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Attachment-based CBT models for psychosis: a PPI-informed approach for acute care settings

Attachment-based CBT models for psychosis: a PPI-informed approach for acute care settings
Attachment-based CBT models for psychosis: a PPI-informed approach for acute care settings
People with psychosis often have prolonged in-patient admissions at high personal and economic costs. This is due in part to cognitive, affective and behavioural processes that delay recovery and discharge. For many, these processes are affected by enduring insecure attachment styles. People with insecure attachment struggle to manage strong feelings when unwell, and ward staff may struggle to know how best to offer support. Here, we outline the model of interpersonal process in cognitive therapy, and how this may be adapted to capture beliefs and behaviours associated with insecure attachment. Psychological interventions in acute care often fail due to implementation issues. For this reason, and in line with current guidance on developing complex interventions, we report on a series of Patient and Public Involvement (PPI) consultations with people with lived experience of psychosis, family members and ward staff on the potential utility of these attachment-based CBT models. The PPI meetings highlighted three themes: (1) the need to improve staff-patient interactions on wards; (2) continuity in staff-patient relationships is key to recovery; and (3) advantages and barriers to an attachment-based CBT approach. We conclude by describing how the models can be implemented in routine clinical practice, and generalised across services where interpersonal cognitive and behavioural processes may contribute to delays in people's recovery.
PPI, acute care, attachment-based CBT, formulation, psychosis, staff-patient interactions
1754-470X
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7
Harper, Sean
a364b82c-751e-4e84-b45d-e79b0ef3bffe
Maguire, Tessa
f720bf11-2227-470f-b9bf-b323a59e176c
Sivyer, Katy
c9831d57-7d6b-4bb6-bb3c-770ea7f9b116
Sapachlari, Christina
99beeb63-7bc9-4155-bcf7-b3c11a7012aa
Carnelley, Katherine B.
02a55020-a0bc-480e-a0ff-c8fe56ee9c36
Newman-Taylor, Katherine
e090b9da-6ede-45d5-8a56-2e86c2dafef7
Harper, Sean
a364b82c-751e-4e84-b45d-e79b0ef3bffe
Maguire, Tessa
f720bf11-2227-470f-b9bf-b323a59e176c
Sivyer, Katy
c9831d57-7d6b-4bb6-bb3c-770ea7f9b116
Sapachlari, Christina
99beeb63-7bc9-4155-bcf7-b3c11a7012aa
Carnelley, Katherine B.
02a55020-a0bc-480e-a0ff-c8fe56ee9c36

Newman-Taylor, Katherine, Harper, Sean, Maguire, Tessa, Sivyer, Katy, Sapachlari, Christina and Carnelley, Katherine B. (2022) Attachment-based CBT models for psychosis: a PPI-informed approach for acute care settings. The Cognitive Behaviour Therapist, 15, [e55]. (doi:10.1017/S1754470X22000526).

Record type: Article

Abstract

People with psychosis often have prolonged in-patient admissions at high personal and economic costs. This is due in part to cognitive, affective and behavioural processes that delay recovery and discharge. For many, these processes are affected by enduring insecure attachment styles. People with insecure attachment struggle to manage strong feelings when unwell, and ward staff may struggle to know how best to offer support. Here, we outline the model of interpersonal process in cognitive therapy, and how this may be adapted to capture beliefs and behaviours associated with insecure attachment. Psychological interventions in acute care often fail due to implementation issues. For this reason, and in line with current guidance on developing complex interventions, we report on a series of Patient and Public Involvement (PPI) consultations with people with lived experience of psychosis, family members and ward staff on the potential utility of these attachment-based CBT models. The PPI meetings highlighted three themes: (1) the need to improve staff-patient interactions on wards; (2) continuity in staff-patient relationships is key to recovery; and (3) advantages and barriers to an attachment-based CBT approach. We conclude by describing how the models can be implemented in routine clinical practice, and generalised across services where interpersonal cognitive and behavioural processes may contribute to delays in people's recovery.

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e-pub ahead of print date: 1 December 2022
Published date: 1 December 2022
Additional Information: Funding Information: We would like to thank all who participated in the consultation groups described here. This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Publisher Copyright: © The Author(s), 2022.
Keywords: PPI, acute care, attachment-based CBT, formulation, psychosis, staff-patient interactions

Identifiers

Local EPrints ID: 473188
URI: http://eprints.soton.ac.uk/id/eprint/473188
ISSN: 1754-470X
PURE UUID: 71630080-c747-4b3b-9d2e-52e155a0778a
ORCID for Katherine Newman-Taylor: ORCID iD orcid.org/0000-0003-1579-7959
ORCID for Katy Sivyer: ORCID iD orcid.org/0000-0003-4349-0102
ORCID for Katherine B. Carnelley: ORCID iD orcid.org/0000-0003-4064-8576

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Date deposited: 11 Jan 2023 17:58
Last modified: 17 Mar 2024 03:59

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Contributors

Author: Sean Harper
Author: Tessa Maguire
Author: Katy Sivyer ORCID iD
Author: Christina Sapachlari

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