Incorporating Social Therapy Into Early Psychosis Intervention Improves Social Engagement

Despite considerable evidence showing the benefit of early intervention services on social recovery in people with first-episode psychosis, many will continue to experience severe and persistent social impairments. A study published yesterday in Lancet Psychiatry suggests that combining early psychosis intervention with social recovery therapy may help to further improve patient outcomes, particularly in individuals who lack the motivation or ability to engage in existing psychosocial interventions.

The social recovery program examined in the study was a three-step approach aimed at (1) establishing a working therapeutic relationship and assessing patient goals, (2) working together to identify ways to initiate meaningful new activities, and (3) engaging in new activities and fostering a sense of mastery and agency in the patient.

David Fowler, M.Sc., of the University of Sussex and colleagues recruited patients aged 16 to 35 with non-affective psychosis who had participated in early intervention services for 12 to 30 months and had low levels of structured activity (defined as ≤30 h/week on the Time Use Survey). Structured activities assessed by the Time Use Survey include work, education, voluntary work, leisure, sports, housework or chores, and child care.

The researchers assigned 155 patients to either early intervention services alone or in combination with social recovery therapy for nine months. 

After nine months, participants who received both psychosis intervention and social therapy engaged in eight more hours of structured activities each week compared with those receiving only early intervention.

“The effect size after treatment is clearly of clinical benefit, especially given the extreme social withdrawal present at baseline,” wrote Fowler and colleagues. They noted that the participants only engaged in around 12 hours of activities per week at baseline. “The size of the effect is twice that identified by consensus groups of users and clinicians as the minimum clinically important difference and represents an amount of activity equivalent to a working day.”

A secondary analysis to see if these improvements persisted six months after the treatments ended (15 months post-baseline) was inconclusive. The authors noted that this may have been due to a high amount of patient dropout after the interventions ended.

For related information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis” and the Psychiatric Services article “Providing Recovery-Oriented Early Intervention Services to Youths Experiencing First-Episode Psychosis.”

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