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Title: Understanding psychological treatment for psychosis from the perspective of those with lived experience : "What's important to us?"
Author: Byrne, Rory
ISNI:       0000 0004 5353 3855
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2014
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This thesis aimed to explore service users’ priorities and preferences for treatment of psychosis-spectrum difficulties, and experiences of Cognitive Behavioural Therapy (CBT). A literature review (Chapter 1) summarised current understanding and treatment of psychosis. A narrative review of qualitative studies examined treatment priorities and preferences of people with experience of psychosis (Chapter 2), and found that common priorities and preferences included improving social and functional ability, reducing symptoms of psychosis, and individualised, collaborative approaches to care, including alternatives to routine psychiatric treatment. A Delphi study of priorities and preferences for treatment of psychosis was conducted (Chapter 3), and identified priorities that included improving difficult emotional and cognitive states, understanding, coping, and self-esteem, along with treatment preferences such as individualised, collaborative care, greater provision of information, and choice of treatment. Three qualitative studies were conducted. The first (Chapter 4) explored the subjective experiences of young people seen in an Early Detection (ED) for psychosis service. Findings indicated that reluctance to communicate mental health concerns delayed help-seeking for the majority of participants. Disclosure of such concerns to staff in the ED service was considered helpful, especially in the context of CBT. The second qualitative study (Chapter 5) explored subjective experiences of CBT for psychosis. CBT-specific processes were summarised as ‘structured learning’, and the most commonly perceived benefits included improved understanding of psychosis and self, and normalisation. The ‘hard work’ of CBT was also highlighted, especially the disclosure and discussion of difficult life experiences and psychological problems. The third qualitative study (Chapter 6) evaluated experiences of involvement in a randomised trial of CBT for young people at risk of developing psychosis. Having a ‘chance to talk’ about mental health concerns was consistently valued by participants in both the control and the treatment arm of the trial. Valued experiences of CBT included ‘rethinking things’, especially through psychological formulation and re-appraisal of distressing beliefs. Participants also described difficult aspects of CBT, such as personal disclosure, though these were often considered necessary for recovery. Across studies, the importance of individualised, collaborative treatment was highlighted consistently. It is also evident that along with reductions in distressing psychological problems, participants across studies also highly valued social and functional aspects of recovery. The methodological limitations and strengths of these studies, along with implications for clinical practice and future research, are discussed.
Supervisor: Morrison, Anthony Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Psychosis ; Treatment priorities ; User-led ; Qualitative ; CBT