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Cognitive Behavioural Therapy for psychosis and anxiety: nurse led research

Cognitive Behavioural Therapy for psychosis and anxiety: nurse led research. Alison Welfare-Wilson. Background.  In clients with first episode psychosis symptoms of anxiety are often overlooked. (Montreuil et al 2013).

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Cognitive Behavioural Therapy for psychosis and anxiety: nurse led research

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  1. Cognitive Behavioural Therapy for psychosis and anxiety: nurse led research Alison Welfare-Wilson

  2. Background  In clients with first episode psychosis symptoms of anxiety are often overlooked. (Montreuil et al 2013).  Up to 60% of clients with chronic psychotic disorder also experience anxiety. Dernovsek and Sprah (2009).  High anxiety, particularly social anxiety in first episode psychosis is associated with reduced social functioning and increased clinical symptoms.Romm et al in (2012).

  3.  Following completion of a 12 week CBT group for clients with first episode psychosis, there was notable reduction in symptoms of depression and anxiety. Gaynor et al (2011).  A RCT of CBT in first episode psychosis versus treatment as usual found that a reduction in duration of untreated psychosis and the promotion of insight were effective in adherence to CBT. Alverez-Jimenez et al (2009).

  4. Methods • Repeated measures feasibility study using the DASS-21 (Lovibond and Lovibond 2004). • Participation in screening assessment. • 12 week group of 2 hours duration based on the work of Greenberger and Padesky (1996).

  5.  Socialisation to the CBT model  Identification of coping strategies  Mindfulness  Relaxation techniques  Behavioural experiments  Completion of thought diaries  Identification of early warning signs.  Care co-ordinator’s learning: addressed in session four when they were invited to attend.

  6. Data collection  Demographic factors.  Primary outcome: Depression, Anxiety and Stress Scale (DASS). (Lovibond and Lovibond 2004).  Secondary outcomes: Return to employment, education and voluntary work  Qualitative questionnaire

  7. Data Analysis  Comprised 57% (4) males and 43% (3) females with a mean age of 25 years, range (18-33 years).  Naturalistic sample: participants representative of the service in terms of race (being predominantly white British), employment/education and receipt of benefits.  Comparisons at screening and three month follow-up indicated statistically significant improved outcomes in the three domains of depression, anxiety and stress as measured by the DASS-21 scale

  8. Data from the DASS-21 at baseline and3-month follow-up

  9. Evaluation  Could be offered both within inpatient settings and in out patient community settings.  Group CBT for clients focusing on the management of anxiety is an effective and viable means of reducing the levels of anxiety and associated stress and depression.  Treatment gains sustainable at three month follow-up.

  10. Nurses as researchers Real and perceived barriers:  Organisational change  Work related stress  Lack of time  Lack of confidence and knowledge (Ferguson & Day 2007; Gerrish & Clayton 2004; Kajermo et al2010; McNicholl 2008; Chan et al 2011)  Creative, dynamic and committed to client care  Evidencing developments and initatives

  11. References Alverez-Jimenez, M., Gleeson, J,F., Cotton, S., Wade, D., Pearce, T., Crisp, K., Spilotacopoulos, D., Newman, B., McGorry, P, D (2009) Predictors of adherence to cognitive behavioural therapy in first episode psychosis. Can J Psychiatry. 54, 710-8. Chan GK, Barnason S, Dakin CL, Gillespie G, Kamienski MC, Stapleton S, Williams J, Juarez A, Li S (2011) Barriers and perceived needs for understanding and using research among emergency nurses. Journal of Emergency Nursing. 37 (1), 24-31. Dernovesk, M.Z & Sprah, L. (2009). Comorbid anxiety in patients with psychosis. Psychiatria Danubina. 21 (1),43-50. Ferguson LM, Day RA (2007) Challenges for new nurses in evidence based practice. Journal of Nursing management.15 (1) 107-113. Gerrish K, Clayton J (2004) Promoting evidence-based practice: an organizational approach. Journal of Nurse Management . 12 (2) 114-23.

  12. Greenberger, D & Padesky, C. (1996). Mind over Mood: Change the way you feel by changing the way you think. Guildford Press. Kajermo KN, Bostrum AM, Thompson DS, Hutichinson AM, Estabrooks CA, Wallin L (2010) The BARRIER scale- the barriers to research utilisation scale: a systematic review Implementation Science. 5 32. Lovibond, SH & Lovibond, PF (2004) Manual for the Depression Anxiety and Stress Scales. Psychology Foundation Monograph, Sydney Australia. McNicholl M, Coates V, Dunne K (2008) Driving towards an improved research and development culture. Journal of Nursing Management. 16 344-351. Montreuil TC., Malla AK., Joober R, Belanger C, Lepage M. (2013) Anxiety symptoms severity and short term clinical outcome in first episode psychosis. Early Intervention in Psychiatry. 7, 5-11. Romm KL., Melle I, Thoresen C., Andreassen O, Ivar J. (2012) Severe social anxiety in early psychosis is associated with poor pre morbid functioning, depression and quality of life. Comprehensive Psychiatry. 53 (4), 434 – 440.

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