Photo: The CAMEO team at Chesterton Medical Centre, Cambridge
New intervention aids recovery for challenging mental health condition
A recent discovery spotted in mental health clinics is helping to transform care for patients, shedding light on how to help people manage delusional beliefs effectively.
Health professionals in Cambridgeshire and Peterborough NHS Foundation Trust’s CAMEO Early Intervention Services have developed a novel intervention to support people with delusional disorders, where they have trouble recognising reality, offering hope for recovery from a condition which can be difficult to treat.
Dr Cate Treise has been a clinical psychologist with CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust since 2013, and noticed an unusual set of delusional symptoms in her clinical conversations with a particular group of mental health patients. She investigated further with a multidisciplinary team of experts from the University of Manchester, the University of Cambridge and Norwich Medical School, and shares their findings in a paper published by the prestigious Psychopathology journal.
Cate said: “In my daily clinical work I noticed some patients had a unique pattern of thinking that was difficult to treat, while they had no other psychotic symptoms like voice-hearing or hallucinations, and I was encouraged to explore this further. This new phenomenon involves repetitive unusual beliefs triggered by an overwhelmingly low mood. It’s essentially a response to managing negative emotions, activated by chronic stress or trauma and exacerbated by sleep disruption and other lifestyle factors. Usual coping strategies for mood disorders are disrupted by unhelpful thoughts and very specific delusions – a ‘dissociative thought-script’ which can be resistant to treatment – such as believing taking one anti-psychotic tablet has caused brain damage."
Cate added: “We’ve used the new model to improve communication to patients and families. It’s quite intuitive and offers an easier way to understand the condition, identifying triggers and how the disruptive thought loops arise. My colleagues at CAMEO have been really supportive throughout the whole process, and it’s exciting to formulate new therapeutic approaches with them and apply those with patients and their families. It’s a great environment to practice in, where you are empowered to innovate and do research alongside caring for people in a busy schedule, developing more effective tools to fix the problems we deal with.”
Working with the CAMEO team, Cate was able to adapt existing ideas about dissociation to make psychological treatments, such as Cognitive Behavioural Therapy for psychosis (CBTp) more accessible, allowing people to question beliefs which were previously resistant to treatment. This approach helps to dismantle some of the reasons for emotional difficulties and explain the causal factors to the patient in therapy sessions.
Professor Jesus Perez, lead consultant psychiatrist at CAMEO, and lead clinical director for the NIHR Clinical Research Network Eastern helped Cate with this conceptual study and said: “It’s crucial that staff in our services are supported to share their ideas, they see patients every day and can spot new symptoms and phenomena simply through clinical observation. By developing these ideas we can improve care and treatment, designing more effective approaches to help our patients and their families. The more healthcare professionals do research- especially together across different disciplines, the quicker we can accelerate recovery for very challenging conditions, improving outcomes while increasing understanding and the evidence base underpinning care.”
The new approach has been used with 21 patients to date and the team is looking into scaling it up with a larger group. The conceptual paper from the study has now introduced the idea into the research community for further testing and work in clinical teams around the world. It provides a new model for understanding the mechanisms in delusional disorders and the role of dissociation in psychosis.
A carer said: “Working with Cate and the CAMEO team we have been able to understand how these difficult symptoms flare up, and what we can do to help manage them. It can be really hard to live with this condition, when you don’t understand what is happening and how best to support your loved one. This new approach has really made a difference with some practical tips and exercises that we can be part of, so we don’t feel so powerless anymore.”
CPFT’s CAMEO early intervention service offers help for people in Cambridgeshire and Peterborough aged 14-65 years old who are experiencing symptoms of psychosis for the first time. People can self refer, or speak to a GP, family member or friend to ask them to refer for specialist assessments, advice and support. More information and contact numbers are provided in this leaflet. Anyone registered with a GP in the Cambridgeshire and Peterborough area can also access the Psychological Wellbeing Service by completing an online form that can be found on the Trust’s website. Alternatively, the service can be contacted by calling 0300 300 0055, 9am to 5pm, Monday to Friday (excluding Bank Holidays).
The full journal article is available from Psychopathology online.