A CBT-based anxiety management workshop in first-episode psychosis Alison Welfare-Wilson and Amy Jones
Key words: Anxiety ■ Psychosis ■ First episode psychosis ■ Cognitive behavioural therapy
P
sychosis is characterised by the presentation of ‘positive’ and ‘negative’ symptoms. Negative symptoms include restricted expression of thoughts and feelings, and loss of motivation (Foussias et al, 2009; Foussias et al, 2014). Such symptoms can delay recovery (Selten et al, 2000) and can lead to physical self-neglect (Deakin and Lennox, 2013). Positive symptoms include hallucinations and delusions, and are associated with heightened anxiety (Garety et al, 2001) and suicidal ideation (Taylor et al, 2010). Anxiety is a significant problem for individuals with psychosis (Michail and Birchwood, 2009), observable throughout the course of illness from the prodromal phase to recovery. It is indicated that 30–60% of service users with psychosis will experience symptoms of anxiety leading to decreased social activity and social withdrawal (Dernovsek and Sprah, 2009; Michail and Birchwood, 2009). Anxiety in combination with a psychotic illness can prove debilitating for service users. There is an increased prevalence
Alison Welfare-Wilson, Mental Health Nurse/Specialist Care Co-ordinator; Amy Jones, Assistant Psychologist, both at West Kent and Medway Early Intervention for Psychosis Service Accepted for publication: March 2015
378
Background Group-based CBT interventions have been proposed as an effective way to maximise access to CBT and reduce the symptoms of anxiety (Gaynor et al, 2011). Based on the increasing evidence base for group-based CBT, a 12-week anxiety management group (Welfare-Wilson and Newman, 2013) was delivered within the authors’ EIPS for service users with a first episode psychosis and comorbid symptoms of anxiety. Qualitative and quantitative feedback suggested that this intervention was effective in reducing anxiety. However, participants reported that a weekly group was disruptive in terms of social and employment commitments. The effectiveness of brief CBT interventions, in the form of 1-day workshops, has been demonstrated elsewhere. Stress management workshops introduced by Brown et al (1999; 2004) led to reduced distress, depression and anxiety scores (Brown et al, 2000; Brown et al, 2004), while workshops delivered by Prytys et al (2010) demonstrated significant improvements in anxiety, depression and insomnia, with high levels of participant satisfaction. This suggests brief, intensive, CBT-based interventions can be an effective means of delivering CBT for the treatment of stress and insomnia. Based on the growing evidence base for brief CBT interventions and the participant feedback of previously cited
© 2015 MA Healthcare Ltd
Abstract
When co-occurring with psychosis, anxiety can adversely affect social and occupational functioning and can cause debilitating levels of distress. This article describes a single-centre three-phase service development project culminating in the introduction of 1-day anxiety management workshops for service users of an Early Intervention for Psychosis Service (EIPS). The workshops, which were run by a mental health nurse and an assistant psychologist, attracted 12 participants with a first episode of psychosis and co-morbid anxiety. Quantitative and qualitative measures demonstrated a statistically significant reduction (p
Key words: Anxiety ■ Psychosis ■ First episode psychosis ■ Cognitive behavioural therapy
P
sychosis is characterised by the presentation of ‘positive’ and ‘negative’ symptoms. Negative symptoms include restricted expression of thoughts and feelings, and loss of motivation (Foussias et al, 2009; Foussias et al, 2014). Such symptoms can delay recovery (Selten et al, 2000) and can lead to physical self-neglect (Deakin and Lennox, 2013). Positive symptoms include hallucinations and delusions, and are associated with heightened anxiety (Garety et al, 2001) and suicidal ideation (Taylor et al, 2010). Anxiety is a significant problem for individuals with psychosis (Michail and Birchwood, 2009), observable throughout the course of illness from the prodromal phase to recovery. It is indicated that 30–60% of service users with psychosis will experience symptoms of anxiety leading to decreased social activity and social withdrawal (Dernovsek and Sprah, 2009; Michail and Birchwood, 2009). Anxiety in combination with a psychotic illness can prove debilitating for service users. There is an increased prevalence
Alison Welfare-Wilson, Mental Health Nurse/Specialist Care Co-ordinator; Amy Jones, Assistant Psychologist, both at West Kent and Medway Early Intervention for Psychosis Service Accepted for publication: March 2015
378
Background Group-based CBT interventions have been proposed as an effective way to maximise access to CBT and reduce the symptoms of anxiety (Gaynor et al, 2011). Based on the increasing evidence base for group-based CBT, a 12-week anxiety management group (Welfare-Wilson and Newman, 2013) was delivered within the authors’ EIPS for service users with a first episode psychosis and comorbid symptoms of anxiety. Qualitative and quantitative feedback suggested that this intervention was effective in reducing anxiety. However, participants reported that a weekly group was disruptive in terms of social and employment commitments. The effectiveness of brief CBT interventions, in the form of 1-day workshops, has been demonstrated elsewhere. Stress management workshops introduced by Brown et al (1999; 2004) led to reduced distress, depression and anxiety scores (Brown et al, 2000; Brown et al, 2004), while workshops delivered by Prytys et al (2010) demonstrated significant improvements in anxiety, depression and insomnia, with high levels of participant satisfaction. This suggests brief, intensive, CBT-based interventions can be an effective means of delivering CBT for the treatment of stress and insomnia. Based on the growing evidence base for brief CBT interventions and the participant feedback of previously cited
© 2015 MA Healthcare Ltd
Abstract
When co-occurring with psychosis, anxiety can adversely affect social and occupational functioning and can cause debilitating levels of distress. This article describes a single-centre three-phase service development project culminating in the introduction of 1-day anxiety management workshops for service users of an Early Intervention for Psychosis Service (EIPS). The workshops, which were run by a mental health nurse and an assistant psychologist, attracted 12 participants with a first episode of psychosis and co-morbid anxiety. Quantitative and qualitative measures demonstrated a statistically significant reduction (p
