Sandra Bucci

• Doctor of Clinical Psychology
• NIHR Research Professor / Professor of Clinical Psychology at The University of Manchester

Background: Cognitive behaviour therapy (CBT) is recommended for the treatment of psychosis; however, only a small proportion of service users have access to this intervention. Smartphone technology using software applications (apps) could increase access to psychological approaches for psychosis. This paper reports the protocol development for a...

Background: Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transit...

There are an increasing number of studies exploring the association between voice-hearing (auditory verbal hallucinations) and dissociative experiences. The current study provides a systematic literature review and meta-analytic synthesis of quantitative studies investigating the relationship between voice-hearing and dissociation. A systematic sea...

Command hallucinations are experienced by 33–74% of people who experience voices, with varying levels of compliance reported. Compliance with command hallucinations can result in acts of aggression, violence, suicide and self-harm; the typical response however is non-compliance or appeasement. Two factors associated with such dangerous behaviours a...

Few randomised controlled trials have been aimed specifically at substance use reduction among people with psychotic disorders. To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive-behavioural therapy (CBT) was more efficacious than routine treatment in reducing substance use and improving symptomat...

Introduction While Patient and Public Involvement and Engagement (PPIE) is a key element of research best practice across healthcare, the co‐design process for digital health interventions (DHIs) remains under‐reported. This study explores the co‐design process of the i‐Minds DHI, developed for young people exposed to technology‐assisted sexual abu...

Background Current approaches to mental healthcare for people with severe mental health problems are limited by sporadic monitoring and symptom recall bias. Emotional and behavioural markers generated by digital health technologies (DHTs) offer the potential to enhance quality of care and clinical decision-making. This study explored early psychosi...

Objectives Delivering psychological therapy via videoconferencing and telephone is now commonplace across mental health services, but many therapists remain concerned about the impact on the therapeutic alliance. This study aimed to establish consensus amongst psychological therapists regarding the factors involved in establishing and maintaining t...

Background Digital health technologies (DHTs) for psychosis have been developed and tested rapidly in recent years. However, research examining mental health professionals’ views on the use of DHTs for people with psychosis is limited. Given the increased accessibility and availability of DHTs for psychosis, an up-to-date understanding of staff per...

Background Psychological therapies are recommended for people with serious mental health problems. However, access is limited, particularly in inpatient mental health settings. The Talk, Understand and Listen in InPatient Settings (TULIPS) study is a large multi-centre cluster-randomised controlled trial which aimed to evaluate a stepped psychologi...

Background Digital health interventions have the potential to improve the efficacy and accessibility of mental health services for people with severe mental health problems, but their integration into routine practice is a challenge. The real-world implementation of digital health interventions should be considered alongside digital intervention de...

Objectives The use of social media is prevalent in society; however, existing evidence is not sufficient to conclude whether the benefits of social media use can outweigh the risks for people with psychosis. In response to a recent call for staff to take a more active role in asking and advising service users about the impact of using social media...

Background It is notoriously challenging to deliver psychosocial interventions on acute mental health wards. This paper presents an ethnographic observational study which captured how ward and staff processes impacted on the delivery of a psychosocial intervention called TULIPS (Talk, Understand and Listen for Inpatient Settings). Although the pape...

Background User-led hearing voices groups (HVGs) have existed for the past 40 years, but little research has been conducted into if and how this approach can be implemented in statutory mental health settings, and whether they can be delivered effectively when held online. The aim of this study was to conduct a feasibility and acceptability trial o...

There is increasing use of digital tools to monitor people with psychosis and schizophrenia remotely, but using this type of data is challenging. This systematic review aimed to summarise how studies processed and analysed data collected through digital devices. In total, 203 articles collecting passive data through smartphones or wearable devices,...

Background Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. Objective This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagemen...

Background Digital mental health interventions are increasingly used to scale up access to mental health support, yet very few mental health apps are empirically supported, with high attrition rates. The therapeutic alliance between therapists and clients is a key factor in predicting psychological therapy retention and outcomes. Understanding how...

Introduction Globally, many people experience mental health difficulties, and the current workforce capacity is insufficient to meet this demand, with growth not keeping pace with need. Digital devices that passively collect data and utilise machine learning to generate insights could enhance current mental health practices and help service users m...

Distressing voices are a core symptom of psychosis, for which existing treatments are currently suboptimal; as such, new effective treatments for distressing voices are needed. AVATAR therapy involves voice-hearers engaging in a series of facilitated dialogues with a digital embodiment of the distressing voice. This randomized phase 2/3 trial asses...

Objectives Talk, Understand and Listen for InPatient Settings (TULIPS) was a multi‐centred randomized control trial of an intervention that aimed to increase patient access to psychological therapies on acute mental health wards. This paper aims to: (i) describe a strategy for designing a psychological intervention that is implementable in inpatien...

Background While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people’s involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meeti...

Objective Technology‐assisted child sexual abuse (TA‐CSA) is defined as any type of sexual abuse with an online element occurring under the age of 18. The literature suggests that victims often experience difficulty in finding support that adequately addresses the online elements of TA‐CSA. Research also suggests that practitioners are unsure about...

Background: In between episodes of (hypo) mania and major depression, people with bipolar disorder can experience ongoing low mood or mood instability, and these may also be present as part of cyclothymic disorder. This is a phase II evaluation of an adapted form of behavioural therapy (STABILISE) for inter-episode bipolar symptoms. The study aims...

BACKGROUND Technology-assisted sexual abuse (TASA) mostly involves the production and non-consensual sharing of sexual images; however, evidence-based support for young people (YP) who have experienced TASA is scant. Digital Health Interventions (DHIs) have the potential to increase access to support and provide timely therapeutic input in a famili...

BACKGROUND Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. OBJECTIVE This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagemen...

Background People with serious mental health problems (SMHP) are more likely to be admitted to psychiatric hospital following contact with crisis services. Admissions can have significant personal costs, be traumatic and are the most expensive form of mental health care. There is an urgent need for treatments to reduce suicidal thoughts and behavio...

Background Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medica...

Background Psychological therapies are recommended for people with serious mental health problems. However, access is limited, particularly in inpatient mental health settings. The Talk, Understand and Listen in InPatient Settings (TULIPS) study is a large multi-centre cluster-randomised controlled trial which aimed to evaluate a stepped psychologi...

Background Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing exp...

Background Given the rapid expansion of research into digital health interventions (DHIs) for severe mental illness (SMI; eg, schizophrenia and other psychosis diagnoses), there is an emergent need for clear safety measures. Currently, measurement and reporting of adverse events (AEs) are inconsistent across studies. Therefore, an international net...

Objective Smartphone apps (apps) are widely recognised as promising tools for improving access to mental healthcare. However, a key challenge is the development of digital interventions that are acceptable to end users. Co-production with providers and stakeholders is increasingly positioned as the gold standard for improving uptake, engagement, an...

Background Access to high-quality mental healthcare remains challenging for people with psychosis globally, including China. Smartphone-based symptom monitoring has the potential to support scalable mental healthcare. However, no such tool, until now, has been developed and evaluated for people with psychosis in China. This study investigated the a...

Background Digital health interventions (DHIs) have significant potential to upscale treatment access to people experiencing psychosis but raise questions around patient safety. Adverse event (AE) monitoring is used to identify, record, and manage safety issues in clinical trials, but little is known about the specific content and context contained...

Background There is growing evidence that Technology Assisted Sexual Abuse (TASA) represents a serious problem for large numbers of children. To date, there are very few evidence-based interventions available to young people (YP) after they have been exposed to this form of abuse, and access to support services remains a challenge. Digital tools su...

Introduction Online child sexual abuse (OCSA) affects considerable numbers of children globally and is associated with a variety of mental health problems. Existing practitioner studies suggest that young people are infrequently asked about online abuse and practitioners have a fragmented understanding of the problems experienced or how they might...

Background Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential...

Objective Psychological formulation is a key competency for clinical psychologists. However, there is a lack of consensus regarding the key components and processes of formulation that are hypothesized to contribute to poor reliability of formulations. The aim of this study was to develop consensus on the essential components of a formulation to in...

Background Psychosis causes a significant burden globally, including in China, where limited mental health resources hinder access to care. Smartphone-based remote monitoring offers a promising solution. This study aimed to assess the validity, feasibility, acceptability, and safety of a symptom self-monitoring smartphone app, YouXin, for people wi...

Introduction Digital mental health is a promising solution to support people with severe mental health problems (SMI) in China. However, little is known about the ownership rate of digital technologies and attitudes towards utilising digital health technologies (DHTs) among people with SMI in the Chinese context. The aims of this study were to unde...

BACKGROUND Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medica...

In the past decade, the sending and sharing of sexual images among youth has become normalized. An associated risk of sharing sexual images is the images being nonconsensually shared among peers or uploaded online. This is the first review to systematically identify, summarize, and critically evaluate existing research on the mental health and soci...

Introduction There has been a rapid increase in prevalence rates of online sexual abuse (OSA). Existing research has highlighted the negative impact OSA can have on victims. However, there is a gap in understanding the long-term impact of OSA when it occurred in childhood. Methods This qualitative study comprised interviews with eight female parti...

Background There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation. Methods A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage r...

BACKGROUND Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative which enables individuals who hear voices to engage with the support of peers, have a longstanding history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing exp...

Background Psychosis is one of the most disabling mental health conditions and causes significant personal, social, and economic burden. Accurate and timely symptom monitoring is critical to offering prompt and time-sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring ap...

The use of digital phenotyping continues to expand across all fields of health. By collecting quantitative data in real-time using devices such as smartphones or smartwatches, researchers and clinicians can develop a profile of a wide range of conditions. Smartphones contain sensors that collect data, such as GPS or accelerometer data, which can in...

Background: Ecological momentary assessment (EMA) involves completing multiple surveys over time in daily life, capturing in-the-moment experiences in real-world contexts. EMA use in psychosis studies has surged over several decades. To critically examine EMA use in psychosis research and assist future researchers in designing new EMA studies, thi...

Aim There is growing interest in tailoring psychological interventions for distressing voices and a need for reliable tools to assess phenomenological features which might influence treatment response. This study examines the reliability and internal consistency of the Voice Characterisation Checklist (VoCC), a novel 10-item tool which assesses deg...

Background: The reported rates of technology-assisted child sexual abuse (TA-CSA) have increased in the last decade. It is unclear how services are currently responding to cases of child sexual abuse that involve an online element. Objective: The aim of this study is to understand the current framework of support offered by National Health Servi...

Aim: Recent years have seen innovation in 'mHealth' tools and health apps for the management/promotion of physical health and fitness across the general population. However, there is limited research on how this could be applied to mental healthcare. Therefore, we examined mental healthcare professionals' current uses and perceived roles of digita...

BACKGROUND Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential...

Fully automated mental health apps provide a promising opportunity for increasing access to mental health care and resources. Given this opportunity, continued research into the utility and effectiveness of mental health apps is crucial. Therapeutic alliance (TA) refers to the relationship between a client and a healthcare professional, and has bee...

Introduction This qualitative study explored healthcare professionals' current understanding of, and clinical practices related to, Online Child Sexual Abuse (OCSA). Methods Data were collected across two UK sites (Manchester and Edinburgh). Interviews and one focus group were held with 25 practitioners working in services offering clinical suppor...

Background: Individuals with psychosis report favourable attitudes towards psychological interventions delivered via smartphone apps. Evidence for acceptability, safety, feasibility and efficacy is promising but in-depth reporting of app engagement in trials is sparse. Aims: To examine how people with psychosis engaged with the cognitive behavio...

The aims of this review were to determine: i) how many studies have examined global functioning outcomes from a psychiatric inpatient stay disaggregated by sex; and ii) if women have worse global functioning outcomes than men following an admission. A systematic review following PRISMA guidance and meta-analysis were conducted. Thirty-six studies m...

Background: Disorganized attachment has been identified as an important factor in the development and maintenance of mental health problems. Further research is required to understand the mechanism by which this attachment pattern predisposes individuals to develop, and maintain, personal and social difficulties and mental health problems utilizin...

BACKGROUND Psychosis is one of the most disabling mental health conditions and causes significant personal, social and economic burdens. Accurate and timely symptom monitoring is critical in offering prompt and time sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring ap...

Background Using digital health technologies (DHTs) to deliver and augment healthcare is an innovative way to solve common challenges that the mental healthcare setting faces. Despite China's rapid development of DHT, a comprehensive understanding of staff views of DHTs is lacking, which limited the evidence to support implementation strategies. In...

Background Psychological therapy is core component of mental healthcare. However, many people with severe mental illnesses do not receive therapy, particularly in acute mental health settings. Aims This study identifies barriers to delivering and accessing psychological therapies in acute mental health settings, and is the first to recommend how s...

BACKGROUND There is no evidence-based support offered to young people who have experienced online sexual abuse (YP-OSA). Interventions aimed at improving mentalisation (the ability to understand the mental states of oneself and others) are increasingly applied to treat young people with varied clinical issues. YP-OSA are reluctant to seek in-person...

Background: No evidence-based support has been offered to young people (YP) who have experienced technology-assisted sexual abuse (TASA). Interventions aimed at improving mentalization (the ability to understand the mental states of oneself and others) are increasingly being applied to treat YP with various clinical issues. Digital technology use...

Fully automated mental health smartphone apps show strong promise in increasing access to psychological support. Therefore, it is crucial to understand how to make these apps effective. The therapeutic alliance (TA), or the relationship between healthcare professionals and clients, is considered fundamental to successful treatment outcomes in face-...

Background Early warning signs monitoring by service users with schizophrenia has shown promise in preventing relapse but the quality of evidence is low. We aimed to establish the feasibility of undertaking a definitive randomised controlled trial to determine the effectiveness of a blended digital intervention for relapse prevention in schizophren...

Introduction: Inpatient care often involves restrictive interventions such as seclusion and restraint and restrictive practices that limit the person's freedom, rights, and daily activities. Restrictive practice has not been the explicit focus in previous research however, it often appears as an important theme, with participants identifying it ca...

Exercise has multiple benefits for the physical and mental health of people with severe mental health problems (SMI). However, people with SMI engage in significantly less exercise than the general population and there is an evidence-practice gap regarding the implementation of exercise in clinical services. Mental health staff in inpatient service...

Objectives: This study aimed to investigate associations between proximity seeking, stress and paranoia in the context of daily life, and whether these relationships are moderated by trait attachment styles. Methods: Sixty non-clinical participants completed 3423 assessments of state stress, proximity seeking and paranoia over a 6-day period usi...

Background Relapse is a major determinant of outcome for people with a diagnosis of schizophrenia. Early warning signs frequently precede relapse. A recent Cochrane Review found low-quality evidence to suggest a positive effect of early warning signs interventions on hospitalisation and relapse. Objective How feasible is a study to investigate the...

Paranoia is associated with significant distress and is associated with childhood trauma. Understanding the mechanisms responsible for this association is important for informing psychological interventions. Theoretical proposals suggest that negative schema and insecure attachment may be important mechanisms in the development of paranoia. Disorga...

In this Viewpoint, we argue for the need to reconceptualise an integrated early-care provision for autistic children in the light of their enduring support needs and relevant new findings from developmental and intervention research. This model goes beyond short-term reactive care to outline an early proactive, evidenced, developmentally phased, an...

Background There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is...

Negative symptoms have an adverse impact on quality of life and functioning in psychosis. Service users with psychosis have identified negative symptoms as a priority for their recovery. Despite this, there is a lack of effective and targeted psychological interventions for negative symptoms and their underlying mechanisms remain poorly understood....

Mental health problems are highly prevalent in China; however, China's mental health services lack resources to deliver high-quality care to people in need. Digital mental health is a promising solution to this short-fall in view of the population's digital literacy. In this review, we aim to: (i) investigate the effectiveness, acceptability, usabi...

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies – such as smartphone apps, vir­tual reality, chatbots, and social media – have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In thi...

Negative self and negative other schema have been implicated in the development of paranoia. The current study provides a meta-analysis, narrative review and quality appraisal of quantitative studies investigating the relationship between negative self and negative other schema and paranoia across the paranoia continuum. A systematic search identif...

Background and objectives Voice-hearing exists on a continuum and research studies have utilised experimental paradigms in an attempt to induce unusual auditory experiences in clinical and non-clinical samples. The aim of the current review was to systematically identify, review and appraise voice-hearing induction paradigms in order to guide resea...

Background AVATAR therapy is a novel intervention targeting distressing auditory verbal hallucinations (henceforth ‘voices’). A digital simulation (avatar) of the voice is created and used in a three-way dialogue between participant, avatar and therapist. To date, therapy has been delivered over 6 sessions, comprising an initial phase, focusing on...

Acute mental health inpatient wards have been criticised for being non‐therapeutic. The study aimed to test the feasibility of delivering a psychologically‐informed intervention in these settings. This single‐arm study evaluated the feasibility of clinical psychologists delivering a ward‐based psychological service model over a 6‐month period on tw...

Cognitive-behavioural models of auditory verbal hallucinations (voices) predict that the interpretation of voices determines the levels of distress experienced by voice-hearers. Examining the contribution of these voice appraisals is central to the delivery of effective psychological interventions for the management of distressing psychotic symptom...

People with psychosis are reported to be one of the most stigmatised minority groups in society. Mental health stigma can have a detrimental impact on quality of life (QoL), which is a meaningful outcome for service users experiencing psychosis and using mental health services. This paper provides the first systematic literature review, meta-analys...

Background The culture of acute mental health wards is often dominated by medical models of care despite some patient dissatisfaction with care in these settings and a demand for increased access to psychosocial interventions. Research has found that psychosocial interventions can improve a number of patient and staff outcomes, however, implementat...

The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental h...

Background: Actissist is a smartphone app designed to deliver an intervention grounded in cognitive behavior therapy for early psychosis. Actissist was developed by a multidisciplinary team of academics, clinicians, experts by experience and software engineers. Actissist has been tested in two trials, the first a proof-of-concept trial where Actiss...

Wearable and mobile technology provides new opportunities to manage health conditions remotely and unobtrusively. For example, healthcare providers can repeatedly sample a person's condition to monitor progression of symptoms and intervene if necessary. There is usually a utility-tolerability trade-off between collecting information at sufficient f...

Aims Functional impairment is a hallmark feature of severe mental health problems (SMI). Attachment theory is a key psychological theory of interpersonal functioning and difficulties in attachment are common in SMI and may help explain functioning problems in SMI. This systematic review aimed to synthesise and critically appraise existing literatur...

UNSTRUCTURED The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in dig...

Objectives This paper outlines best practice recommendations for the clinical psychologist's role in inpatient settings and also presents a methodology for deriving evidence‐based recommendations, which may be replicated by health care professionals in other areas of service development. Methods Twenty‐three, nationally drawn experts, deemed exper...

Background Psychosis relapses are common, have profound adverse consequences for patients, and are costly to health services. ‘Early signs’ (e.g. anxiety; insomnia) have been used to predict relapse, in the hope of prevention or mitigation, with moderate sensitivity and specificity. Recent studies have provided preliminary prospective evidence that...

Objectives The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorga...

Background and objectives The cognitive model of voices suggests that negative appraisals of hallucinatory experiences result in responses, such as rumination, which maintain voice-hearing. Our principal aim was to investigate the effect of rumination on the frequency of voice-hearing. Methods A two-group randomised experimental design was employe...