Social recovery therapy for young people with emerging severe mental illness: the Prodigy RCT
Open accessAbstract
BACKGROUND: Young people with social disability and non-psychotic severe and complex mental health problems are an important group. Without intervention, their social problems can persist and have large economic and personal costs. Thus, more effective evidence-based interventions are needed. Social recovery therapy is an individual therapy incorporating cognitive-behavioural techniques to increase structured activity as guided by the participant's goals. OBJECTIVE: This trial aimed to test whether or not social recovery therapy provided as an adjunct to enhanced standard care over 9 months is superior to enhanced standard care alone. Enhanced standard care aimed to provide an optimal combination of existing evidence-based interventions. DESIGN: A pragmatic, single-blind, superiority randomised controlled trial was conducted in three UK centres: Sussex, Manchester and East Anglia. Participants were aged 16-25 years with persistent social disability, defined as < 30 hours per week of structured activity with social impairment for at least 6 months. Additionally, participants had severe and complex mental health problems, defined as at-risk mental states for psychosis or non-psychotic severe and complex mental health problems indicated by a Global Assessment of Functioning score ≤ 50 persisting for ≥ 6 months. Two hundred and seventy participants were randomised 1 : 1 to either enhanced standard care plus social recovery therapy or enhanced standard care alone. The primary outcome was weekly hours spent in structured activity at 15 months post randomisation. Secondary outcomes included subthreshold psychotic, negative and mood symptoms. Outcomes were collected at 9 and 15 months post randomisation, with maintenance assessed at 24 months. RESULTS: The addition of social recovery therapy did not significantly increase weekly hours in structured activity at 15 months (primary outcome treatment effect -4.44, 95% confidence interval -10.19 to 1.31). We found no evidence of significant differences between conditions in secondary outcomes at 15 months: Social Anxiety Interaction Scale treatment effect -0.45, 95% confidence interval -4.84 to 3.95; Beck Depression Inventory-II treatment effect -0.32, 95% confidence interval -4.06 to 3.42; Comprehensive Assessment of At-Risk Mental States symptom severity 0.29, 95% confidence interval -4.35 to 4.94; or distress treatment effect 4.09, 95% confidence interval -3.52 to 11.70. Greater Comprehensive Assessment of At-Risk Mental States for psychosis scores reflect greater symptom severity. We found no evidence of significant differences at 9 or 24 months. Social recovery therapy was not estimated to be cost-effective. The key limitation was that missingness of data was consistently greater in the enhanced standard care-alone arm (9% primary outcome and 15% secondary outcome missingness of data) than in the social recovery therapy plus enhanced standard care arm (4% primary outcome and 9% secondary outcome missingness of data) at 15 months. CONCLUSIONS: We found no evidence for the clinical superiority or cost-effectiveness of social recovery therapy as an adjunct to enhanced standard care. Both arms made large improvements in primary and secondary outcomes. Enhanced standard care included a comprehensive combination of evidence-based pharmacological, psychotherapeutic and psychosocial interventions. Some results favoured enhanced standard care but the majority were not statistically significant. Future work should identify factors associated with the optimal delivery of the combinations of interventions that underpin better outcomes in this often-neglected clinical group. TRIAL REGISTRATION: Current Controlled Trials ISRCTN47998710. FUNDING: Vol. 25, No. 70. See the NIHR Journals Library website for further project information.
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Fowler 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 [54]
The Discussion reports no evidence that SRT was superior to enhanced standard care in improving time spent in structured activity. The Analysis of secondary and other outcomes likewise reports no superiority in constructive economic activity. Although both groups improved over time, the paper does not attribute those gains to SRT. (LLM, conf=0.91)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe TUS has been used to measure time use as an indicator of social recovery.
“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 [54]
Fowler et al. and Inman et al. concluded respectively that the TUS is a relevant and sensitive measure of real-world functioning, and a suitable outcome measure for evaluating individualized occupational therapy interventions.
“Fowler et al. (54) and Inman et al. (55) concluded respectively that the TUS is a relevant and sensitive measure of real-world functioning, and a suitable outcome measure for evaluating individualized occupational therapy interventions.”
From Contributions of a time use perspective in community mental health practice: a scoping review (2024) · cites this paper as [54]
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Hodgekins, J., Coker, S., Freeman, D. H., Ray, K., Bebbington, P., Garety, P. A., Kuipers, E., Dunn, G., & Fowler, D. G. (2012) · Journal of Experimental Psychopathology · doi:10.5127/jep.021211 · Cited by 17 · see citing works
Gee, B., Notley, C. J., Byrne, R. E., Clarke, T., Hodgekins, J., French, P., & Fowler, D. G. (2016) · Early Intervention in Psychiatry · doi:10.1111/eip.12381 · Cited by 13 · see citing works
Social recovery therapy: a treatment manual
Fowler, D. G., Hodgekins, J., Berry, C., Clarke, T., Palmier‐Claus, J. E., Sacadura, C., Graham, A., Lowen, C., Steele, A., Pugh, K., et al. (2019) · Psychosis · doi:10.1080/17522439.2019.1607891 · Cited by 13 · see citing works
Measuring adherence in social recovery therapy with people with first episode psychosis
Lowen, C., Hodgekins, J., Pugh, K., Berry, C., Fitzsimmons, M., French, P., Sacadura, C., Birchwood, M. J., Jackson, C., Baggott, E., et al. (2019) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465819000432 · Cited by 7 · see citing works
Notley, C. J., Green, G., & Marsland, L. (2014) · Sage eBooks · doi:10.4135/9781473920514.n20 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Short S. Review of the UK 2000 Time Use Survey. Newport: Office for National Statistics; 2006.
- Gershuny J. Time-Use Surveys and the Measurement of National Well-Being. Oxford: Centre for Time-use Research, Department of Sociology, University of Oxford; 2011.
Cited by
Sorted by citations
Malik, K., Parikh, R., Sahu, R., Sudhir, P., Fairburn, C. G., Patel, V., & Michelson, D. (2023) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/papt.12433 · Cited by 7 · see citing works
“…“non-specific” effect of research assessments has been observed in other studies, where participants have described the benefits of warm and empathic interactions with researchers, irrespective of the specific intervention(s) that were being trialled (Fowler et al., 2021; Sanchez et al., 2022).”
ResultContributions of a time use perspective in community mental health practice: a scoping review
Fossey, E., Doroud, N., Harvey, C. A., Dun, C., Hitch, D., Farnworth, L., & Krupa, T. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1461705 · Cited by 5 · see citing works
Xie, J., Long, X., Xie, J., Yang, D., Yang, J., & Mao, X. (2024) · International Urology and Nephrology · doi:10.1007/s11255-024-04046-0 · Cited by 3 · see citing works
Imtiaz, S., Zafar, R., Tahir, A., Abdeali, M., Ahmed, F., Mansoor, A., Khan, A., Fawwad, A., Basit, A., Walker, S., et al. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01762-x
“…healthcare resource utilisation Modified Client Service Receipt Inventory capturing medications, clinical appointments, and hospital services [28] Anthropometry Height (cm), weight (kg), blood pressure (mmHg), waist circumference (cm), hip circumference (cm), total body fat%, and visceral…”
Karaağaç, M., Bakay, B., Şimşek, F., Kaya, F. Ç., & Ferahkaya, E. (2026) · International Journal of Social Psychiatry · doi:10.1177/00207640261438844
“In addition to correcting distorted cognitions related to trauma, social rehabilitation programs and interventions are promising in addressing social withdrawal (Fowler et al., 2021).”
Do Psychological Interventions Reduce Paranoia in Adolescents? A Systematic Review
Tierney-Sutton, L., Taylor, C. D. J., Pile, V., Watling, D., Lobo, S., Courten, E., & Kingston, J. L. (2026) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-026-00587-1
- Authors
- Fowler, D., Berry, C., Hodgekins, J., Banerjee, R., Barton, G., Byrne, R., Clarke, T., Fraser, R., Grant, K., Greenwood, K., Notley, C., Parker, S., Shepstone, L., Wilson, J., & French, P.
- Affiliations
- University of Sussex (GB)
- Brighton and Sussex Medical School (GB)
- University of East Anglia (GB)
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- Norfolk and Suffolk NHS Foundation Trust (GB)
- Sussex Partnership NHS Foundation Trust (GB)
- Corresponding author
- Fowler, David
- ORCID
- Venue
- Health Technology Assessment
- Published
- 2021-11
- Volume
- 25
- Issue
- 70
- Pages
- 1-98
- ISSN
- 1366-5278 (ISSN-L)
- 2046-4924
- OpenAlex
- W3215578493
- Cited by
- 7
- References
- 97
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 1 · 2022: 1
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Health Technology Assessment (publishedVersion, cc-by)
- PubMed (publishedVersion)
- e-space (Manchester Metropolitan University) (acceptedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Health Technology Assessment programme (10/104/501)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- youth, social dysfunction, structured activities, clinical high risk for psychosis, psychosis risk, cognitive behavioral therapy, adjunctive therapy, depression, social anxiety, Global Assessment of Functioning, PRODIGY trial
- MeSH terms
- Adolescent, Adult, Mental Disorders, Cost-Benefit Analysis, Humans, Technology Assessment, Biomedical, Single-Blind Method, Treatment Outcome, Young Adult
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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