Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms C. Jackson a, b, * , P. Trower b , I. Reid c , J. Smith c , M. Hall d , M. Townend e , K. Barton a , J. Jones a , K. Ross a , R. Russell a , E. Newton a , G. Dunn f , M. Birchwood a, b a Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK b School of Psychology, University of Birmingham, Birmingham, UK c Department of Psychology, Worcestershire Mental Health Partnership NHSTrust, Worcester, UK d Department of Psychology, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK e Programme in Community Mental Health School of Social Sciences, University of Birmingham, Birmingham, UK f School of Medicine, University of Manchester, Manchester, UK article info Article history: Received 26 June 2008 Received in revised form 22 December 2008 Accepted 13 February 2009 Keywords: First episode psychosis Cognitive behaviour therapy Early intervention Psychological adjustment PTSD Trauma Self esteem Depression abstract There are few evaluated psychological interventions or theoretical approaches which are specifically aimed at reducing problems related to adjustment and adaptation following a first episode of psychosis. The present study tests the efficacy of a form of CBT (Cognitive Recovery Intervention; CRI) in reducing trauma, depression and low self esteem following a first episode of psychosis, in a single-blind rando- mised controlled trial. A total of 66 patients who had recently experienced a first episode of psychosis were randomly assigned to CRI or treatment as usual (TAU) and followed up at 6 and 12 months. People receiving CRI tended to have lower levels of post-intervention trauma symptoms and demonstrated greater improvement than those receiving TAU alone. This was especially the case at 6 months for those with high pre-treatment levels of trauma. There was, however, no advantage for the CRI group with regards to reduced depression or improved self esteem. In conclusion, CRI appears to be an effective intervention to help young people adapt to the traumatic aspects of a first episode of psychosis although further evaluation in a larger study is warranted. Ó 2009 Elsevier Ltd. All rights reserved. Introduction Psychological adjustment following a first episode of psychosis remains an important but poorly understood area (Jackson & Iqbal, 2000). Whilst a significant minority of people experiencing a first episode may naturally adjust to the psychological impact of such a life event (May, 2004), many may struggle and go on to develop a number of psychological and emotional dysfunctions such as PTSD, depression, social anxiety disorder, low self esteem and suicidality (Birchwood, Fowler, & Jackson, 2001; Morrison Frame, & Larkin, 2003). The treatment of choice for such emotional dysfunctions is predominantly CBT (Birchwood, Iqbal, Jackson, & Hardy, 2004). Yet, despite this, there have been relatively few psychological interventions specifically developed in the context of psychosis in general (Birchwood & Trower, 2006) and even less for young people experiencing the onset of psychosis for the first time. Hall and Tarrier (2003) evaluated the efficacy of a simple cognitive– behavioural intervention designed to improve low self esteem in people with multiple episode psychosis and bipolar disorder. Results indicated that when used as an adjunct to treatment as usual (TAU), the intervention resulted in increased self esteem, reduced psychotic symptomatology and improved social func- tioning. These gains were maintained over 3 months. In another evaluation of the impact of CBT on self esteem in people with psychosis, Gumley et al. (2006) using a CBT protocol aimed at the early signs of relapse, also found greater increases in self esteem (as measured by the Rosenberg Self Esteem Questionnaire) for those receiving CBT than TAU. Unfortunately the generalisability of these studies to younger first episode populations is difficult to ascertain as both studies included a large number of older people with * Corresponding author at: Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham B6 4NF, UK. Tel.: þ44 121 301 1850. E-mail address: chris.jackson@bsmhft.nhs.uk (C. Jackson). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2009.02.009 Behaviour Research and Therapy 47 (2009) 454–462