Table 3 Characteristics of recovery focused interventions

Farhall et al., 2009 Australia

Recovery concept: recovery.

Main content: the recovery therapy intervention is a form of CBTp, which focuses on agreed recovery goals using one or more recovery therapy components such as everyday coping, working with symptoms, understanding experience of psychosis, strengthening adaptive view of self, personal/emotional issues or comorbid disorders, relapse prevention, and family or social reintegration.

RCT

94 total

45 intervention

49 control

Recovery therapy (CBTp) + TAU

Individual

12–24 sessions

TAU

9 months

Primary measures: PANSS; HADS.

Secondary measures: RSE; Self Report Insight Scale; LSP.

No statistically significant differences between CBTp + TAU and TAU.

Weak

Fowler et al., 2009 The UK

Recovery concept: social recovery.

Main content: stage one involved formulation of the person in social recovery as well as identifying day-to-day meaningful personal goals to address motivation and hopelessness. Stage two involved identifying and working towards medium- to long-term goals and promotion of a sense of agency and addressing hopelessness, feelings of stigma and negative beliefs about self and others. Stage three involved the active promotion of social activity, work, education and leisure linked to meaningful goals, while managing symptoms of anxiety and low-level psychotic symptoms.

CCT*

77 total

35 intervention

42 control

Social Recovery Cognitive Behaviour Therapy (SRCBT) + TAU

Mean of 12 sessions

TAU

No follow up

Primary measures: Time Use Survey

Secondary measures: PANSS; BHS; QLS;

Tertiary assessments: BDI-II; BAI; SOFAS; CAN.

No main effects of CBT treatment for any of the outcome variables for the total sample.

Global scores:

Non-affective psychosis group improved on PANSS.

Non-affective psychosis group improved on constructive economic activity and structured activity (Time Use Survey).

Moderate

Grant et al., 2012

The USA

Recovery concept: the Recovery Movement with central features referring to goal-directed framework, personalized and person-oriented therapeutic approach highlighting the patients’ interests, assets, and strengths.

Main content: initial sessions focused on enhancing the therapeutic relationship and stimulating patients’ interest and motivation to focus respectively on achievable goals. Impediments to goals achievement were also addressed in the later phases of the intervention.

RCT

60 total

31 intervention

29 control

Cognitive Therapy plus standard treatment (ST)

Flexible

Standard treatment (ST)

6 months;

12 months;

18 months.

Primary measures: GAS.

Secondary measures: SANS, SAPS.

Mental functions:

Avolition-apathy (SANS) across the trial

Global scores:

Positive symptoms (SAPS) across the trial.

Global functioning (GAS) across the trial.

Moderate

Johns et al., 2015

The UK

Recovery concept: recovery referred to as “living a satisfying, hopeful and contributing life even with limitations caused by the illness” and “having a sense of purpose and direction”.

Main content: the authors described the interventions as compatible with conceptualizations of recovery. The intervention promoted psychological flexibility (a more accepting, mindful, and de-fused approach) in response to symptoms of psychosis and associated emotions/thoughts, in order to help the person act in accordance with their personal values.

Pre + post

89 total

Acceptance and Commitment Therapy

Group

4 sessions,

one optional telephone session

No control group

20 weeks

The Sheehan Disability Scales, HADS, AAQ-II, CFQ, SMQ.

Mental functions:

Mood over time (HADS)

Global scores:

Functioning over time (The Sheehan Disability Scales)

Other:

Processes targeted by the intervention (AAQ-II, CFQ, SMQ).

Weak

Laithwaite et al., 2009

The UK

Recovery concept: recovery.

Main content: a recovery intervention was based on the compassionate mind training. During the first module of the intervention participants were encouraged to think about their recovery beyond symptom reduction and as a journey of experience. Further modules targeted compassion with reference to working on strength, acceptance, forgiveness as well as developing the ideal friend. The last module focused on developing plans for recovery after psychosis.

Pre + post

19 total

Compassionate mind training (CMT)

Group

20 sessions

No control group

6 weeks

Primary measures: SCS, OAS, SeCS, BDI-II, RSE, SIP-AD. Secondary measures: PANSS.

Mental functions:

Depression (BDI-II)

Global scores:

General psychopathology (PANSS)

Personal factors:

Comparisons to others (SCS), self-esteem (RSE), external shame (OAS).

Weak

Study

(country)

Recovery

Study design

n

Intervention group

Control group

Follow up

Outcome measures

Impact on disability

Quality of rating

Penn et al., 2011

The USA

Recovery concept: illness management and functional recovery.

Main content: the program placed an emphasis on personal goal pursuit to foster optimism and self-esteem, targeted malleable factors that may enhance recovery such as residual symptoms and substance use, and enlists external social support to maximize therapeutic gains and engagement. The intervention consisted of four phases: engagement and wellness management; substance use; persistent symptoms; and functional recovery.

RCT

46 total

23 intervention

23 control

Graduated Recovery Intervention Program (GRIP) (CBT) + TAU

Individual

36 sessions

TAU

3 months

Primary outcomes: QLS; RFS, MCAS; SSPA.

Secondary outcomes: the PANSS; CDSS; subscales from the Scales of

Psychological Well-Being; MSPSS; AUS; DUS; BEMIB.

Activity and participation domain: Work functioning at follow-up (RFS)

Within-group analysis

Mental functions:

Depression (CDSS) across the trial

Activity and participation domain:

Extended social network (RFS) across the trial

Global scores:

Total role functioning (RFS) across the trial

Personal factors:

Social competence (MCAS) across the trial

Weak

Williams et al., 2014

The UK

Recovery concept: the recovery model described as building a meaningful and satisfying life defined by the person themselves, focusing upon strengths and wellness not illness and pathology, a sense of hope, and possibility of change, promotion of self-management and personal identity (not patient identity), the therapeutic relationship being one of partnership not “expert-patient”; and encouragement of group members to help each other in recovery.

Main content: The intervention was delivered in five modules. The first one focused on engagement and treatment preparation, module two on individual analysis of the person and schizophrenia, module three understanding and managing positive symptoms, module four maximizing mental health and module five reviews of personal aims and goals, reinforcement of protective factors, development of a detailed relapse recognition and staying well plan as well as discussion of future directions.

CCT

47 total

30 intervention

17 control

Cognitive-behavioural therapy

Individual and group

35 planned sessions

TAU

No follow up

SAPS, SANS, PSYRATS, DASS, IIP.

Mental functions:

Delusions (SAPS)

Hallucinations (SAPS)

Affective flattening (SANS)

Alogia (SANS)

Anhedonia (SANS)

Avolition (SANS)

Depression (DASS)

Anxiety (DASS)

Overall interpersonal problems (social inhibition and self-sacrifice) (IIP)

Moderate