Planned interventions
The worry intervention will be provided in six sessions over eight weeks by two clinical psychologists. This is an increase in the number of sessions used in the pilot, since the patients requested extra sessions. The eight-week window will allow some flexibility for appointment times and the extension of intervals between the final two sessions. The intervention is designed to provide clear and simple messages for patients to take into their day-to-day lives. A series of session booklets have been produced. The worry reduction strategies included are indicated in the anxiety literature to be effective at reducing worry and do not challenge or review the delusion itself. Key influences from the generalized anxiety disorders literature were Butler et al. [31], Dugas and Ladouceur [32], Wells [33] and Leahy [34]. The main techniques are psychoeducation about worry, reviewing of positive and negative beliefs about worry, increasing awareness of the initiation of worry and identification of individual triggers, learning to ‘let go’ of worry, use of worry periods, substituting problem-solving in place of worry, and relaxation exercises. Homework exercises are set between sessions. Sessions will be taped for assessment of adherence and for competence [35]. Patients will also be asked to complete an assessment of the therapist’s empathy [36]. Standard care is delivered according to national and local service protocols and guidelines. During hospitalization standard care usually involves prescription of anti-psychotic medication, and to some extent occupational therapy activities and exercise groups. Following discharge, the level of standard care varies according to the needs of the individual. However, this usually consists of prescription of anti-psychotic medication, visits from a community mental health worker and regular outpatient appointments with a psychiatrist. Service use will be measured using the Client Service Receipt Inventory (CSRI) [37]. The CSRI covers services provided by the National Health Service, other health and social care agencies, the criminal justice system and informal carers. Antipsychotic medication data will be extracted from medical records and dosages converted into chlorpromazine equivalents.