Early intervention talking therapy to reduce risk of psychosis

Talking therapy for patients with symptoms of anxiety and depression could be key to significantly reducing the risk of them developing psychosis, according to new research.

A study by the University of Southampton has found that simple tweaks to cognitive behavioral therapy (CBT)—currently offered by the NHS to 1.2 million patients with anxiety and depression every year—could make a huge difference to those at risk of developing psychosis.

Introducing a few additional questions into the beginning of CBT enables clinicians to identify those at risk of psychosis, the research has found. The study is published in the journal BJPsych Open.

Professor Katherine Newman-Taylor, Consultant Clinical Psychologist and CBT lead at the University of Southampton, said, “Many people who access NHS Talking Therapies services for anxiety and depression have low-level psychotic type experiences, but they don’t report these and clinicians are not trained to identify them, so they go unnoticed. We have found that when they go unnoticed, people are unlikely to recover.

“Our research shows that slightly tweaking CBT enables clinicians to pick up on early psychotic-type experiences. This enables patients to use the skills they’re developing to manage their anxiety or depression to manage these low-level psychotic experiences too.”

Psychosis affects about 1 in 100 people. Symptoms include hearing voices and seeing things, and unusual beliefs such as paranoia or grandiosity.

Typically, psychosis goes untreated for one to two years, due to factors such as the person themselves not initially identifying that there is a problem, stigma associated with the condition, and delays within mental health services.

Psychosis presents on a sliding scale. Professor Newman-Taylor explained, “Some people might have psychotic-type experiences that are not particularly troublesome. For others, these experiences can be troubling, but the associated stigma means they can feel too ashamed or afraid to ask for help.

Established psychosis can be very disabling. Psychosis is on a continuum, and we think we can help people much earlier, when they are experiencing less severe symptoms.”

The research team worked with NHS trusts across Hampshire on a feasibility study with patients seeking help for anxiety or depression. They found that minimally adapted CBT is acceptable to patients, is likely to improve outcomes for anxiety, depression and psychosis risk, and can be delivered in NHS Talking Therapies.

“We know that people accessing talking therapy are presenting with more complex problems than the service was designed for,” added Professor Newman-Taylor. “We also know that people are often too ashamed or fearful to talk about their unusual experiences. If we can intervene very early in this way, we may be able to prevent some people from developing psychosis.”

The research team is now planning a full trial with patients undergoing CBT.