Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design.

BACKGROUND

Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity.

AIMS

To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self.

METHOD

This was a four-phase ABC plus community follow-up (D) mixed methods

RESULTS

Compared with baseline, the behavioural and the cognitive interventions appeared effective in terms of improving calmness, optimism and rumination, but the effects on sociability were poor. There was evidence across idiographic and nomothetic outcomes of a relapse during the follow-up phase in the community. Eleven idiographic changes were reported in the interview and these tended to be unexpected, related to the therapy and personally important.

DISCUSSION

Single case methods can be responsive to tracking the progress of patients moving through in-patient pathways and differing modules of evidence-based interventions. There is a real need to implement robust outcome methodologies on PICUs to better evaluate the psychological aspects of care in this context.