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Cited by 33Psychiatric care and mental health servicesSchizophrenia research and treatmentPsychotherapy Techniques and Applications

Psychologists’, perspectives on the implementation of psychological therapy for psychosis in the acute psychiatric inpatient setting.

Open access
Wood, Lisa, Williams, Claire, Billings, Jo, Johnson, Sonia·2019·Qualitative Health Research
DOI 10.1177/1049732319843499
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Abstract

Psychological therapies should be delivered in psychiatric inpatient settings to people experiencing psychosis. However, inpatient populations present with complex needs and usually are admitted only briefly. This makes the delivery of psychological therapies for people experiencing psychosis particularly challenging. Our aim was to explore the adaptations required to deliver psychological therapies to this population from the perspective of inpatient psychological practitioners. Twelve participants were recruited, and a qualitative semistructured interview schedule was administered examining their perspectives on important factors required to deliver psychological interventions in this context. Data were analyzed using thematic analysis. Three superordinate themes were identified: "crisis-focused psychological approaches," "working with and supporting the wider system," and "environmental adaptations." Traditional psychological therapies are a challenge to deliver in inpatient environments due to complex needs, essentiality of team working, and brief admission. Several adaptations are required to ensure psychological therapy is effective in this setting.

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  • Prioritizing change mechanisms in therapy might positively impact disease progression and prognosis of patients with acute psychosis.

    “Given the urgent need for effective inpatient care (14, 15), prioritizing change mechanisms in therapy therefore might hold a great potential to positively impact disease progression and prognosis of patients with acute psychosis (16).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [16]

    The Introduction reports that psychological therapies can reduce symptoms in inpatients experiencing psychosis. In “Delivering psychology in a restrictive environment,” psychologists describe prioritizing crisis-focused change mechanisms to manage the current crisis and facilitate discharge. The paper does not establish that prioritizing those mechanisms improves disease progression or prognosis. (LLM, conf=0.84)

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  • In our epidemiological assessment, we specified two main mental health problems for acute inpatients with psychosis: severe positive symptoms and resulting dangerous behaviors making immediate compulsory hospitalization necessary.

    “In the course of our epidemiological assessment, we specified two main mental health problems for acute inpatients with psychosis (16, 25): (1) severe positive symptoms such as hallucinations and delusions and (2) resulting dangerous behaviors toward themselves and others making immediate (compulsory) hospitalization necessary.”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [16]

    The Introduction (page unavailable) describes acute psychiatric inpatients experiencing psychosis in a setting with rising compulsory detention. “Working with complexity and high risk” (page unavailable) says acute mental health experiences are often intertwined with risk issues. The paper does not identify severe positive symptoms and resulting danger to self or others as two main problems, or say that this sequence makes immediate compulsory hospitalization necessary. (LLM, conf=0.85)

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  • Patients with acute psychiatric conditions name social circumstances and intra- and interpersonal symptom distress (e.g., unwanted internal states, sleep difficulties, lost sense of identity, social isolation, and stigma) as their main concerns, whereas care taker priorities often focus on symptom and risk management.

    “While care taker priorities often focus on symptom and risk management, patients themselves name social circumstances and intra- and interpersonal symptom distress (e.g., unwanted internal states, sleep difficulties, lost sense of identity, social isolation, and stigma) as their main concerns (16, 25, 28, 120).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [16]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Available concepts are often lengthy and complex, and it is doubtful if they can work efficiently in acute settings.

    “Available concepts are often lengthy and quite complex in content and it has to be doubted if they can actually work efficiently in acute settings (6, 16, 28).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [16]

    The Introduction (page unavailable) says recommended therapy involves 16–24 weekly sessions, which are not achievable during brief inpatient admissions, and that a brief intervention for the three-week treatment window had not been developed. This supports the concern about length and fit in acute settings, but the paper does not describe the interventions’ content as complex or establish that they cannot work efficiently when adapted. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • MEBASp operates through a non-confrontational and symptom-neutral "backdoor" approach that could be beneficial to address a transdiagnostic spectrum of patients and diverse needs, foster rapid alliance building, motivate resistant patients, lower drop-out rates, and enhance recovery rather than illness elimination.

    “As suggested by Moritz and Woodward (21), MEBASp operates through a non-confrontational and symptom-neutral “backdoor” approach (p. 623) that could be beneficial to address a transdiagnostic spectrum of patients and diverse needs, foster rapid alliance building, motivate resistant patients, lower drop-out rates, and enhance recovery rather than illness elimination (6, 16, 19, 145).”

    From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [16]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

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Research works printed but not linked: 1

  1. Department of Health. (2017). Mental Health Act: Independent Review. London: Department of Health.

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Authors
Wood, L., Williams, C., Billings, J., & Johnson, S.
Affiliations
  • University of Essex (GB)
  • North East London NHS Foundation Trust (GB)
  • University College London (GB)
Corresponding author
Wood, Lisa
ORCID
Venue
Qualitative Health Research
Publisher
SAGE Publications
Published
2019-04-23
Volume
29
Issue
14
Pages
2048-2056
ISSN
  • 1049-7323 (ISSN-L)
  • 1552-7557
DOI
10.1177/1049732319843499
OpenAlex
W2941935845
Cited by
33
References
16
Citations by year
2026: 3 · 2025: 3 · 2024: 7 · 2023: 4 · 2022: 6 · 2021: 8 · 2020: 1
FWCI
4.38
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Qualitative Health Research (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
psychotherapy, psychosis, acute psychiatric inpatient care, teamwork, environmental adaptation, service delivery adaptation, mental health services
MeSH terms
Adult, Attitude of Health Personnel, Female, Humans, Interviews as Topic, Male, Psychiatric Department, Hospital, Psychology, Clinical, Psychotherapy, Psychotic Disorders, Cognitive Behavioral Therapy

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