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      A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis

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          Background and objectives

          Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp.


          Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later.


          The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects.


          We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample.


          The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.


          • Illness beliefs predicted response to cognitive therapy in psychosis (CBTp).

          • Key predictors concerned the likelihood of curing or controlling problems.

          • The Cure/control subscale was expanded to include CBT-specific change items.

          • Findings could help to more efficiently target limited provision in routine services.

          • ‘Pre-therapy’ interventions could target these beliefs to improve outcomes.

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          Most cited references 41

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          Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial.

          This study was designed to examine whether a brief hospital intervention designed to alter patients' perceptions about their myocardial infarction (MI) would result in a better recovery and reduced disability. In a prospective randomized study, 65 consecutive patients with their first MI aged were assigned to receive an intervention designed to alter their perceptions about their MI or usual care from rehabilitation nurses. Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital. The intervention caused significant positive changes in patients' views of their MI. Patients in the intervention group also reported they were better prepared for leaving hospital (p<.05) and subsequently returned to work at a significantly faster rate than the control group (p<.05). At the 3-month follow-up, patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects (14.3 vs. 39.3, p<.03). There was no significant differences in rehabilitation attendance between the two groups. An in-hospital intervention designed to change patients' illness perceptions can result in improved functional outcome after MI.
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            The role of illness perceptions in patients with medical conditions.

            In this article we summarize recent investigations into the influence of illness perceptions on outcomes in patients with medical conditions. Developments in assessment include the publishing of a new brief scale to assess illness perceptions and the examination of the relationship between patient drawings of their illness and outcomes. Recent studies in primary care highlight the importance of patients' beliefs and emotional responses to their illness as being important in influencing their satisfaction with the consultation, reassurance following negative medical testing and future healthcare use. Recent research shows illness perceptions to have associations with a number of outcomes in chronic illness including self-management behaviours and quality of life. As yet, however, few interventions have been developed designed to change illness perceptions and improve illness outcomes. Emerging areas of research include the application of illness perceptions to mental illness and genetic and risk factor testing. Research on illness perceptions has confirmed that patients' beliefs are associated with important outcomes in a broadening range of illnesses and risk factor testing. New interventions based on this model have the potential to improve patient outcomes but have yet to be widely developed and applied.
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              The revised illness perception questionnaire (IPQ-R)


                Author and article information

                J Behav Ther Exp Psychiatry
                J Behav Ther Exp Psychiatry
                Journal of Behavior Therapy and Experimental Psychiatry
                1 December 2014
                December 2014
                : 45
                : 4
                : 459-466
                [a ]King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
                [b ]King's College London, Institute of Pharmaceutical Science, 5th Floor Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK
                [c ]Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
                [d ]Division of Psychiatry, University College, London, 67-73 Riding House Street, London W1W 7EJ, UK
                [e ]University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK
                [f ]School of Psychology, University of Sussex, Pevensey Building, Falmer BN1 9QH, UK
                Author notes
                []Corresponding author. Tel.: +44 020 7848 5028; fax: +44 020 7848 5006. Suzanne.Jolley@
                © 2014 The Authors

                Clinical Psychology & Psychiatry

                schizophrenia, cbt, engagement, ipq, therapy outcome


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