Measurement of the prevalence and impact of psychotic experiences in the Improving Access to Psychological Therapies (IAPT) service, and the clinical and cost-effectiveness of a tailored therapy to address common mental disorder with psychotic experiences.
Approximately half of people using IAPT services have some psychotic experiences in addition to common mental disorder (PE-CMD). These people begin treatment with higher scores on indices of depression and anxiety and are less likely to recover by the end of therapy. Currently, IAPT neither screens for nor provides specific interventions for PE-CMD.
The TYPPEX programme has developed a training course for high intensity IAPT therapists (CBT-Tackling Severity; CBT-TS) and will examine whether people with CMD-PE are more likely to recover following treatment by a therapist trained in CBT-TS.
Project aims and objectives
- Introduce a simple tool to identify the prevalence of PE in the IAPT population and examine the impact of PE on mental health and recovery outcomes;
- Develop a tailored evidence-based cognitive behavioural therapy for people with CMD-PE and training programme IAPT therapists;
- Implement the training in IAPT services and examine its clinical and cost-effectiveness via a stepped-wedge cluster-randomised controlled trial;
- Define best policy and commissioning practice regarding care pathways for people with CMD-PE involving service-users, therapists, managers and commissioners.
The programme has five workpackages:
Workpackage 1: A qualitative analysis of the views of IAPT managers, therapists and service users on the identification and treatment of CMD-PE in IAPT.
Workpackage 2: The development of the CBT-TS concept and associated package of training and supervision for high intensity IAPT therapists.
Workpackage 3: The measurement of the prevalence of CMD-PE in IAPT caseloads and its impact on recovery, and a feasibility study of the acceptability and implementation of CBT-TS and confirmation of sample size for a substantive trial.
Workpackage 4: A stepped-wedge cluster randomised trial of the clinical and cost-effectiveness of CBT-TS.
Workpackage 5: Dissemination of new knowledge, evaluating policy implications and translation into practise.
Potential or actual impact
Dissemination of a new clinical understanding of PE as not only harbingers of schizophrenia and other psychoses but also markers of common but more severe anxiety and depression.
- A simple model to enhance detection and clinical evaluation of people with CMD-PE across IAPT services by introducing a short, effective assessment tool, in parallel with the patient-reported outcomes employed in the IAPT programme.
- An evidence-based CBT therapy for people with CMD-PE and a package of training and supervision for IAPT therapists.
- Evaluation of this in a pragmatic, stepped-wedge, cluster randomised trial to evaluate the clinical and cost-effectiveness of CBT-TS.
- Development of skills and knowledge of the IAPT workforce that could be demonstrable to both IAPT therapists and service-users with CMD-PE with an increased quality in service provision.
- Innovation through definition of new care pathways (routine measurement of psychotic experiences and immediate allocation to CBT-TS where present) to meet the needs of people with CBT-TS in IAPT.
- Economic evaluations of newly proposed intervention within IAPT services in order to measure “value for money”.
- Evidence to enhance NHS policy and NICE guidance regarding people with CMD-PE who are currently facing a gap in health service provision.
- A blueprint for the routine evaluation of new developments in the national IAPT programme.
Papers/resources associated with this study
Georgiadis A, Duschinsky R, Perez J, Jones PB, Russo D, Knight C, Soneson E, Dixon-Woods M. Coproducing healthcare service improvement for people with common mental health disorders including psychotic experiences: a study protocol of a multiperspective qualitative study. BMJ Open. 2018 Nov 8;8(11):e026064. doi: 10.1136/bmjopen-2018-026064. PMID: 30413522; PMCID: PMC6231599.
Knight C, Stochl J, Soneson E, Russo DA, Jones PB, Perez J. Revisiting CAPE-P15 cut-off values to increase sensitivity for detecting psychotic experiences in primary care. Schizophr Res. 2020 Feb;216:507-510. doi: 10.1016/j.schres.2019.11.051. Epub 2019 Dec 5. PMID: 31813808.
Knight C, Russo D, Stochl J, Croudace T, Fowler D, Grey N, Reeve N, Jones PB, Perez J. Prevalence of and recovery from common mental disorder including psychotic experiences in the UK Primary Care Improving Access to Psychological Therapies (IAPT) Programme. J Affect Disord. 2020 Jul 1;272:84-90. doi: 10.1016/j.jad.2020.04.015. Epub 2020 May 3. PMID: 32379625.
Knight C, Russo D, Stochl J, Jones PB, Perez J. More sensitive identification of psychotic experiences in common mental disorder by primary mental healthcare services - effect on prevalence and recovery: casting the net wider. BJPsych Open. 2020 Nov 6;6(6):e136. doi: 10.1192/bjo.2020.120. PMID: 33153513.
Perez J, Jones PB. Breaking the web: life beyond the at-risk mental state for psychosis. Psychol Med. 2019 Sep 30:1-6. doi: 10.1017/S0033291719002605. Epub ahead of print. PMID: 31566146.
Soneson E, Russo D, Knight C, Lafortune L, Heslin M, Stochl J, Georgiadis A, Galante J, Duschinsky R, Grey N, Gonzalez-Blanco L, Couche J, Griffiths M, Murray H, Reeve N, Hodgekins J, French P, Fowler D, Byford S, Dixon-Woods M, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis. Syst Rev. 2019 May 23;8(1):124. doi: 10.1186/s13643-019-1041-5. PMID: 31122287; PMCID: PMC6533690.
Soneson E, Russo D, Stochl J, Heslin M, Galante J, Knight C, Grey N, Hodgekins J, French P, Fowler D, Lafortune L, Byford S, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: A systematic review and meta-analysis of controlled and uncontrolled effectiveness and economic studies. Aust N Z J Psychiatry. 2020 Jul;54(7):673-695. doi: 10.1177/0004867420913118. Epub 2020 May 28. PMID: 32462893; PMCID: PMC7324911.
The TYPPEX stepped-wedge cluster-randomised controlled trial is expected to open imminently and will remain open for 30 months. Following a 6-month control step, therapists who have been grouped into 8 clusters will be randomly allocated to training at 6-month intervals, until all participating therapists have received training in CBT-TS. Throughout this time, TYPPEX will collect routine clinical data including a short screening tool for PE (Community Assessment of Psychic Experiences; CAPE P-15) to assess cluster-level recovery rates before and after CBT-TS training. Health economics data will be collected to assess the cost-effectiveness of the training package. Once recruitment has closed, people with CMD-PE will be followed up for 12 months.