Mindfulness-based crisis interventions (MBCI) for psychosis within acute inpatient psychiatric settings; a feasibility randomised controlled trial

Background Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. Brief inpatient talking therapies for psychosis could help reduce re-admission rates. The primary aim was to assess feasibility and acceptability of a novel, brief, mindfulness-based intervention for inpatients with psychosis. The secondary aim was to collect pilot outcome data on readmission rate, at 6 and 12 months (m) post discharge, and self-report symptom measures at 6 m. Methods The amBITION study (BrIef Talking therapIes ON wards) was a parallel group, feasibility randomised controlled trial (RCT). In addition to treatment as usual (TAU), eligible inpatients with psychotic symptoms were randomly allocated to receive either (Mindfulness-Based Crisis Intervention; MBCI) or a control intervention (Social Activity Therapy; SAT), for 1–5 sessions. Results Fifty participants were recruited (26 MBCI; 24 SAT); all received at least 1 therapy session (mean = 3). Follow-up rates were 98% at 6 m and 96% at 12 m for service use data extracted from clinical notes, and 86% for self-report measures. At 6 m follow-up, re-admission rates were similar across groups (MBCI = 6, SAT = 5; odds ratio = 1.20, 95% CI: 0.312–4.61). At 12 m follow-up, re-admissions were lower in the MBCI group (MBCI = 7, SAT = 11; odds ratio = 0.46, 95% CI: 0.14–1.51). Three participants experienced adverse events; none was related to trial participation. Conclusions Delivering a brief mindfulness-based inpatient intervention for psychosis is feasible and acceptable, and may reduce risk of short-term readmission. These promising findings warrant progression to a larger clinical effectiveness trial. Trial registration ISRCTN37625384.

Self-report Baseline, end of therapy, 3 mth midpoint and 6 mth follow-up

1) Therapy Credibility
Immediately after randomisation, participants were read a brief description of the therapy they had been assigned to. They were then asked to rate on a scale from 0 (not helpful at all) to 10 (extremely helpful) how helpful they thought the therapy sounded.

2) Stress Bubbles
The use of within-session measures can be helpful in measuring change in brief interventions, by capturing small shifts in key processes that may occur over the course of a therapy session. Stress bubbles are a form of visual analogue scale, with 6 bubbles gradually increasing in size from "not at all" (1) to "extremely" (6). Participants rated 3 items (stress, interference from symptoms, and hope for the future) at the beginning and end of every session. These unpublished scales have been successfully used in a previous study of mindfulness interventions for psychosis (Jacobsen et al., 2011).

3) Self-ratings of psychotic symptoms
This is a self-report scale that asks respondents to rate their psychotic symptoms (voices and/or distressing beliefs) on a scale of 1-7 (frequency) and 0-10 (distress and believability).
These scales were used in the ACT inpatient trials (Bach andHayes, 2002, Gaudiano andHerbert, 2006), and were found to be easy for participants to complete, and showed sensitivity to change over time.

1995)
The DASS-21 is a short-form version of the original 42-item DASS comprising 7 items on each of the 3 sub-scales for depression, anxiety and stress. It is a self-report scale with respondents scoring each item on a four-point scale from 0 (never) to 3 (almost always). The DASS-21 has been well-validated in both clinical (Antony et al., 1998) and non-clinical samples (Henry and Crawford, 2005). The DASS-21 is particularly suitable for this study, being relatively quick and easy to complete, and has been shown to have good internal consistency and convergent validity in an acute psychiatric population (Weiss et al., 2015) and is suitable for use with people experiencing psychotic symptoms (Samson and Mallindine, 2014).

5) Questionnaire about the Process of Recovery; QPR (Neil et al., 2009)
The QPR is a 22-item self-report measure based on service user accounts of the process of recovery from psychosis. It has 2 sub-scales assessing both intrapersonal and interpersonal processes in recovery. Each item is rated on a 5-point scale from 0 (disagree strongly) to 4 (agree strongly). Neil et al. (2009) report that the scale has good internal consistency, construct validity and reliability.

Lieshout and Goldberg, 2007)
The HPSVQ is a 13-item self-report measure in which respondents rate the first 9 items on a five-point Likert scale from zero (lowest severity) to four (highest severity). The total score of these 9 items is intended to indicate the severity of auditory verbal hallucinations, and

7) Southampton Mindfulness Questionnaire; SMQ (Chadwick et al., 2008)
The SMQ is a 16-item self-report measure designed to assess mindfulness of difficult thoughts and images. Each item is scored on a 7-point scale ranging from 0 (totally agree) to 6 (disagree totally). The SMQ has been validated in a clinical sample of people experiencing distressing psychotic symptoms. Chadwick et al. (Chadwick et al., 2008) report that the SMQ has good internal reliability, and shows convergent reliability with other established mindfulness scales (e.g. MAAS; (Brown and Ryan, 2003)).

Symptom and recovery outcome measures
Tables 4 and 5 show the data from the symptom and recovery outcome measures (self-report questionnaires). In line with the analysis plan, descriptive statistics were first calculated based on unadjusted means (Table 4), before adjusting for baseline score (Table 5). Data are presented separately for beliefs (delusions) and voices for the self-rating psychotic symptom scales in both Tables 4 and 5. Participants reported delusions more commonly than voices, so the sample size is larger for the delusions ratings.