A systematic review of adherence to group interventions in psychosis: do people attend?

Abstract

Background Evidence supports the use of group therapy for symptom reduction and improving functioning in people with psychosis. However, research guidelines highlight the importance of establishing the feasibility of interventions. Adherence is an important indicator of feasibility and an essential step in supporting the development of the evidence base for group interventions. This review aims to estimate adherence, and possible barriers and facilitators, to psychotherapeutic groups in people with psychosis. Methods Embase, Ovid MEDLINE and PsycINFO databases were searched for cross-referencing terms related to group therapy and psychosis. Studies were assessed against inclusion criteria and methodological quality was evaluated. Data wasextracted from each paper including the average session attendance, demographic, clinical, study and therapy-related characteristics and the impact of these on adherence levels evaluated. Results Fifty-nine original research papers were included, reporting on 52 independent studies which consisted of 66 therapy groups comprised of 2109 participants. Average adherence was 76.4% (s.d. = 17.4). Adherence was improved by receiving incentives and was higher in participants of older age. Study sample size was inversely associated with adherence levels. Study quality was variable with approximately 61.5% found to be at risk of bias. The results support the feasibility of group therapy and suggest that adherence in people with psychosis is not dissimilar to those for people experiencing common mental health difficulties. These findings, alongside efficacy evidence, support the use of group interventions in people with psychosis but also highlight the need for further high-quality research on the efficacy for these approaches.

Feasibility of six-month outpatient cognitive remediation in schizophrenia: Experience from the randomized controlled integrated social cognition and social skills therapy study

“…The present study primarily investigated therapy adherence and safety, which are both aspects of feasibility, and showed that the mean percentage of attendance at therapy sessions in the whole group of participants is 77 %. This result is consistent with a large systematic review by Sedgwick et al (2021) , in which the mean percentage of therapy adherence to various group interventions for the treatment of psychosis was 76.4 % (SD = 17.4).…”

Managing emotions in psychosis: Evaluation of a brief DBT‐informed skills group for individuals with psychosis in routine community services

“…This evaluation was conducted in routine clinical practice and found that a brief DBTinformed group for individuals with established psychosis was feasible and acceptable (uptake, completion, service-users' views) and associated with potential clinical impact (pre-post outcome measures). Rates of uptake were around 80%, with nearly 80% of those completing, comparing favorably to other group interventions for psychosis (Sedwick, Hardy, Newbery, & Cella, 2021). Service users reported high satisfaction and valued outcomes, including increased emotional awareness, understanding and acceptance, selfefficacy in relation to managing emotions, and pursuit of valued activities.…”

Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review

“…45 Finally, the specifics of intervention delivery (e.g., individual vs group format) could impact engagement/adherence. 86 Further research is needed to clarify which and how intervention characteristics influence participant engagement.…”