Change processes in group compassion focused therapy for psychosis
Research type
Research Study
Full title
Building a grounded theory of change processes in group compassion focused therapy for psychosis in relation to stages of recovery.
IRAS ID
336146
Contact name
Megan Crawford
Contact email
Sponsor organisation
Canterbury Christ Church University
Duration of Study in the UK
1 years, 4 months, 1 days
Research summary
Summary of Research
Research indicates high levels of shame and self-criticism in people with experiences of psychosis, which can be a barrier to engaging in traditional cognitive behavioural therapy. Compassion focused therapy (CFT) aims to reduce shame and self-criticism by developing self-compassion through psychoeducation, imagery and mindfulness. Research indicates good acceptability and feasibility of CFT for psychosis, and positive outcomes for self-esteem, self-criticism, mood and psychosis symptoms. Group-based CFT (CFTgp) could be more powerful than an individual format, due to group processes such as normalisation, shared experience and increasing social confidence. Additionally, group-based therapies demonstrate advantages such as cost-reduction, increased access and efficient use of resources.Though research indicates efficacy and acceptability of CFTgp for psychosis, specifically what works for whom remains unknown as individuals may derive different benefits depending on their stage of recovery. For example, given that shame and stigma are associated with lower engagement in individual therapies, processes in CFTgp such as normalisation, reduction of shame and self-criticism may be particularly beneficial for someone who has not yet felt able to engage in individual therapy. Recovery style may also impact therapeutic processes as ‘sealing over’ strategies such as reluctance to explore experiences of psychosis are associated with poorer engagement in therapy. This highlights the need for developing a conceptual framework for how individuals at different stages of recovery can derive therapeutic benefits from CFTgp.
This study’s research questions are:
a. How do service users and therapists describe the process of change from participating in or delivering CFTgp for psychosis?
b. How do people at different stages of recovery describe the process of change that they experienced participating in CFTgp psychosis?
c. How do people describe how the change processes from participating in CFTgp for psychosis relate to previous or subsequent experiences of therapies?
Summary of Results
Summary Given current access issues of psychological therapies for psychosis it is prudent to explore waiting list interventions and group interventions which might be more efficient. There is some evidence for the efficacy of group compassion focused therapy (CFTgp) for psychosis but a lack of clarity regarding who might benefit and when. This study aimed to understanding therapeutic change processes of CFTgp, and how these relate to timing of the group and service user experiences of recovery.10 participants took part in the study; 6 service users who had participated in CFTgp, and 4 therapists who had facilitated CFTgp. Participants were recruited from two NHS psychosis community services. Transcripts of semi-structured interviews were analysed using a critical realist grounded theory approach. A theoretical model was created to capture the experiences of change during and after CFTgp, and how these related to group timing and experiences of recovery. The model depicted five key categories that facilitated therapeutic change.
Readiness for CFTgp was highlighted as important for meaningful therapeutic change. Openness appeared necessary for initial engagement in CFTgp, particularly openness to being in a group. Individuals arrived to CFTgp with varying experiences of previous therapy, social safeness and shame which explained variations in openness and motivations for joining (e.g. seeking social connection, consolidation of previous therapy, seeking opportunity for change).
Experiencing social safeness emerged as a powerful therapeutic change; this captured feeling safe, understood and cared for by others. In the early stages of the group, the role of the facilitators was particularly important for making the group feel safe (meeting members before the group and providing reassurance). Facilitator self-disclosure was also felt to be really important for normalising experiences. As the group progressed, members began to open up and connect, enhancing a sense of belonging and common humanity (e.g. all having ‘tricky brains’). An initial sense of safety was important for working together (e.g. practicing group exercises) and supporting each other when finding things difficult.
Participants noticed changes self-compassion and self-awareness. In particular, participants found CFT theory helpful for make sense of difficulties (e.g. three systems) and finding tools that worked for them (e.g. activating soothing system through breathing, mindfulness and compassionate imagery). Participants noticed increased mindfulness of emotions, and a shift in their perspective on self-compassion (e.g. recognising that compassion to others is often easier than self-compassion). Most noticeable, participants described becoming kinder to themselves, although recognised that this was an ongoing journey.
Participants described challenges that arose during the group (e.g. struggling to practice homework and external events). Managing these hurdles and barriers compassionately appeared to enhance changes in self-compassion. This helped participants to manage distress and reframe struggles as resilience. The role of the facilitators and supportive group dynamics was important for this.
However, where participants did not connect with other members in the group, or did not find CFT ideas helpful, therapeutic change seemed to be diminished and could lead to drop out. This highlighted the importance of readiness for CFTgp, and how this can impact therapeutic change.
Experiencing social safeness and changes in self-compassion during the group contributed to a sense of rebuilding, re-integrating and reclaiming which continued after the group. Members described rebuilding life through re-engagement in valued activities and taking pride in recovery. Therapeutic changes during CFTgp appeared to enhance openness to further therapeutic support and shape a view of recovery as a journey, mitigating the experience of ending as a loss.
The model adds to the current literature on change processes of CFTgp, and how changes can be enhanced and integrated into individuals’ recovery journeys. The results provide useful information about factors that participants felt were important in enhancing or diminishing therapeutic change, though further research is needed to clarify factors that inhibit engagement or therapeutic change. Relevance to previous literature, limitations and clinical and research implications were considered.
It is intended that the findings of this study will be prepared for submission to either the Journal of Qualitative Health Research or Psychosis journal for dissemination. A report has also been prepared to send to the participants of the study who opted to received this.
REC name
North of Scotland Research Ethics Committee 2
REC reference
24/NS/0013
Date of REC Opinion
18 Mar 2024
REC opinion
Further Information Favourable Opinion