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Schizophrenia Bulletin Advance Access published online on October 30, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp117
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© The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

CHoice of Outcome In Cbt for psychosEs (CHOICE): The Development of a New Service User–Led Outcome Measure of CBT for Psychosis

Kathryn E. Greenwood1,2, Angela Sweeney3, Sally Williams2, Philippa Garety2,4, Elizabeth Kuipers2,4, Jan Scott5 and Emmanuelle Peters2,4
2 Department of Psychology, Institute of Psychiatry, London, UK
3 Service User Research Enterprise, Institute of Psychiatry, London, UK
4 National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley National Health Service Foundation Trust, London, UK
5 Department of Psychiatry, Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK

1 To whom correspondence should be addressed; Department of Psychology, Maudsley Psychology Centre, Maudsley Hospital and Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; tel: 00-44-203-228-2194, fax: 00-44-203-228-2920, e-mail: k.greenwood{at}iop.kcl.ac.uk

Outcome measures for cognitive behavior therapy for psychosis (CBTp) have been derived from pharmacological studies, focusing on symptom change rather than outcomes such as distress or fulfilment. This study presents the development and psychometric properties of a new outcome measure (CHoice of Outcome In Cbt for psychosEs [CHOICE]), which reflects more strongly the aims of CBTp and the priorities of service users. Service users who had received CBTp participated in focus groups to discuss their outcome priorities, using a topic guide generated by a panel of experts in CBTp. A qualitative thematic analysis was undertaken to reach consensus on themes and generate items. Response scales were constructed for 3 dimensions: severity, satisfaction, and importance. The resulting questionnaire was piloted with service users who had not received CBTp, stratified by service type, ethnicity, and first language to ensure that it was user friendly and applicable prior to CBTp. The psychometric properties of the measure were then examined in a sample of 152 service users. Twenty-four items, and 2 of the dimensions (severity and satisfaction), were retained in the final measure. A factor analysis revealed a single psychological recovery factor interspersed throughout with both CBTp and recovery items. Test-retest reliability, construct validity, and sensitivity to change following CBTp were confirmed. The CHOICE measure is unique in being the first psychometrically adequate service user–led outcome measure of CBTp. It provides the opportunity to examine the evidence base for CBTp with an assessment approach that prioritizes service user definitions of recovery and CBT aims.

Keywords: subjective / measurement / cognitive behavior therapy / trials / schizophrenia


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