Aims of ISP To give the service user in crisis the following hopeful Recovery message: Their distress is understandable and taken seriously Their central role in making things change is demonstrated. To teach new ways of coping and support the use of these skills. To enable all staff to work with the psychological model, through training, supervision and support from the therapy service.

“Third Wave” – term coined by Hayes Mindfulness Based Stress Reduction (Kabat-Zinn) Mindfulness Based Cognitive Therapy (Segal, Teasdale & Williams) Dialectical Behaviour Therapy (Linehan) Mindfulness groups for voices (Chadwick) Compassion focused therapy (Gilbert) Acceptance and Commitment Therapy (Hayes)

Emotion and Behaviour Based Formulation Template Try to escape from the emotion by avoidance, self harm etc. Feel better short term Bad longer term consequences. Aversive emotion worse. Past: abuse, trauma etc. Recent triggering event Another maintaining cycle feeding the emotion Aversive Emotion

Skills teaching and coaching – a team response Staff trained, supported and supervised to deliver basic psychological strategies to break the cycles Assessment and support on the practical side by Occupational Therapy staff. Programme of psychologically informed group work. Individual coaching on the ward or by Hospital at Home staff. Including carers, partners etc. where relevant

Skills Programme Anxiety and stress management. Breathing techniques. Management of arousal - up and down Managing attention - Mindfulness DBT techniques Interpersonal effectiveness Distress tolerance Emotion regulation Managing the self-self relationship - Self compassion Managing psychotic symptoms: Living with unusual experiences groups Self designed prevention and wellness process - WRAP

Evaluating the Programme 3 papers Quantitative – Pre and post measures Qualitative – Staff perceptions of ISP on individual and team work, milieu and impact on service user Qualitative 2 – Service user experiences of ISP

Study 1 Participants - 46 male, 85 female (N = 131) Mean age of (SD = 12.01)

Study 2 Investigating the Impact on Acute Staff Sample of 10 Nursing staff Occupational therapists Mental health practitioners Team managers Interviewers have been through acute services Semi structured interviews Thematic analysis

Study 3 The Perspective of the Service User REC/R&D approved Aiming for sample size of 12 Interviewers have been in acute services Semi structured interviews Thematic analysis Individual experience of ISP, what works well and what needs improving, longer term impact

Contact details, References and Web addresses Durrant, C., Clarke, I., Tolland, A. & Wilson, H. Designing a CBT Service for an Acute In-patient Setting:A pilot evaluation study. Clinical Psychology and Psychotherapy. 14, Clarke, I. (Ed.) (2010) Psychosis and Spirituality: consolidating the new paradigm. Chichester: Wiley Clarke, I. (2008) Madness, Mystery and the Survival of God. Winchester:'O'Books. Clarke, I. & Wilson, H.Eds. (2008) Cognitive Behaviour Therapy for Acute Inpatient Mental Health Units; working with clients, staff and the milieu. London: Routledge.