Interventions in Early
Onset Psychosis
Manchester Mental Health &
Social Care Trust
Aims & Objectives
Aims – To introduce the principles of
psychological interventions for people with
early onset psychosis
Objectives – To provide an introduction to:
Family interventions
Coping strategy enhancement
Motivational interviewing
Early warning signs and action planning
Cognitive behavioural therapy
Group Exercise
Divide into small groups
The task of each group is to list as
many ‘talking therapies’ as they can,
discussing the usefulness of each
therapy for people with psychosis
Feed back to whole group for
Psychological Interventions
An Overview
Psychological interventions are an
essential part of treatment options for
both relapse prevention and symptom
Most of the current evidence base is for
cognitive-behavioural interventions
(CBT) and family interventions (FI)
(NICE 2002)
CBT should be offered to clients with
psychosis who have ‘persistent’
symptoms(NICE 2002). It also assists in the
development of insight
CBT encourages people to make links
between thoughts, feelings and behaviours
and helps to re-evaluate perceptions, beliefs
and reasoning about targeted symptoms
CBT depends on an effective
therapeutic alliance between clinician
and client
Several research studies have now
investigated the efficacy of these
approaches (e.g. Sensky et al 2000,
Tarrier et al 1998, Kuipers et al 1997)
A collaborative approach ensures the client
is at the centre of care and is an active
participant in decisions about treatment.
This enhances engagement with services.
Structured and clearly defined sessions help
to make time spent with clients as useful as
The Provision of CBT by
Most mental health professionals can
effectively apply the principles of CBT,
although there are some professionals
who have more advanced training as
Ongoing supervision is also necessary
to ensure safety and effectiveness
Family Interventions
FI should be available to families who are
living with someone with psychosis or who
are in close contact with them(NICE 2002)
High levels of ‘expressed emotion’ (EE) within
a family has been shown to be an effective
predictor of relapse in schizophrenia.
High EE is harmful when it is associated with
critical and hostile comments and emotional
over-involvement towards the person with
Family Interventions
FI can improve symptoms and reduce the
chances of another acute episode
FI use psycho-education and problem solving
to help families cope managing the illness
more effectively, deal with crises, reduce
levels of distress, improve communication
and provide support and education for the
family (Barrowclough and Tarrier 1992)
Coping Strategy Enhancement
CSE encourages clients to collaboratively
review their present coping skills in managing
distressing experiences.
Coping skills that work effectively can then be
developed and enhanced. Those coping
strategies that are less effective can be
modified or abandoned.
This therapy is more ‘behavioural’ than
‘cognitive’ but has proved to be successful in
clinical trials (Tarrier et al 1993; Tarrier et al
Interviewing (MI)
MI was originally developed as a treatment
for drug and alcohol addiction (Miller and
Rollnick 1991; Rollnick and Miller 1995).
It is now used with clients with psychosis to
enhance conmpliance with medication
(Kemp et al 1996) and for those clients with a
‘dual diagnosis’ of drug and alcohol use and
psychosis (Haddock et al 2002).
Interviewing (MI)
MI is based on the theory of the ‘stages
of change’ (Prochaska and DiClemente
It is especially effective when clients are
at either the ‘pre-contemplation’ or
‘contemplation’ stages.
Early Warning Signs &
Relapse Prevention
Relapse rates in psychosis are extremely
high – even if people stay on medication, up
to 81% of patients relapse within 5 years
(Robinson et al 1999)
A number of studies have investigated the
possibility of delaying, preventing or altering
the course of relapse (Herz & Melville 1980;
Birchwood et al 1989)
Early Warning Signs &
Relapse Prevention
Birchwood et al (1989) designed an Early
Signs Questionnaire which encourages the
development of a detailed ‘time-line’ to clearly
explore the pattern of events and changes in
thoughts, feelings and behaviours that lead
up to an episode of psychosis.
Working closely with the client and their
closest carers, a list of early signs can be
developed. This can lead to an action plan to
help to spot relapse.
Early Warning Signs &
Relapse Prevention
Once the early warning signs list has been
collaboratively identified, a detailed action
plan can be negotiated.
This usually includes the following areas –
 What the client and family should do if signs
of relapse are spotted
 What services agree to do to respond to the
client’s and family’s concerns
 A DETAILED list of all resources – extra
medication, phone numbers to call in a crisis
Early Warning Signs &
Relapse Prevention
This work can be hard, especially when
previous crises are reviewed in detail, as lots
of bad memories and difficult feelings can be
This approach is very empowering for clients
and families. At its best it enhances the
relationship between them and services,
gives them much more control over their
treatment and enables them to feel supported
in practical ways.
Psychological Therapy
There is a huge interest in providing
psychological treatments to people with
psychosis and the evidence base is growing.
If people with early onset psychosis are given
this treatment, outcomes can improve
One study has shown that using CBT can
even prevent or delay the development of
psychotic symptoms (Morrison et al 2004)

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