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Pilot study of a group worry intervention for recent onset psychosis

Published online by Cambridge University Press:  05 April 2021

Teal Mackintosh Open the ORCID record for Teal Mackintosh [Opens in a new window] ,
Melanie Lean  and
Kate Hardy
Teal Mackintosh*
Affiliation:
Pacific Anxiety Group, 845 El Camino Real, Menlo Park, CA94025, USA
Melanie Lean
Affiliation:
Stanford University Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA94305, USA
Kate Hardy
Affiliation:
Stanford University Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA94305, USA
*
*Corresponding author. Email: tmackintosh@paloaltou.edu
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Abstract

Worry is common among individuals with psychosis and has been found to be a causal factor in the development of paranoia. Previous research has shown that a cognitive behavioural therapy protocol targeting worry helps to reduce persecutory delusions and associated distress in a population experiencing longstanding psychotic symptoms. However, there has yet to be a published adaptation of the protocol for individuals experiencing a recent onset of psychosis. The current study aims to examine the feasibility of adapting the worry intervention for recent onset psychosis in a group setting. Six young adults with a recent onset of psychosis, aged 18–32 years, participated in a pilot study of an 8-week group intervention covering cognitive behavioural strategies for managing worry, including worry periods, worry postponement techniques, mindfulness and relaxation, and problem solving. Pre- and post-intervention data were collected on worry, anxiety, depressive symptoms, psychotic symptoms, and perceived recovery from psychosis. In addition, qualitative feedback from group members was gathered during a post-intervention focus group. Feasibility of the group appeared promising, despite high participant attrition. All components of the intervention were successfully implemented, and group members provided positive feedback regarding acceptability of the group. Contrary to prediction, there was not a consistent decrease in worry from pre- to post-intervention. Findings from secondary symptom measures were mixed and may have been related to participants’ subjective experience of the group. Specifically, participants who experienced high levels of group cohesion seemed to benefit more from the intervention.

Key learning aims

  1. (1) To gain awareness of the gaps in treatment for early psychosis.

  2. (2) To understand the role of worry in psychosis.

  3. (3) To learn about the feasibility of implementing a group worry intervention for recent onset psychosis.

  4. (4) To consider the impact of group cohesion and symptom severity on treatment engagement.

Keywords

CBTearly interventionfirst episode psychosisgroup psychotherapypsychosisworry
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e14
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

Courtney, H., White, L., Richardson, T., Dasyam, B., Tedbury, J., & Butt, J. (2019). Impact of a brief worry-based cognitive therapy group in psychosis: a study of feasibility and acceptability. The Cognitive Behaviour Therapist, 12, E29.CrossRefGoogle Scholar
Freeman, D., Dunn, G., Startup, H., Pugh, K., Cordwell, J., Mander, H., Černis, E., Wingham, G., Shirvell, K., & Kingdon, D. (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The Lancet Psychiatry, 2, 305–313.CrossRefGoogle ScholarPubMed
Isham, L., Grafahrend, H., Nickless, A., Pugh, K., Pleasants, S., Smedley, N., Freeman, D., & Mulligan, A. (2018). Group-based worry intervention for persecutory delusions: an initial feasibility study. Behavioural and Cognitive Psychotherapy, 46, 619–625.CrossRefGoogle Scholar
Startup, H., Pugh, K., Dunn, G., Cordwell, J., Mander, H., Černis, E., Wingham, G., Shirvell, K., Kingdon, D., & Freeman, D. (2016). Worry processes in patients with persecutory delusions. British Journal of Clinical Psychology, 55, 387–400.CrossRefGoogle ScholarPubMed

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