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May 2017 - Page 2 of 5 - Psychosis Research Unit
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May 2017

The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis

Alison Brabban, Rory Byrne, Eleanor Longden & Anthony P. Morrison Full Article Abstract Cognitive behavioural therapy for psychosis (CBTp) is, at times, perceived as a technical therapy that undervalues the importance of human relationships and the fundamental principles on which CBTp itself is based (such as collaboration, validation, optimism and recovery-orientated practice). As such, it can be dismissed by service users or practitioners as undesirable. It is also possible that delivering CBTp that does not adhere to these values can be unhelpful or harmful. We review the evidence regarding what service users want from mental health services and the ability of CBTp to meet these standards. Evidence from qualitative studies and randomised controlled trials suggests that CBTp should be delivered in a manner that is both acceptable...

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An Integrative Cognitive Model of Internalized Stigma in Psychosis

Lisa Wood, Rory Byrne and Anthony P Morrison Full Article Abstract Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma...

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The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem

Lisa Wood, Rory Byrne, Eilish Burke, Gabriela Enache, Anthony P. Morrison Full Article Abstract Internalised shame and self-esteem have both been proposed to play an integral role in the relationship between stigma and its negative psychological sequelae in people who experience psychosis, but there has been little quantitative exploration to examine their roles further. The aim of this study was to examine the relationship of stigma (experienced and perceived) with emotional distress and recovery in psychosis, and to examine internalised shame and self-esteem as potential mediators. A total of 79 participants were included for the purposes of this study. Participants were administered a battery of assessment measures examining experienced and perceived stigma, internalised shame, self-esteem, depression, hopelessness, and personal recovery. Results illustrated that stigma (experienced and perceived) was...

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A pilot randomised controlled trial comparing antipsychotic medication, to cognitive behavioural therapy to a combination of both in people with psychosis: rationale, study design and baseline data of the COMPARE trial

Heather Law, Lucy Carter, Rachel Sellers, Richard Emsley, Rory Byrne, Linda Davies, Paul French, Peter M. Haddad, Elizabeth Pitt, Melissa Pyle, David Shiers, Alison R. Yung & Anthony P. Morrison Full Article Abstract Aims: Ongoing NICE guidance recommends research on the clinical and cost effectiveness of psychological treatment alone, compared to antipsychotic medication and compared to psychological treatment and antipsychotic medication combined. The COMPARE study (Cognitive behaviour therapy or Medication for Psychosis- A Randomised Evaluation) was a pilot trial designed to inform a definitive trial to answer this question. Method: COMPARE was a single-site pilot randomised controlled trial to compare a standardised Cognitive Behaviour Therapy (CBT) intervention to treatment with antipsychotic medication (APs) and a combined treatment (CBT plus APs) in adults with psychosis. Participants were assessed using...

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Quality of prescribing for schizophrenia: Evidence from a national audit in England and Wales

Patel MX, Bishara D, Jayakumar S, Zalewska K, Shiers D, Crawford MJ, et al. (2014) Full Article Abstract The National Audit of Schizophrenia (NAS) examined the quality of care received in England and Wales. Part of the audit set out to determine whether six prescribing standards, set by the national clinical guidelines for schizophrenia, were being implemented and to prompt improvements in care. Mental Health Trusts and Health Boards provided data obtained from case-notes for adult patients living in the community with schizophrenia or schizoaffective disorder. An audit of practice tool was developed for data collection. Most of the 5055 patients reviewed were receiving pharmacological treatment according to national guidelines. However, 15.9% of the total sample (95%CI: 14.9–16.9) were prescribed two or more antipsychotics concurrently and 10.1% of...

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