Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial

McCabe, Rose, John, Paula, Dooley, Jemima, Healey, Patrick, Cushing, Annie, Kingdon, David, Bremner, Stephen and Priebe, Stefan (2016) Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial. The British Journal of Psychiatry, 209 (6), 517-524. (doi:10.1192/bjp.bp.115.179499).

Abstract

BACKGROUND: A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis.

AIMS: To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422).

METHOD: In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship.

RESULTS: Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46-11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03-0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01-0.41, P = 0.043, a medium effect).

CONCLUSIONS: Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.

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