Strengths and Limitations
first-episode non-affective psychosis
RECRUITMENT, BLIND
This is the largest study of CR in people with a diagnosis of first-episode non-affective psychosis. Individuals were excluded at the prescreen or screening stages that might have affected confidence in the results, although the sample characteristics were remarkably similar to those of previous observational studies. As this study considered the therapist contact needed for wider implementation we chose a personalized measure of outcome—the GAS—favored by clinical staff and service users to record an individual’s functional recovery targets. This outcome requires rater consistency, although not more so than symptom measures such as PANSS. To ensure consistency we trained and supervised all these ratings that were made blind to group allocation. Missing outcome data could be a potential bias, but our broad sensitivity analyses suggest that our results are robust. While early slow recruitment required changes to randomization, all recruits were randomly allocated and balanced in characteristics suggesting no bias was introduced. We carried out the study in Early Intervention Services which have access to a wide range of recovery services and so the results may not be applicable to those in longer-stay services although this was a stringent test of any additional therapy added to case management.