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New research programme to address cognitive problems in psychosis

Researchers at King’s College London and UCL have been awarded £2m by the National Institute for Health Research (NIHR) to identify the best way of implementing cognitive remediation therapy in NHS Early Intervention Services (EIS) for people who have recently experienced psychosis.

As well as hallucinations and delusions, people with psychosis also suffer from cognitive problems, including difficulties with memory and attention. Cognitive recovery strongly predicts functional recovery, e.g. building social relationships, going to work or taking part in further education, even with the best possible rehabilitation opportunities and optimal medication.

Cognitive remediation therapy (CRT) aims to improve thinking skills in people with psychosis. Previous research has shown that people receiving CRT make significantly greater improvements in memory and flexible thinking than people who received treatment-as-usual. CRT also has a beneficial impact on self-esteem, improving functioning in social situations and symptoms. Research has also shown that the therapy is highly valued by service users who reported noticeable improvements in their thinking skills. 

Til Wykes, Professor of Clinical Psychology and Rehabilitation at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s and co-Principal Investigator of the research programme, says: “The ideal time to provide cognitive remediation therapy is as soon as possible after psychosis develops as we know that it is effective for younger people and may have larger effects on functioning if we intervene at the earliest opportunity. This research programme is specifically designed to investigate how cognitive remediation could be incorporated into the currently available EIS services.” 

The study aims to develop a training programme to guide UK-wide implementation.  To do this different methods of CRT implementation will be investigated which vary in the level of therapist input. This will be evaluated from different perspectives including which therapy is the most effective and which patients benefit most.  Specifically, the research team will investigate:

  • The service user perspective through effects on service user defined personal goals as well as direct cognitive and functioning gains. We will detect therapy satisfaction and the most acceptable method of provision and the most sustainable therapy.
  • The staff perspectives on the different implementation methods such as the level of training required and effect of their commitment and the resources required  as well as considering organisational facilitators and barriers, and finally 
  • The provider perspective in terms of the costs and cost-effectiveness of the different methods of providing therapy. 

Eileen Joyce, Professor of Neuropsychiatry at UCL Institute of Neurology and joint PI, says: “For several years we have been building up the evidence that cognitive problems are present by the time of the first psychotic episode and that they strongly predict early outcome such as being able to go back to work or education. We have also shown that cognitive remediation therapy works. This is an exciting project because it enables us to put this knowledge into NHS practice.”

The multi-disciplinary research team involves service users, staff as well as health economists, statisticians, service managers, organisational behaviour specialists and practitioners. 

The research programme will ultimately allow for (i) policy makers to plan for this treatment; (ii) individual teams to understand what is required before and during implementation; and (iii) service users to receive the best individualised care to improve their recovery potential.

Funding for the study is through the NIHR Programme Grants for Applied Research.