Predictors of disengagement from cognitive behavioural therapy for psychosis in a National Health Service setting: A retrospective evaluation

Abstract

Objectives. To evaluate whether demographic and clinical variables are related to disengagement rates in cognitive behavioural therapy (CBT) for psychosis in a clinical setting.Methods. The medical records and symptom severity data (from Health of the Nation Outcome Scales) were analysed retrospectively for 103 referrals for CBT for psychosis in a National Health Service secondary care and Early Intervention in Psychosis team.Results. Overall, 42.7% (n = 44) disengaged from CBT. There was no impact of gender or ethnicity, and no impact of clinical variables such as risk history and comorbid diagnosis. However, risk of disengagement was significantly higher for those who were younger, F = 6.89, partial g 2 = .064, p = <.05; those with greater total HoNOS scores, F = 4.22, partial g 2 = .04, p < .05; more severe symptoms on the HoNOS items of overactive, aggressive, disruptive, or agitated behaviour, v 2 = 6.13, p < .01; problem drinking or drug taking, v 2 = 7.65, p < .05; depressed mood, v 2 = 7.0, p < .01; and problems with occupation and activities: v 2 = 3.68, p < .05. There was a non-significant trend for shorter waiting times to be associated with greater levels of disengagement. Conclusions.These results indicate that it may not be psychosis per se that disrupts engagement in CBT, but linked behavioural and emotional factors. A more assertive approach to these factorsoveractive, aggressive, disruptive, or agitated behaviour, problem drinking or drug taking, depressed mood, and problems with occupation and activities, particularly in younger peoplemay be valuable prior to or early on in therapy as a means of increasing engagement in CBT for psychosis. Practitioner PointsRisk of disengagement from CBT for psychosis increases with overactive, aggressive, disruptive, or agitated behaviour (54.9% vs. 30.8%), problem drinking and drug taking (61.1% vs. 32.8%), depressed mood (56% vs. 30.2%), and problems with occupation and activities (53.3% vs. 34.5%), with a trend for younger age.An assertive and motivational approach to engagement and a focus on addressing low mood and problematic behaviours, prior to or early in therapy, may be warranted, particularly for younger people. This evaluation is limited by small sample size and being retrospective. These results speak to the question of whether psychosis itself renders people inappropriate for CBT for psychosis, or whether problems arise due to behavioural and emotional factors that might be addressed to increase access to CBT for psychosis. Disengagement in psychosis 441

Outcomes 1 year after a first episode of psychosis in migrants to the Republic of Ireland

“…Although, in the UK, ethnicity has been shown to be associated with receipt of CBT, with individuals of African and Black-Caribbean ethnicity being less likely to receive CBT for psychosis (Morris et al, 2020). However, our study also highlights that only half of individuals with a FEP attended CBT and this supports findings from a recent UK study which found high disengagement rates (43%) from CBT in the total FEP population (Richardson et al, 2019). Therefore, the barriers to engaging with psychosocial interventions needs to be determined, in order to improve these engagement rates.…”

Cognitive behavioural therapy for psychosis: The end of the line or time for a new approach?

“…There is good evidence that people with psychosis delay accessing treatment (Birchwood et al, 2013) and around a third then disengage from services (Doyle et al, 2014; Kreyenbuhl et al, 2009). Rates of disengagement from CBTp reported in routine clinical practice vary widely (13% [Peters et al, 2015] – 43% [Richardson et al, 2019]), though this is likely to be lower in research settings (e.g. Johns et al, 2019).…”