Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial
Open accessAbstract
Background: A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. Aims: To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422). Method: In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship. Results: Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46–11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03–0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01–0.41, P = 0.043, a medium effect). Conclusions: Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.
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In the TEMPO training, long-term effectiveness of the intervention was associated with the inclusion of a dedicated session (4-step approach) on SDM in patients with psychosis aimed at changing the patient decision-making style.
“In the case of the TEMPO training [40], long-term effectiveness of the intervention was associated with the inclusion of a dedicated session (4-step approach) on SDM in patients with psychosis aimed at changing the patient decision-making style.”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [40]
Projects specifically addressed to mental health professionals have shown promising results in improving the quality of therapeutic alliance and patient acceptance of pharmacological treatments.
“Interestingly, projects specifically addressed to mental health professionals have shown promising results in improving the quality of therapeutic alliance and patient acceptance of pharmacological treatments.”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [40]
Patients treated by psychiatrists receiving TEMPO training reported a more positive therapeutic relationship, as did psychiatrists.
“Patients treated by psychiatrists receiving the TEMPO training reported a more positive therapeutic relationship as did psychiatrists”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [40]
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- Authors
- McCabe, R., John, P., Dooley, J., Healey, P., Cushing, A., Kingdon, D., Bremner, S., & Priebe, S.
- Affiliations
- University of London (GB)
- Corresponding author
- McCabe, Rose
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-12
- Volume
- 209
- Issue
- 6
- Pages
- 517-524
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2356179094
- Cited by
- 74
- References
- 30
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 9 · 2023: 8 · 2022: 9 · 2021: 7 · 2020: 10 · 2019: 5 · 2018: 11 · 2017: 9
- FWCI
- 11.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- Queen Mary University of London
- Royal Devon and Exeter NHS Foundation Trust
- National Institute for Health and Care Research (PB-PG-0408-16279)
- University of Exeter
- University of Southampton
- School of Electronic Engineering and Computer Science, Queen Mary University of London
- Barts and The London School of Medicine and Dentistry
- Research for Patient Benefit Programme
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- communication training, therapeutic relationship, psychosis, schizophrenia, schizoaffective disorder, mutual understanding, self-healing, outpatient psychiatry
- MeSH terms
- Adult, Communication, Female, Humans, Male, Middle Aged, Physician-Patient Relations, Psychiatry, Psychotic Disorders, Schizophrenia, Single-Blind Method
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