Relapse Prevention: An Elusive Target for Psychological Interventions for Psychosis?
The recurrence of psychosis is linked to significant personal, interpersonal and societal costs. For individuals, the recurrence of psychosis is frequently linked to significant emotional distress, disruptions in daily life, personal relationships and the experience of coercive interventions. However, despite the considerable advances made by Cognitive Behavioural Therapy for Psychosis (CBTp), the prevention of relapse remains an elusive target. I will argue that the failure of CBT to successfully alleviate the recurrence of psychosis is due to a lack of clarity regarding the definition and complexity of recurrence itself; an emphasis on risk; and a lack of clarity regarding cognitive, interpersonal and systemic causal mechanisms underpinning recurrence. A cognitive interpersonal model predicts that recurrence of psychosis arises from an interaction of individual cognitive (including fear of relapse, stigma, shame), interpersonal (attachment appraisals, interpersonal coping and help seeking) and systemic (responses of others including mental health staff) factors. Current approaches to defining recurrence fail to fully capture the importance of these interactions contributing to the experience of recurrence. Indeed, approaches to CBTp need to evolve to meaningfully target these proposed causal mechanisms and embrace not just individual based CBTp but also digital technology and systemically based interventions.