Rosemarie McCabe

• PhD
• Professor at City, University of London

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of...

Aims Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This pape...

Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide int...

Background Theories and meta-analyses have elucidated individual-level mechanisms of action in behaviour change interventions. Although group-based interventions are commonly used to support health-related behaviour change, such interventions rarely consider theory and research (e.g. from social psychology) on how group-level mechanisms can also in...

Associations between mental health and poverty are increasingly well established. Yet in neoliberally oriented contexts in which distress engendered through the everyday hardships of poverty is increasingly pathologised and medicalised, important questions are raised over the assumptions inherent within mental health policy and its implementation....

Background: Every year, more than 800,000 people worldwide die by suicide. The aim of this study was to conduct a systematic review of the effectiveness of brief psychological interventions in addressing suicidal thoughts and behaviour in healthcare settings. Methods: Following PRISMA guidelines, systematic searches were conducted in MEDLINE, CI...

Background UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors. Aims An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders. Method An expert working grou...

Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants – CORRIGENDUM - Volume 4 Issue 3 - Katrina A. S. Davis, Jonathan R. I. Coleman, Mark Adams, Naomi Allen, Gerome Breen, Breda Cullen, Chris Dickens, Elaine Fox, Nick Graham, Jo Holliday, Louise M. Howard, Ann John, Will...

Receiving a diagnosis of dementia is a life-changing event and can cause strong emotional reactions. The aim of this study was to examine patient and companion concerns expressed during dementia diagnosis feedback meetings. Sixty consultations between 19 health-care professionals (HCPs), 60 patients and 59 companions were video-recorded and transcr...

Recent drives to facilitate earlier identification of dementia have led to increased memory clinic referrals and diagnoses. This study explored the perspectives of memory clinic doctors on making and delivering diagnoses. Four focus groups were conducted with 13 psychiatrists and two geriatricians in the UK. Transcripts were coded line by line usin...

The effectiveness of medical treatment depends on the quality of the patient–clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric co...

Background Dementia diagnosis rates are increasing. Guidelines recommend that people with dementia should be told their diagnosis clearly and honestly to facilitate future planning. Aims To analyse how doctors deliver a dementia diagnosis in practice. Method Conversation analysis was conducted on 81 video-recorded diagnosis feedback meetings with...

Background: Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence t...

Background Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to investigate the views of stakeholders on the key components of community-based interventions coordinating care in dementia. Methods We searched four databases from incept...

Background Groups are often used to promote personal and health-related psychological and behavioural change. Although there is considerable literature on group dynamics and intra- and inter-personal change processes in groups, this knowledge is dispersed across different disciplines and rarely used in the design, delivery and evaluation of group-b...

Diagnosis and treatment recommendation are standard phases in medical interaction. Structural models of the GP consultation typically place these in a linear order, with the doctor first giving their professional opinion on the patient’s condition before offering a treatment to ameliorate that condition. In this paper, we will focus on a primary...

Background There is little evidence on how professionals communicate to assess suicide risk. This study analysed how professionals interview patients about suicidal ideation in clinical practice. Methods Three hundred nineteen video-recorded outpatient visits in U.K. secondary mental health care were screened. 83 exchanges about suicidal ideation w...

Background Research has shown that interactions in group therapies for people with schizophrenia are associated with a reduction in negative symptoms. However, it is unclear which specific interactions in groups are linked with these improvements. The aims of this exploratory study were to i) develop and test the reliability of using video-annotati...

Background At least 100,000 patients with schizophrenia receive care from community mental health teams (CMHTs) in England. These patients have regular meetings with clinicians, who assess them, engage them in treatment and co-ordinate care. As these routine meetings are not commonly guided by research evidence, a new intervention, DIALOG, was prev...

Disfluencies such as self-repairs, filled pauses such as 'um' and silent pauses are pervasive in dialogue, but there is no consensus in the literature as to whether they reflect internal production pressures, or interactive issues -- or how their effects are manifest in dialogue. It is well-known that patients with schizophrenia have problems with...

Background: In the UK, over 6500 people die by suicide each year. In England alone, this is one person every 2 h. Professionals assess risk of suicide in face-to-face contacts with people potentially at risk. The National Confidential Inquiry into Suicide found that most people who took their life were classified as 'low risk' in their final conta...

Background The relevance of early decision making will rise with increasing availability of early detection of Alzheimer’s disease (AD) using brain imaging or biomarkers. Results Five people with mild AD, six relatives and 13 healthcare professionals with experience in the management of AD were interviewed in a qualitative study regarding medical...

Background and objectives: Dialectical behaviour therapy (DBT) trains participants to use behavioural skills for managing their emotions. The study aimed to evaluate whether skills use is associated with positive treatment outcomes independently of treatment processes that are common across different therapeutic models. Method: Use of the DBT sk...

Background A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. Aims To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422)....

This Handbook gathers together empirical and theoretical chapters from leading scholars and clinicians to examine the broad issue of adult mental health. The contributors draw upon data from a variety of contexts to illustrate the multiple ways in which language as action can assist us in better understanding the discursive practices that surround...

Valuing patients underlies good communication in psychiatry and mediates positive outcomes. The aim of this study was to (1) identify and reliably assess valuing and devaluing communicative behaviour of psychiatrists in routine consultations, and (2) explore whether valuing behaviour is associated with patient satisfaction. In an inductive study, p...

Background: Research suggests that while patients wish to talk about positive psychotic symptoms, psychiatrists may be reluctant to do so in routine outpatient consultations. Aims: To explore the content, context and impact of discussion of positive symptoms within psychiatric consultations. Methods: Thematic analysis was applied to first disc...

Background: Psychiatrists' questions are the mechanism for achieving clinical objectives and managing the formation of a therapeutic alliance - consistently associated with patient adherence. No research has examined the nature of this relationship and the different practices used in psychiatry. Questions are typically defined in binary terms (e.g...

Background: Current health and social care systems are providing suboptimal and fragmented care to the growing dementia population. Interventions aiming to coordinate care services for individuals with dementia and their families are already widely used; however, the structure and implementation of these interventions vary. This mixed studies revi...

DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focused approach to initiate change. This study tested the effectiveness of DIALOG+ in the community treatment of patients with psychosis. This was a pragmatic, exploratory, parallel-group, cluster-randomis...

Background Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services.AimsTo review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services.Method Systematic r...

Patient involvement in decision making is endorsed by patients and professionals. While research has recently been conducted on how professionals can promote shared decision making (SDM), little is known about how patients can also facilitate SDM. Seven focus groups were conducted: 3 with psychiatrists and 4 with patients with schizophrenia or depr...

Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identi...

Background: Communication is affected by dementia, even in the early stages. Studies directly observing how patients, companions and healthcare professionals communicate have not yet been reviewed. Methods: Eight databases were searched, and hand searches of relevant journals and grey literature were performed up to August 2014. Two authors review...

Objective Recent evidence found that patients with schizophrenia display non-verbal behaviour designed to avoid social engagement during the opening moments of their meetings with psychiatrists. This study aimed to replicate, and build on, this finding, assessing the non-verbal behaviour of patients and psychiatrists during meetings, exploring chan...

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods a...

Background: Service user dissatisfaction with acute psychiatric wards is frequent. Previous studies indicate that service users prefer crisis houses, but we lack clear quantitative evidence about why. Qualitative studies suggest the quality of staff–service user relationships may be key. Aims: (1) To test the hypothesis that stronger therapeutic al...

Background Communicating about delusions can be challenging, particularly when a therapeutic relationship needs to be established in acute care. So far, no systematic research has explored how psychiatrists address patients’ delusional beliefs in first meetings in acute care. The aim of this study was to describe how psychiatrists address patients’...

Mental illnesses such as depression and anxiety are highly prevalent, and therapy is increasingly being offered online. This new setting is a departure from face-toface therapy, and offers both a challenge and an opportunity ‐ it is not yet known what features or approaches are likely to lead to successful outcomes in such a different medium, but o...

Patients with a diagnosis of schizophrenia are socially excluded. The aim of this study was to investigate how patients participate in first encounters with unfamiliar healthy participants, who are unaware of their diagnosis. Patterns of participation were investigated during interactions involving three-people. Three conversation roles were analys...

Patients with a diagnosis of schizophrenia display social cognitive deficits. However, little is known about patients' nonverbal communication during their social encounters with others. This review identified 17 studies investigating nonverbal communication in patients' unscripted face-to-face interactions, addressing a) nonverbal differences betw...

Listeners normally provide speakers with simultaneous feedback such as nods, "yeah"s and "mhm"s. These 'backchannels' are important in helping speakers to talk effectively. Two factors are known to influence when a backchannel is produced; if the speaker is looking at the listener or if the speaker is presenting new information. We investigate a th...

Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational...

Previous research shows that aspects of doctor-patient communication in therapy can predict patient symptoms, satisfaction and future adherence to treatment (a significant problem with conditions such as schizophrenia). However, automatic prediction has so far shown success only when based on low-level lexical features, and it is unclear how well t...

Background: Large numbers of patients with psychosis have regular meetings with key clinicians in the community. There is little evidence on how these meetings should be conducted to be therapeutically effective. DIALOG, a computer mediated procedure, was shown to improve outcomes in a European multi-centre trial. DIALOG structures the patient-cli...

Background Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer...

Annex A1. Provisional search strategy for MEDLINE for capturing diverse ethnic groups. Annex2: preliminary searches on key words using PubMed.

Patients with a diagnosis of schizophrenia display nonverbal deficits in social cognitive assessments. However, little is known about patients' nonverbal communication during social encounters. This review identified seventeen studies investigating nonverbal communication in patients' unscripted face-to-face interactions addressing: (i) nonverbal d...

This interactive workshop will focus on experiences and challenges of communicating with patients about psychosis. It is based on research identifying what works and what does not work in naturally occurring communication between psychiatrists and psychotic patients. It will include a voices simulation exercise, learning specific cognitive behaviou...

Having friends is associated with more favourable clinical outcomes and a higher quality of life in mental disorders. Patients with schizophrenia have fewer friends than other mentally ill patients. No large scale studies have evaluated so far what symptom dimensions of schizophrenia are associated with the lack of friendships. Data from four multi...

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Background: Communicating about psychotic symptoms can be challenging. This study aimed to identify (1) how psychiatrists and patients communicate about psychotic symptoms from a research and clinical perspective and (2) whether communication patterns depend on patients' symptom levels. Sampling and methods: Consultations between 27 psychiatrist...

Background: Studies have shown patient attitudes to be an important predictor for health related behaviours including medication adherence. It is less clear whether patient attitudes are also associated with medication adherence among patients with psychoses. Method: We conducted a systematic review and meta analysis of the data of studies that...

Background: Nonverbal communication is a critical feature of successful social interaction and interpersonal rapport. Social exclusion is a feature of schizophrenia. This experimental study investigated if the undisclosed presence of a patient with schizophrenia in interaction changes nonverbal communication (ie, speaker gesture and listener noddi...

Background DIALOG is an intervention to structure the communication between patient and key worker, which has been shown to improve patient outcomes in community mental health care. As part of the intervention, patients provide ratings of their subjective quality of life (SQOL) on eight Likert type items and their treatment satisfaction on three su...

Background Nonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clini...

Table S4. Characteristics of included studies.

Recent work on consultations between out-patients with schizophrenia and psychiatrists has shown that adherence to treatment can be predicted by patterns of repair -- specifically, the pro-activity of the patient in checking their understanding, i.e. patient clarification. Using machine learning techniques, we investigate whether this tendency can...

Previous research has shown that a better therapeutic relationship (TR) predicts more positive attitudes towards antipsychotic medication, but did not address whether it is also linked with actual adherence. This study investigated whether the TR is associated with adherence to antipsychotics in patients with schizophrenia. 134 clinicians and 507 o...

PURPOSE: This study sought to establish which psychotherapeutic methods can be used effectively in routine clinical encounters (in contrast to formal therapy) with people with psychotic disorders. METHODS: To identify psychotherapeutic methods for use in routine community care, a range of experts were consulted. A literature search was then underta...

Quality of life is an important outcome in the treatment of patients with schizophrenia. It has been suggested that patients' quality of life ratings (referred to as subjective quality of life, SQOL) might be too heavily influenced by symptomatology to be a valid independent outcome criterion. There has been only limited evidence on the association...

Family caregivers of people with mental disorders are frequently involved in involuntary hospital admissions of their relatives. To explore family caregivers' experience of involuntary admission of their relative. 30 in-depth interviews were conducted with family caregivers of 29 patients who had been involuntarily admitted to 12 hospitals across E...

This study aimed to establish whether psychiatric patients' subjective initial response (SIR) to hospital and day hospital treatment predicts outcomes over a one-year follow-up period. We analysed data from 765 patients who were randomised to acute psychiatric treatment in a hospital or day hospital. SIR was assessed on day 3 after admission. Outco...

To explore involuntary patients' retrospective views on why their hospitalisation was right or wrong. Involuntary patients were recruited from 22 hospitals in England and interviewed in-depth. The study drew on grounded theory and thematic analysis. Most of the patients felt mentally unwell before admission and out of control during their treatment...

Background Trust, choice and power are critical issues in clinical practice, public policies and a post-modern understanding of mental health care. We aimed to investigate the experiences and attitudes of patients with psychosis in relation to trust, choice and power. Method We conducted 20 in-depth interviews with patients with psychotic disorder...

The effectiveness of psychosocial interventions in community mental healthcare has been shown to depend on the setting in which they are implemented. Recently structured patient-clinician communication was found to be effective in a multi-centre trial in six European countries, the DIALOG trial. In the overall study, differences between centres wer...

Subjective quality of life (SQOL) is an established patient-reported outcome in the evaluation of treatments for psychosis. The use of SQOL measures in the presence of psychiatric symptoms and cognitive deficits has been questioned. However, there is little evidence on whether items function differently as indicators of SQOL in psychotic patients w...

The communication between clinician and patient is the basis of psychiatric treatment. However, there has been little practical attention to training in it, and no specific theory of what constitutes good communication in psychiatry has been developed. This review aims to identify principles that guide good communication. A conceptual review of gui...

The study aimed to identify patient characteristics associated with differences in outcomes of acute treatment in day hospitals and conventional hospital wards. Data were from the European Day Hospital Evaluation (EDEN) (2000-2003), a multicenter randomized controlled trial comparing acute treatment in day hospitals and conventional wards in five E...