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The field of mindfulness practice and research has expanded over recent years and become more established in the public consciousness. In this paper we explore four key tensions for the mindfulness community to hold in awareness. These include: Mindfulness for me vs. mindfulness for others (an awareness of the loss of the spiritual and collective elements historically essential to mindfulness), Mindfulness for some vs. mindfulness for all (understanding why mindfulness may be more appealing for some more than others), The whole vs. the sum of its parts (the need to understand the mechanisms of mindfulness and still preserve its integrity), and Improving access vs. preserving fidelity (balancing modifications to address issues such as accessibility with retaining core components). Recognising such challenges is a vital aspect of ensuring that mindfulness researchers and practitioners continue to work in a way that retains authenticity and trust within this burgeoning field and helps to support engagement from a diverse range of people across the modern world.

ObjectivesWe aim to investigate the effects of directly manipulating response style to simulated voice hearing on subjective distress and sustained attention in a non-clinical population. Specifically, we aim to test the effect of mindful acceptance, where voices are accepted with a sense of kindliness without attempting to change them, compared to attentional avoidance, where participants will attempt to avoid listening to the voices.DesignA between subjects design with one independent variable, response style (with two levels: mindful acceptance vs attentional avoidance). The dependent variables are subjective distress which is the primary outcome and performance on the continuous performance task which is the secondary outcome (reaction times and rate of correct responses).MethodsParticipants will be randomly assigned to one of two response styles (mindful acceptance versus attentional avoidance). They will complete a computerised attention task whilst listening to a simulation of negative voice hearing, delivered via headphones. Participants will rate their experience of anxiety and distress before and after completing the sustained attention task which will be used to measure their accuracy and response times. ResultsWe will test whether participants in the attentional avoidance group will have higher post-test distress and anxiety scores, and a higher error rate and slower response time, compared to the mindfulness acceptance group. ConclusionsWe will interpret the results in relation to theories of mindfulness for psychosis which predict that a more mindful accepting response style would lead to less distress and functional impairment for people who hear distressing voices.

Background International clinical practice guidelines commonly recommend the provision of psychological therapies for psychosis and schizophrenia as an adjunct to medication. However, access to recommended therapies in routine clinical practice is limited. The aim of this review was to synthesise the available data on the provision of recommended psychological therapies for psychosis and schizophrenia across international mental health systems. Methods Electronic databases (PsychINFO, Pubmed and EMBASE) were searched for audits, service evaluation projects, or surveys, which reported data on rates of offer or receipt of any recommended psychological therapy or therapeutic intervention as part of routine clinical care. Results Twenty-two eligible studies from 9 countries were identified (N participants = 79,407). The most commonly recommended therapies in national guidelines were Cognitive-Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI). The overall pooled prevalence of rate of receipt of CBTp was 24% [95% CI 0.15–0.32] based on 15 studies (N = 42,494), with a higher rate of receipt of therapy found when pooling data from Early Intervention services only (41% [95% CI 0.21–0.60], 6 studies, N = 11,068). The overall pooled prevalence of rate of receipt of FI was 30% [95% CI 0.22–0.37] based on 14 studies (N = 13,863). Conclusions Overall rates of receipt of recommended psychological therapies for psychosis were low across the 9 countries data were available for in this review. However, there were high rates of heterogeneity across studies, meaning that pooled estimates should be interpreted with caution. Sources of heterogeneity included different service settings (e.g. early intervention vs. non-early intervention services), and varying methods used to collect the data (e.g. audit of electronic health records vs. self-report etc.). There were no available data from the continents of South America, Asia, or Africa, meaning that a truly global picture of provision of psychological therapies for psychosis and schizophrenia is currently lacking.

Research has suggested people who hear voices may be at risk of epistemic injustice. This is a form of discrimination whereby someone is unfairly judged to be an unreliable knower (testimonial injustice) or is unable to contribute to, and therefore access, concepts that make sense of their experience within mainstream society (hermeneutical injustice). Voice-hearing occurs both in people who are mental health service users and in the general population (clinical and non-clinical voice-hearers, respectively). The degree of distress and impairment associated with voices has been shown to relate to how individuals make sense of their experiences and how others respond to their identity as a voice-hearer. The aim of this study was to explore people's experiences of epistemic injustice in relation to voice-hearing and to understand how these may differ between clinical and non-clinical voice-hearers.A qualitative design was used.Eight clinical and nine non-clinical voice-hearers partook in semi-structured interviews, which were analysed using thematic analysis.Three pairs of themes related to (i) identity, (ii) relationships and (iii) power and position were constructed across the clinical and non-clinical groups, and two shared themes within both groups were created relating to testimonial and hermeneutical injustice.Both clinical and non-clinical voice-hearers described experiencing epistemic injustice in wider society. The presence of a 'safe haven' (e.g. spiritualist churches) for non-clinical voice-hearers ameliorated the impact of this to some degree, by allowing people to make connections with others with similar experiences within a non-judgemental and accepting community.

BACKGROUND Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP (‘Successful Treatment of Paranoia’). OBJECTIVE 1) take a user-centered approach to create and evaluate paranoia-relevant item content to be used in STOP with input from experts by experience, clinicians, and academics, and 2) engage with experts by experience to pilot test and evaluate feedback from STOP mobile app prototype METHODS We invited people with lived experience of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated by experts by experience, clinicians, and academics for paranoia severity, readability, and length. Items were evenly distributed into six, 40-item sessions. Finalized items were presented in the STOP mobile app and user acceptance was evaluated across two pilot tests involving experts by experience. RESULTS All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity, readability, and length of the scenarios, and there was no systematic difference between intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users’ ratings of complexity, attractiveness, and interest, between intervention and control group materials. User acceptance testing of the mobile app found the application easy to use and navigate, interactive, and helpful. CONCLUSIONS Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple stakeholders. Appropriate user-centered development can create user-friendly mobile health applications, which have good face validity, and have a greater chance to be engaging and acceptable to the target end users.

INTRODUCTION: Improving Access to Psychological Therapies (IAPTs) Services could offer smoking cessation treatment to improve physical and psychological outcomes for service users, but it currently does not. This study aimed to understand participants' views and experiences of receiving a novel smoking cessation intervention as part of the ESCAPE trial (intEgrating Smoking Cessation treatment As part of usual Psychological care for dEpression and anxiety). We used the Capability, Opportunity and Motivation Model of Behaviour (COM-B) to understand the (i) acceptability of the integrated smoking cessation treatment, (ii) views of psychological well-being practitioners' (PWPs) ability to deliver the smoking cessation treatment and (iii) positive and negative impacts of smoking cessation treatment.METHODS: This was a qualitative study embedded within a feasibility randomized-controlled trial (ESCAPE) in primary care services in the United Kingdom (IAPT). Thirty-six participants (53% female) from both usual care and intervention arms of the ESCAPE trial, including both quitters and nonquitters, were interviewed using semi-structured interviews. Data were analysed using a framework approach to thematic analysis, using the COM-B as a theoretical frame.RESULTS: Psychological Capability: Integrated smoking cessation treatment was acceptable and encouraged participants to reflect on their mental health. Some participants found it difficult to understand nicotine withdrawal symptoms.MOTIVATION: Participants were open to change during the event of presenting to IAPT. Some described being motivated to take part in the intervention by curiosity, to see whether quitting smoking would help their mental health. Physical Opportunity: IAPT has a natural infrastructure for supporting integrated treatment, but there were some barriers such as session duration and interventions feeling segmented. Social Opportunity: Participants viewed PWPs as having good interpersonal skills to deliver a smoking cessation intervention.CONCLUSION: People with common mental illness generally accepted integrated smoking cessation and mental health treatment. Smoking cessation treatment fits well within IAPT's structure; however, there are barriers to implementation.PATIENT OR PUBLIC CONTRIBUTION: Before data collection, we consulted with people with lived experience of smoking and/or mental illness and lay public members regarding the aims, design and interview schedules. After analysis, two people with lived experience of smoking and mental illness individually gave feedback on the final themes and quotes.

Background It is essential to conduct randomised controlled trials of psychological interventions on acute psychiatric wards to build a robust evidence base for clinical practice. Aims This paper aims to share strategies from three different in-patient trials that successfully recruited and retained participants, to disseminate good practice for the conduct of future trials in this challenging and complex clinical setting. Method We present strategies from three in-patient trials of psychological interventions: TULIPS (Talk, Understand, Listen for Inpatient Settings), amBITION (Brief Talking Therapies on Wards) and INSITE (Inpatient Suicide Intervention and Therapy Evaluation). All studies recruited participants from acute in-patient wards, initiated therapy within the in-patient setting and followed up on participants post-discharge. Results We summarise our recommendations for good practice in the form of ten top tips for success, based on our collective experience of conducting trials on psychiatric wards. Key themes relate to the importance of relationships between the research team and clinical staff; good stakeholder involvement and getting early buy-in from the team; and adapting to the particular demands of the clinical setting. Conclusions Sharing good practice recommendations can help reduce research waste arising from poor recruitment and/or retention in future in-patient clinical trials.

Cognitive Behavioral Therapy for psychosis (CBTp) is a psychological therapy recommended for people with psychosis which can start in the acute phase. However, there is not consensus on how CBTp should be delivered in an acute mental health inpatient setting. This study aimed to gain consensus from therapists on how CBTp should be delivered in this context. A 2-stage Delphi study was conducted to establish consensus on what the core components are of inpatient CBTp from the perspective of therapists who are experts in the field. Forty-five therapists took part in 2 rounds of rating statements on the areas of engagement and feedback, assessment and model, formulation, change strategies, homework, and principles and values. A final list of 114 statements were included, which were rated as essential or important by ≥80% of respondents. The delivery of inpatient CBTp is dependent on several adaptations to traditional CBTp including indirect work, being more flexible with session content and delivery, and making adaptations to the restrictive environment. These recommendations could inform training, competency frameworks, and delivery of CBTp in inpatient settings.

AimEmotional stress reactivity may be a mediating factor in the association between trauma and psychosis. This review aimed to (i) identify, summarise and critically evaluate the link between emotional stress reactivity and psychotic experiences (ii) examine evidence for a 'dose–response' relationship between stress reactivity and psychosis in the wider psychosis phenotype (i.e., sub-clinical symptoms).MethodsElectronic database searches (PsychINFO, MEDLINE, EMBASE) were conducted for studies which investigated the link between stress reactivity and psychosis, psychotic symptoms, or a vulnerability to developing psychosis (wider phenotype). Cross-sectional, experimental and experience sampling method study designs were eligible for inclusion.ResultsFourty five eligible articles were identified (N participants = 8830). Narrative synthesis showed that increased emotional stress reactivity was associated with psychosis and subclinical psychotic experiences across all study designs, however, findings were inconsistent across studies. The preliminary meta-analysis (k = 4, n = 383) showed increases in emotional stress reactivity was associated with higher negative affect in response to event-related stress, in those with psychosis compared to controls (mean difference in beta coefficients = 0.05, 95% CI 0.02–0.08, p = .004). However, this difference was small with a considerable degree of heterogeneity (p = .001, I2 = 81%) so results should be interpreted with caution.ConclusionsOverall, the evidence suggests that there is a link between emotional stress reactivity and psychosis in those with psychosis, those at high risk of developing psychosis and in relation to subclinical psychotic-like experiences in the general population.

ObjectiveTo compare the outcomes in published core outcome sets with the outcomes recommended in corresponding guidance documents from the European Medicines Agency (EMA) and US Food and Drug Administration (FDA), matched by health condition.DesignCross sectional analysis.SettingUS and Europe.PopulationSample of core outcome sets related to drugs, devices, and gene therapy that involved patients in the consensus process, published between 1 January 2015 and 31 December 2019; and corresponding EMA and FDA guidance documents.Main outcome measuresThe extent of matches between outcomes included within core outcome sets and those recommended in corresponding EMA and FDA guidance documents were assessed. Matches were considered to be general (ie, non-specific) or specific (ie, exact). General matches were assessed to determine whether the core outcome set or guidance document outcome was narrower.ResultsRelevant guidance documents were found for for 38 (39%) of 98 eligible published core outcome sets. Among outcomes in core outcome sets, medians of 70% (interquartile range 48-86%) and 52% (33-77%) were matches with outcomes recommended in EMA and FDA documents, respectively. Medians of 46% (27-68%) and 26% (18-46%) were specific matches with outcomes in EMA and FDA documents, respectively. When outcomes were generally matched, the outcomes from core outcome sets were more frequently narrower than the regulatory outcomes (83% and 75% for EMA and FDA, respectively).ConclusionGreater adoption of, and reference to, core outcome sets in regulatory guidance documents can encourage clinical trialists, especially those in industry, to measure and report consistent and agreed outcomes and improve the quality of guidance. Given the overlap between outcomes in core outcome sets and regulatory guidance, and given that most core outcome sets now involve patients in the consensus process, these sets could serve as a useful resource for regulators when recommending outcomes for studies evaluating regulated products. Developers are encouraged to appraise recommended outcomes in salient regulatory documents when planning a core outcome set.

Background: The COMET Initiative promotes the development and use of ‘core outcome sets’ (COS), agreed standardised sets of outcomes that should be measured and reported in all studies in a particular clinical condition. COS are determined by consensus amongst key stakeholders, including health professionals, policymakers and patients, ensuring that the priorities and expertise of these representatives inform the choice of the most important outcomes to measure for a given condition. There is increased recognition of the need to integrate COS across the healthcare system and with existing regulatory apparatus, to ensure that outcomes being recorded are those of key relevance to important stakeholders. The aim of this study is to assess the degree of concordance between outcomes recommended in COS for research and in guidance provided by two key regulators: US Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Methods: COS for research published during 2015-2019 with patient involvement and covering drug or device interventions will be compared against relevant regulatory guidelines, matched by condition. Guidance documents matching in scope (relating to intervention and population) to a COS for research will be scrutinised to identify all suggested outcomes for comparison against the core outcomes in the corresponding COS. Discussion: This study will identify variation between outcomes suggested in FDA and EMA regulatory guidance relative to outcomes included in published COS for research, thus demonstrating the degree of representation of COS in regulatory guidance and vice versa. We will share the study findings (in particular, highlighting any lack of concordance between COS and regulatory guidance overall or for particular disease areas) and will invite feedback from FDA and EMA; we will seek to highlight where findings support the recommendations towards using well-developed COS or will make recommendations to COS developers on outcomes of importance to these key regulators.

Many individuals have positive experiences of voice-hearing (VH). However, current assessment tools do not capture positive aspects of VH as comprehensively as they do negative aspects. This may li...

Aim: An initiative was proposed to integrate local hearing voices groups within statutory adult mental health services in a particular NHS Trust. The aim of this service evaluation project was to assess clinician’s attitudes towards, and understanding of the groups to better inform the proposal. Methods: Multi-disciplinary NHS staff members were invited to participate in a brief survey on their attitudes towards, and understanding about hearing voices groups. The survey was co-produced with people with lived experience of hearing voices, and local mental health professionals. Content analysis was used to analyse qualitative data from an additional free text section of the survey. Results: Forty mental health professionals responded to the survey. There was majority consensus (>50% agreement) on all items relating to perceived benefit of hearing voices groups. The findings also showed that only 25% of respondents felt they were aware of the evidence base for hearing voices groups, and only 30% felt confident explaining hearing voices groups to service users. Conclusions: The data suggests that the majority of mental health professionals hold positive attitudes towards hearing voices groups. However, many mental health professionals expressed uncertainty about the evidence base and discussing the groups with service users, highlighting further training needs in these areas.

Objective: Being admitted to a psychiatric ward can be a distressing and confusing experience. Our objective was to develop and pilot a Timeline Tool as a way of supporting service users in developing a narrative of their experiences in the run up to admission. Method: We designed and piloted a ‘Timeline of Crisis Tool’ with 50 service users, incorporating a card sort exercise, comprising eight factors relevant to people’s experiences in the run up to a crisis admission. We asked service users for feedback on the experience of completing the Timeline Tool. Results: Service user feedback indicated advantages of completing the Timeline Tool in terms of feeling listened to and respected, reflecting and making sense of experiences. Discussion: Collaborative completion of the Timeline Tool on admission could help foster good service user-staff relationships. Information arising from the completed tool could be used to increase shared decision-making in the development of care plans during inpatient admissions.

BBackground. Under the S136 of the UK Mental Health Act, people experiencing a mental health crisis may be taken to a locally agreed location (Place of Safety) by police for urgent assessment. Research has shown that mental health professionals (MHPs) face high levels of burnout, but we know very little about the particular challenges staff who work in extreme clinical settings such as a Place of Safety service face. Aim. This study aimed to fill this gap by exploring the wellbeing experiences of staff in a Place of Safety service. Method. A mixed-methods approach was used, with quantitative data on job satisfaction (Job Satisfaction Survey) and burnout (Maslach Burnout Inventory-Human Services Survey) and qualitative data from focus groups. Purposive sampling was used. Qualitative data was analysed using thematic analysis and descriptive statistics were calculated for the quantitative data. Results. Twenty staff scored within the moderate range for emotional exhaustion, depersonalisation and personal accomplishment, and in the satisfied range for job satisfaction. Three overarching themes were identified: i) united as insiders, ii) surviving and thriving, and iii) narratives of coping. Conclusions. Despite unique setting-related stressors, participants showed comparable levels of wellbeing to other MHPs. Implications are discussed.

Background There is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to (1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and (2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes. Methods A new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation ‘taster’ session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions. Results A high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation ‘taster’ session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group. Conclusions Offering service users with psychosis the opportunity to attend a mindfulness for psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning.

Objectives: Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to 1) review the existing evidence on how much home practice people do in Mindfulness for Psychosis groups, and 2) explore participants’ experiences of the barriers and facilitators to completing home practice in a Mindfulness for Psychosis group using a qualitative study.Methods: In study 1, we conducted a systematic review of Mindfulness for Psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a Mindfulness for Psychosis group (N=5) as part of their routine community care, specifically focusing on experiences of home practice.Results: Out of twenty-two studies included in the systematic review, only 4 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis.Conclusions: We recommend that future Mindfulness for Psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of a Mindfulness for Psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.

SummaryMindfulness-based therapies are increasingly available for a range of mental disorders, such as depression and anxiety. However, there remain concerns that mindfulness has the potential to exacerbate psychosis, despite a growing body of literature demonstrating effectiveness. These concerns may relate to long-standing perceptions about the suitability of offering psychological therapies to people with psychosis.

Objectives The aim of the study was to assess the convergent and divergent validity, reliability, utility, and treatment sensitivity of a newly translated German version of the Southampton Mindfulness Questionnaire (SMQ). The SMQ is a 16-item instrument measuring mindful awareness of distressing thoughts, images, and perceptions, developed originally within the mindfulness for psychosis field. Methods Overall, three studies were conducted, comprising (1) a non-clinical sample of n = 848 (638 community sample and 210 meditators); (2) a clinical sample of n = 213 (106 schizophrenia and 107 depression); and (3) a clinical sample with n = 122 participants with emotional disorders within a randomized controlled study, of which 30 participants were also included in study 2. To assess convergent validity, participants completed the SMQ, Freiburg Mindfulness Inventory (FMI), and Comprehensive Inventory of Mindfulness Experiences (CHIME). To measure divergent validity, participants completed the Brief Symptom Inventory 18 (BSI-18), Positive and Negative Affect Schedule (PANAS), Brief Experiential Avoidance Questionnaires (BEAQ), and Anxiety Sensitivity Index 3 (ASI-3). Results Mean internal consistency (α = 0.89) and convergent (r = 0.66 to 0.73) and divergent validity (r = − 0.09 to − 0.50) were established and sensitivity to change over time following treatment (d = 0.86) was shown. For the clinical sample, a single-factor structure is suggested by principal component analysis. Conclusions Results provide first evidence for the utility of the German version of the SMQ for clinical practice and research in healthy individuals, meditators, and clinical groups. Further research is needed to examine the underlying construct of mindfulness.

Objectives The objective of this study was to develop and pilot a standard framework that could be used to assess risk of contamination in psychological therapy trials, at the protocol development stage. Study Design and Setting We developed and piloted a risk of contamination framework on a sample of 100 psychological therapy trial protocols registered on the International Standard Randomised Controlled Trial Number (ISRCTN) registry ( www.isrctn.com ). We assessed all protocols as being low or high risk via three possible sources of contamination: 1) participants in the control arm, 2) participants in the intervention arm, 3) therapists in the intervention arm. Results Overall, we found that the risk of contamination across all three sources was low for most studies (86 of 100 trial protocols; 86%). We identified 14 studies that had a potentially high risk for contamination. Most of these (N = 10) were identified as risk of contamination arising from a therapist in the intervention arm. Conclusion The risk of contamination framework we piloted in this study could be a helpful tool for researchers aiming to identify and manage risk of contamination in their trial protocol development. We found that the risk of contamination was relatively low in the psychological therapy trials we sampled for this study, as measured by our framework, and could usually be mitigated through reasonable adjustments to the study design.

BackgroundHearing voices can be a distressing and disabling experience for some, whilst it is a valued experience for others, so-called ‘healthy voice-hearers’. Cognitive models of psychosis highlight the role of memory, appraisal and cognitive biases in determining emotional and behavioural responses to voices. A memory bias potentially associated with distressing voices is the overgeneral memory bias (OGM), namely the tendency to recall a summary of events rather than specific occasions. It may limit access to autobiographical information that could be helpful in re-appraising distressing experiences, including voices.MethodsWe investigated the possible links between OGM and distressing voices in psychosis by comparing three groups: (1) clinical voice-hearers (N = 39), (2) non-clinical voice-hearers (N = 35) and (3) controls without voices (N = 77) on a standard version of the autobiographical memory test (AMT). Clinical and non-clinical voice-hearers also completed a newly adapted version of the task, designed to assess voices-related memories (vAMT).ResultsAs hypothesised, the clinical group displayed an OGM bias by retrieving fewer specific autobiographical memories on the AMT compared with both the non-clinical and control groups, who did not differ from each other. The clinical group also showed an OGM bias in recall of voice-related memories on the vAMT, compared with the non-clinical group.ConclusionsClinical voice-hearers display an OGM bias when compared with non-clinical voice-hearers on both general and voices-specific recall tasks. These findings have implications for the refinement and targeting of psychological interventions for psychosis.

Persecutory and grandiose delusions are the most commonly reported sub-types of delusions within inpatient populations. However, little is known about whether clinical profiles might differ between these sub-types, within a sample of patients who agree to engage in a psychological therapy during an acute inpatient admission. We report data on 41 participants who took part in the amBITION study, a randomised controlled trial of a brief talking therapy for psychosis on inpatient wards. Participants with persecutory and grandiose delusions were compared on i) clinical and demographic profiles, ii) psychotic and affective symptoms, and iii) inpatient treatment received (both psychological and pharmacological). Average ratings of frequency of delusions and believability/conviction at the start of therapy were similar between those with persecutory and grandiose delusions. Number of therapy sessions completed, satisfaction with therapy, and medication received, was similar between both groups. Our findings indicate that people with persecutory or grandiose delusions may report distress associated with their experiences, and so be willing to engage in a psychological therapy.

We developed and piloted a simple framework, to help people identify contamination risk when writing protocols for psychological therapy trials. Contamination means people in the control arm getting the treatment, or aspects of the treatment, intended for people in the intervention arm. We tested the framework out on 100 trial protocols registered on the ISRCTN trial registry (isrctn.com). We found that only 14 out of the 100 protocols we looked at had a potential risk of contamination via any of the sources identified in the framework. Most of these trial protocols had already identified the potential contamination risk and had put in place appropriate design adaptations to help guard against the risk.

Background: There is an emerging evidence base that mindfulness for psychosis is a safe and effective intervention. However, empirical data on the within-session effects of mindfulness meditation was hitherto lacking. Aims: The aim of the study was to assess the impact of taking part in a mindfulness for psychosis group, using a within-session self-report measure of general stress, and symptom-related distress. Method: Users of a secondary mental health service (n = 34), who experienced enduring psychotic symptoms, took part in an 8-week mindfulness for psychosis group in a community setting. Mindfulness meditations were limited to 10 minutes and included explicit reference to psychotic experience arising during the practice. Participants self-rated general stress, and symptom-related distress, before and after each group session using a visual analogue scale. Results: Average ratings of general stress and symptom-related distress decreased from pre- to post-session for all eight sessions, although not all differences were statistically significant. There was no increase in general stress, or symptom-related distress across any session. Conclusions: There was evidence of positive effects and no evidence of any harmful effects arising from people with psychotic symptoms taking part in a mindfulness for psychosis session.

Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. Brief inpatient talking therapies for psychosis could help reduce re-admission rates. The primary aim was to assess feasibility and acceptability of a novel, brief, mindfulness-based intervention for inpatients with psychosis. The secondary aim was to collect pilot outcome data on readmission rate, at 6 and 12 months (m) post discharge, and self-report symptom measures at 6 m. The amBITION study (BrIef Talking therapIes ON wards) was a parallel group, feasibility randomised controlled trial (RCT). In addition to treatment as usual (TAU), eligible inpatients with psychotic symptoms were randomly allocated to receive either (Mindfulness-Based Crisis Intervention; MBCI) or a control intervention (Social Activity Therapy; SAT), for 1–5 sessions. Fifty participants were recruited (26 MBCI; 24 SAT); all received at least 1 therapy session (mean = 3). Follow-up rates were 98% at 6 m and 96% at 12 m for service use data extracted from clinical notes, and 86% for self-report measures. At 6 m follow-up, re-admission rates were similar across groups (MBCI = 6, SAT = 5; odds ratio = 1.20, 95% CI: 0.312–4.61). At 12 m follow-up, re-admissions were lower in the MBCI group (MBCI = 7, SAT = 11; odds ratio = 0.46, 95% CI: 0.14–1.51). Three participants experienced adverse events; none was related to trial participation. Delivering a brief mindfulness-based inpatient intervention for psychosis is feasible and acceptable, and may reduce risk of short-term readmission. These promising findings warrant progression to a larger clinical effectiveness trial. ISRCTN37625384.

Objectives The Consolidated Standards of Reporting Trials extension for the stepped-wedge cluster randomized trial (SW-CRT) is a recently published reporting guideline for SW-CRTs. We assess the quality of reporting of a recent sample of SW-CRTs. Study Design and Setting Quality of reporting was asssessed according to the 26 items in the new guideline using a novel crowd sourcing methodology conducted independently and in duplicate, with random assignment, by 50 reviewers. We assessed reliability of the quality assessments, proposing this as a novel way to assess robustness of items in reporting guidelines. Results Several items were well reported. Some items were very poorly reported, including several items that have unique requirements for the SW-CRT, such as the rationale for use of the design, description of the design, identification and recruitment of participants within clusters, and concealment of cluster allocation (not reported in more than 50% of the reports). Agreement across items was moderate (median percentage agreement was 76% [IQR 64 to 86]). Agreement was low for several items including the description of the trial design and why trial ended or stopped for example. Conclusions When reporting SW-CRTs, authors should pay particular attention to ensure clear reporting on the exact format of the design with justification, as well as how clusters and individuals were identified for inclusion in the study, and whether this was done before or after randomization of the clusters, which are crucial for risk of bias assessments. Some items, including why the trial ended, might either not be relevant to SW-CRTs or might be unclearly described in the statement.

A major barrier to clinicians referring service users with psychosis for psychological therapies is the belief that they will not engage. We investigated therapy receipt after discharge, in a sample of service users who had already demonstrated willingness to engage in psychological therapy during an inpatient admission. Only one-third of service users (33%; 16/48) received at least 1 session of evidence-based therapy at 6-month follow-up after discharge. Therapy receipt was more common for service users with (i) lower delusional distress at discharge, (ii) Black and Minority Ethnic (BME) background, and (iii) discharged to an Early Intervention (EI) service.

We carried out a study on offering people psychological therapy when they were admitted to hospital due to a mental health crisis. We know that psychiatric wards can sometimes be noisy and chaotic places, and so keeping the therapy room private, and therapy sessions uninterrupted can be challenging. As part of the study, we recorded how often therapy sessions on the ward got interrupted by other patients or ward staff, or when patients were called out of therapy sessions early to attend other meetings. We actually found that only a small number of therapy sessions got interrupted (just over 1 in 10; 13%) or ended early (less than 1 in 20; 3%). When sessions were interrupted, most of the time it was ward staff rather than other patients who were doing the interrupting. This information is helpful as it shows that most therapy sessions on wards can be completed as planned. It might be helpful to put in place a few practical steps to help ward staff be more aware when therapy sessions are being held (e.g. Do not Disturb signs on the door of the therapy room) and to remind them of the importance of not disturbing therapy sessions unless it is urgent.

BackgroundPeople with psychotic disorders account for most acute admissions to psychiatric wards. Psychological therapies are a treatment adjunct to standard medication and nursing care, but the evidence base for such therapies within in-patient settings is unclear.AimsTo conduct a systematic scoping review of the current evidence base for psychological therapies for psychosis delivered within acute in-patient settings (PROSPERO: CRD42015025623).MethodAll study designs, and therapy models, were eligible for inclusion in the review. We searched PubMed, PsycINFO, EThOS, ProQuest, conference abstracts and trial registries.ResultsWe found 65 studies that met criteria for inclusion in the review, 21 of which were randomised controlled trials (RCTs). The majority of studies evaluated cognitive–behavioural interventions. Quality was variable across all study types. The RCTs were mostly small (nConclusionsBased on these findings, there is a clear need to improve methodological rigour within in-patient research. Interpretation of the current evidence base is challenging given the wide range of different therapies, outcome measures and models of delivery described in the literature.Declaration of interestNone.

A brief questionnaire was developed to evaluate crisis services. Results showed that it could be used within standard clinical practice and that there was a statistically significant change for participants on the majority of the items.

Cognitive remediation therapy (CRT) is a psychological therapy which has been shown to be effective in improving cognitive functioning in service users with schizophrenia spectrum disorders. There are challenges to routinely implementing CRT within inpatient services due to a limited availability of therapists to deliver it. This paper describes a model of service delivery piloted in a specialist inpatient psychosis service which included health-care assistants (HCAs) working under the supervision of a clinical psychologist to help deliver CRT. The experience of the HCAs in undertaking this work is described from a first-person perspective.

Background: Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. People often need to go into hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings.Methods/Design: The amBITION study is a feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention; MBCI). Inpatients on acute psychiatric wards are eligible for the study if they report at least one positive psychotic symptom, and are willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants will be randomly allocated to receive either MBCI or a control intervention (Social Activity Therapy; SAT) which will be based on doing activities on the ward with the therapist. The primary objective of the study is to find out whether it is possible to carry out this kind of trial successfully within UK inpatient settings and to find out whether patients and staff find it an acceptable intervention. The secondary objective is to collect pilot data on primary and secondary outcome measures, including re-admission rates at 6 month follow-up. This will provide information on the appropriateness of re-admission as the primary outcome measure for future efficacy trials, as well as data on the acceptability and utility of the clinical self-report measures.Discussion: The results of the feasibility trial will indicate whether a subsequent efficacy pilot trial is warranted, and if so, will provide vital information for the planning of such a trial (e.g. pilot data on expected effect sizes). If future research finds that MBCI is an effective and safe intervention, then patients will benefit from access to better treatment within inpatient care which would reduce re-admission rates. This trial therefore addresses an area of urgent concern for service users, clinicians and the wider NHS.Trial Registration: ISRCTN37625384

Individuals reporting persistent psychotic experiences (PEs) in the general population, but without a "need for care", are a unique group of particular importance in identifying risk and protective factors for psychosis. We compared people with persistent PEs and no "need for care" (non-clinical, N=92) with patients diagnosed with a psychotic disorder (clinical, N=84) and controls without PEs (N=83), in terms of their phenomenological, socio-demographic and psychological features. The 259 participants were recruited from one urban and one rural area in the UK, as part of the UNIQUE (Unusual Experiences Enquiry) study. Results showed that the non-clinical group experienced hallucinations in all modalities as well as first-rank symptoms, with an earlier age of onset than in the clinical group. Somatic/tactile hallucinations were more frequent than in the clinical group, while commenting and conversing voices were rare. Participants in the non-clinical group were differentiated from their clinical counterparts by being less paranoid and deluded, apart from ideas of reference, and having fewer cognitive difficulties and negative symptoms. Unlike the clinical group, they were characterized neither by low psychosocial functioning nor by social adversity. However, childhood trauma featured in both groups. They were similar to the controls in psychological characteristics: they did not report current emotional problems, had intact self-esteem, displayed healthy schemas about the self and others, showed high life satisfaction and well-being, and high mindfulness. These findings support biopsychosocial models postulating that environmental and psychological factors interact with biological processes in the aetiology of psychosis. While some PEs may be more malign than others, lower levels of social and environmental adversity, combined with protective factors such as intact IQ, spirituality, and psychological and emotional well-being, may reduce the likelihood of persistent PEs leading to pathological outcomes. Future research should focus on protective factors and determinants of well-being in the context of PEs, rather than exclusively on risk factors and biomarkers of disease states.

Objectives. This study investigated whether a reasoning bias (‘jumping to conclusions’; JTC) found to be associated with higher levels of conviction in delusions is also associated with high-conviction beliefs in obsessive-compulsive disorder (OCD). Design. The experimental design was mixed-effects, with one between-subjects factor of group and one within-subjects factor of task. Methods. Participants were 16 people with high-conviction OCD (≥50%), 16 people with low-conviction OCD (