clínicas para un Nuevo Modelo de Atención a las Psicosis
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- Authors
- Fowler, D., Hodgekins, J., Painter, M., Reilly, T., Crane, C., Macmillan, I., Mugford, M., Croudace, T., & Jones, P. B.
- Affiliations
- University of East Anglia (GB)
- University of Cambridge (GB)
- Corresponding author
- Fowler, D.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2009-04-01
- Volume
- 39
- Issue
- 10
- Pages
- 1627-1636
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2121758476
- Cited by
- 125
- References
- 36
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 5 · 2022: 5 · 2021: 5 · 2020: 2 · 2019: 11 · 2018: 6 · 2017: 6 · 2016: 6 · 2015: 10 · 2014: 14 · 2013: 9 · 2012: 15
- FWCI
- 8.25
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, early psychosis, social recovery, social functioning, unemployment, non-affective psychosis, affective psychosis, structured activities, usual care
- MeSH terms
- Adult, Female, Humans, Male, Mental Health Services, Psychiatric Status Rating Scales, Psychotic Disorders, Rehabilitation, Vocational, Social Adjustment, Social Behavior, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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