The SPS study
Research type
Research Study
Full title
Assessing psychological support for people with emotional distress and difficulties in relationships: The SPS study.
IRAS ID
315951
Contact name
Mike Crawford
Contact email
Sponsor organisation
Imperial College London
ISRCTN Number
ISRCTN13918289
Duration of Study in the UK
2 years, 7 months, 30 days
Research summary
People with a diagnosis of personality disorder have high levels of contact with health services but the care they receive is often poor. National guidelines recommend that people are offered evidence-based psychological treatments. These treatments last between one to two years and require people to attend therapy groups on a regular basis, but these intensive treatments are not suitable for everyone with personality disorder.
In an effort to provide services that are more inclusive and to increase the number of people with personality disorder that receive effective treatment, clinicians have begun to develop lower intensity treatments. However, we do not have good quality evidence about whether they help patients in the long term or provide value for money.
Structured Psychological Support (SPS) is an individual low intensity intervention, which was developed in collaboration with people with lived experience of personality disorder. It consists of six to ten sessions of person-centred psychological support and aims to help people develop a better understanding of their difficulties and techniques that they can use to improve their mental health and functioning. This trial will investigate whether SPS is a clinically effective and cost-effective approach to improving the mental health and social functioning of people with personality disorder. Participants will be allocated at random to receive SPS or treatment as usual, and then compared over one year on social functioning, mental health, suicidal behaviour, and patient-rated experience of care. Cost effectiveness of the treatment will be evaluated using a measure of quality of life and comparing use of health and social care services in the SPS group versus treatment as usual group. We will interview participants and staff delivering the treatment to understand how it may be delivered in usual clinical care if found to be effective.Summary of results
Some people with Complex Emotional Needs that are associated with 'personality disorder' are offered long-term therapy, often in groups that last a year or more. But many people find this hard to commit to or don’t want to attend groups. Recently, mental health services have started offering shorter treatments that last less than six months—but we don’t yet know whether these shorter treatments are helpful.Working together with people who have lived experience of Complex Emotional Needs, we created a new treatment called Structured Psychological Support (SPS). SPS is a one-to-one intervention delivered in up to 10 sessions. It aims to help people understand their mental health challenges and learn ways to manage them.
We carried out the first large study of SPS to see whether it helps people with Complex Emotional Needs feel better and manage their lives more effectively.
Between early 2023 and early 2024, we invited people from seven NHS mental health services across England to take part. A total of 336 people joined the study. Half were offered SPS sessions, and the other half were offered a single session of crisis planning, along with their usual care. We followed up most people (85%) a year later and conducted longer interviews with some people to hear about their experiences.
People with lived experience were involved throughout the study - helping us design it, interpret the results, and write this summary.What We Found
• Most people offered SPS gave it a try: 88% attended at least one session, and the average number of sessions attended was seven.
• There were small improvements in mental health and social functioning in both groups, but we did not find clear differences between those who had SPS and those who had the crisis planning session and most people continued to experience major problems in completing day-to-day tasks in their lives.
• On average, people who had SPS felt their mental health had slightly improved. People who only had the crisis planning session said their mental health had stayed the same.
• People in both groups became better at managing their emotions.
• The cost of care was similar among people offered SPS sessions and those offered a crisis planning session.
• Many people who had SPS said they felt listened to and supported, but they also worried about what would happen after the sessions ended.In conclusion, the brief individual psychological intervention for with probable personality disorder that we tested in this trial was not associated with improved social functioning or reductions in suicidal behaviour and is unlikely to provide a cost-effective use of resources.
REC name
London - Bromley Research Ethics Committee
REC reference
22/LO/0631
Date of REC Opinion
20 Oct 2022
REC opinion
Further Information Favourable Opinion