New research conducted in the UK shows promising results for social recovery therapy for people experiencing a first-episode of psychosis. The intervention was designed to support individuals who do not respond well to standard early intervention services. The study suggests that adding social recovery therapy to early intervention services significantly increases social functioning.
“Addressing these issues at an early stage is key because the presence of persistent early social decline is associated with a poor long-term course of schizophrenia,” the authors write.
Past research has shown decreased levels of social functioning in persons who experience psychosis. The current treatments for first-episode psychosis are provided in early intervention clinics. Early intervention services for first-episode psychosis aim to address deficits in multiple domains of functioning and symptoms of psychosis, including social functioning.
The authors of this study highlight that while early intervention services have proven to increase rates of recovery in social functioning to between 40-60%, many individuals continue to show deficits in social functioning after 12 months of early intervention services.
The authors of this study were interested in developing an intervention that addresses a “wider construct of social recovery,” expanding on the typical focus that is placed on obtaining paid employment in interventions within early intervention clinics. After developing a social recovery therapy, a randomized controlled trial (RCT) was conducted to assess its efficacy.
This RCT was carried out in four early intervention clinics. They compared social recovery therapy plus early intervention services to early intervention services alone. Seventy-six participants were included in the social recovery therapy plus intervention services group, and seventy-nine participants received early intervention services alone. All participants received early intervention services which included: intensive and assertive recovery-oriented case management, supported employment, peer support, group interventions, family work and CBT for psychosis, psychiatric medications, and psychiatric monitoring.
Those in the intervention group received social recovery therapy, which is made-up of three stages. Stage one is the engagement and formulation period, which focuses on developing the therapeutic relationship, goals, and assessing current levels of functioning and motivation. In stage 2, the client and therapist work on identifying how the client will engage in new activities, developing a sense of agency, and addressing other barriers to completing the new activities (e.g., shame, stigma). In stage 3, the client engages in the new activities, and the therapist provides support, addressing any problems that may arise. This involves working with the community, with family members, employers, and education providers when needed. Social disability was measured as engagement in less than 30 hours per week of structured activity. The primary outcome was time spent in structured activities at nine months.
Outcomes were assessed at baseline, nine months (post-intervention), and 15 months (6-month follow-up). The primary outcome – “time spent in structured activities” – was measured using the “Time Use Survey.” This survey assesses time spent over the past month on work, education, voluntary work, leisure, sports, housework or chores, and child care.
Results demonstrated that adding social recovery therapy to early intervention services is associated with a significant increase in structured activity. Those in the social recovery group saw an improvement of more than 8 hours/week in structured activity compared to those who only received early intervention services. At nine months, 7% of cases had missing data, at 15 months 16% of participants overall were missing data.
Diminished levels of social functioning are associated with poorer long-term outcomes for people diagnosed with psychotic disorders. These researchers developed and assessed the efficacy of an additive intervention to support social functioning for patients who are at risk of poor long-term outcomes.
This study provides evidence that social recovery therapy may be an effective intervention for improving functional outcomes in people with first-episode psychosis. However, given the high percentage of missing data, further research is needed to determine the long-term effects of the intervention.
Fowler, D., Hodgekins, J., French, P., Marshall, M., Freemantle, N., McCrone, P., … & Singh, S. (2017). Social recovery therapy in combination with early intervention services for the enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial. The Lancet Psychiatry. (Link)