Mechanism-based psychotherapy for acute psychosis

Gussmann, Eva Dorothea (2025): Mechanism-based psychotherapy for acute psychosis: development and evaluation of a modularized group intervention. Dissertation, LMU München: Medizinische Fakultät

Abstract

Improving psychotherapeutic inpatient care for acute patients with psychotic symptoms is a key issue for national and international health care services. However, most studies of psychotherapy for psychosis have primarily focused on outpatient settings, leaving a knowledge gap regarding effective interventions for acute inpatients. Furthermore, recent systematic reviews and meta-analyses of the effectiveness of guideline-recommended cognitive behavioural therapy for psychosis (CBTp) in acute settings have reported rather disappointing results. Nevertheless, there is increasing evidence for mechanism-based third-wave therapies, such as the Acceptance and Commitment Therapy, and third-wave-inspired approaches, such as the Metacognitive. However, although promising, few of these mechanism-based interventions have been specifically developed or adapted for acute psychiatric settings. Therefore, the current research aimed to develop and test a novel mechanism-based and needs-oriented psychological intervention (MEBASp) for acute inpatients with psychotic symptoms. Intervention Mapping (IM), a six-step structured methodological framework for scientific intervention design, was used to guide both the rigorous development process of MEBASp in Stage I (Publication I) and the subsequent feasibility study in Stage II (Publication II). The MEBASp intervention designed in Stage I consists of a three-module, low-threshold, experiential, and destigmatizing group intervention focusing on different aspects of metacognitive change mechanisms. Modules I and II focus on enhancing cognitive insight to alleviate acute symptoms, while Module III emphasizes cognitive defusion to reduce participants' distress. In Stage II, a sample of 37 participants with psychotic symptoms (ICD-10 codes F20-39: schizophrenia, schizotypal, delusional and psychotic mood disorders) was recruited from the locked acute ward of the Max Planck Institute of Psychiatry (MPI) in Munich, Germany, and received up to nine sessions of MEBASp. Primary outcome measures were feasibility (recruitment, retention and session attendance rates) and acceptability (participant satisfaction with treatment). Secondary outcome measures included general psychopathology, psychotic symptoms, global functioning, symptom distress, and symptom severity assessed at baseline and post-intervention. Measures of the hypothesized mechanisms of change were administered before and after each module. High feasibility was demonstrated by a recruitment rate of 78.8%, retention rate of 89.2% and attendance rate of 86.5%. 80% of participants rated their overall satisfaction with the treatment as the highest possible, further indicating a high level of acceptability. In addition to the primary outcome measures, the feasibility and acceptability of MEBASp were supported by secondary outcome measures and qualitative data. Although the feasibility study was not designed or powered to assess clinical effectiveness, there was evidence of significant pre-post effects on all secondary clinical outcomes and hypothesized mechanisms of change. The results of the two-stage MEBASp research project provide compelling evidence for the feasibility and acceptability of a group intervention based on a meta-cognitive model for patients with psychosis in acute inpatient settings. The positive outcomes observed in terms of clinical improvements and mechanisms of change warrant further investigation in a randomized controlled trial.

Abstract

Abstract

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Acute inpatient setting, Acute psychosis, Mechanism-based, Metacognition, Group therapy
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 31. Januar 2025
• 1. Bericht­erstatter:in: Lucae, Susanne