Impact in Qualitative Research: Caroline Lawlor on developing the Managing Emotions Group

Dr Caroline Lawlor is a Senior Clinical Psychologist at South London and Maudsley NHS Foundation Trust and a Research Affiliate at King’s College London. In this blog she writes about the role of qualitative work in developing a new group therapy supporting people with psychosis to manage their emotions.      

Why is research needed? 
 
Emotions are vital to our survival and tell us important things about our needs and they can be overwhelming and difficult to manage. Many people with psychosis say that difficulties understanding and navigating their emotions get in the way of doing what matters to them: 
 

I was struggling with controlling my emotions… I didn’t have a plan, it just used to get out of control. I used to start crying… (and had) suicidal thoughts, feeling, hopeless, worthless.

 
There are already effective and helpful therapies to help people to manage their emotions, however we know very little about whether and how they can meet the needs of people with psychosis. Existing evidence-based therapies are also often quite long and intensive (e.g., individual and group sessions plus phone support) and we need to better understand whether something briefer can be helpful to people with severe mental health issues and made widely available. 
 
In my local NHS services, I have adapted part of an existing therapy, Dialectical Behaviour Therapy, into a group programme for people with psychosis. The adapted therapy is called the ‘Managing Emotions Group’, and it has been gradually refined based on service user feedback. Over the course of 8 weeks, participants learn about and have a chance to practice a range of skills. These include skills for understanding emotions, managing intense emotions, and responding effectively or ‘wisely’ when experiencing an emotion.  
 
What do people with psychosis think of a Managing Emotions Group?  
 
Fourteen people with psychosis were interviewed about their experiences of attending the Managing Emotions Group.  
 
Everyone who was interviewed reported benefitting from learn about emotions in a group and realising that everyone can struggle to manage emotions:  

It’s just nice in a group because you don’t feel so on your own (or) stupid for feeling that way. 

Participants learnt about ‘how emotions work’ and found that experiential exercises helped them to tune into their emotions: 
 

We all had a card with a different emotion and acting it out made it a bit more real and made you more conscious of what an emotion is and what it can feel like.

 
Trying things out and hearing from others helped people to believe that the skills can help them to manage their emotions and that emotions can change: 

(Now) I know that this is what I can do… and it will help.. it’s like a toolbox.. so hopefully when things come up you have more things at your disposal.

 
The skills helped people to pursue things in their lives: 

Now I’m able to cope and be productive during my days, rather than getting bogged down by it all and finding myself feeling stuck.

However, several participants said that the skills can be hard to remember in the moment. Some suggested that it would help if there was a bit more guidance on how to apply the skills to specific situations: 
 

Maybe if there were… written down situations and then you say how you would normally react and then do a way around that… I guess it’s just judging each emotion, each situation differently.

What impact has this work had on what services offer? 
 
The Managing Emotions Group is now routinely offered in Lambeth community psychosis services and has been introduced to the other three boroughs in South London and Maudsley NHS Foundation Trust. It has been successfully adapted to meet the needs of different populations including people with psychosis; people with complex emotional needs; young adults. It is also now offered face to face and remotely on Microsoft Teams to increase access. 
 
Since publishing this evaluation in an academic journal, I have been contacted by clinicians nationally and internationally who have been inspired to offer the Managing Emotions Group or something similar in their services.  
 
What next?  

More research is needed to develop an evidence-based therapy that could be routinely rolled out in the NHS. We need to make sure it is as helpful as possible to people with psychosis and can be implemented by busy clinicians. In particular, we need to understand how to help people make use of what they have learned in their lives. 
 
To further this work, I have developed a service user advisory group who have shared their ideas on how to make the therapy as accessible, engaging and helpful as possible. I am also benefiting from the experiences of other clinicians who are applying these ideas in healthcare settings. 
 
Ultimately what is needed is a therapy that has been designed by the people who will use it. I have recently successfully applied for research funding and will be codesigning a therapy in partnership with service users, clinicians and researchers. Guided by the qualitative feedback of service users and subsequent patient and public involvement, the therapy will use virtual reality to support people with psychosis to learn and feel confident using skills to manage emotions to maximise how much they can benefit from them in everyday life.