My research programme has two complementary strands: the first on therapeutic relationships and interactions in mental health care and the second on interactional markers of schizophrenia. It draws on concepts and methods from psychology, psychiatry and sociology.
Current projects:
Doctor-patient communication and outcome in the treatment of schizophrenia (MRC)
Providing effective services for people with schizophrenia is a particular challenge making it crucial that services are tailored to suit their specific needs so that they are satisfied with them and derive benefit from treatment. People respond to treatment simply by virtue of being treated, through the placebo effect. Even when no active medication has been given, people show positive psychological and physiological change. The placebo effect highlights the importance of meaning in treatment and we have found that the meaning of peoples' experiences in psychotic illness is a concern for them. This multi-centre study explores whether the effort invested in producing and negotiating meaning (by both patient and psychiatrist) in naturalistic consultations is associated with the outcome of treatment.
Structured patient-clinician communication and one-year outcome in community mental health care (European Commission FPV)
http://www.mecca.eu.org/index.htm
A cluster randomised controlled trial to test a new computer-mediated intervention structuring patient-clinician dialogue (DIALOG) focusing on patients’ quality of life and needs for care in 6 countries. Every 2 months for one year, clinicians ask patients to rate satisfaction with quality of life and treatment, and request additional/different support. Responses are fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome: subjective quality of life. Secondary outcomes: unmet needs and treatment satisfaction.
Talk about suicide in psychiatric consultations
Using conversation analytic techniques, we are analysing how psychiatrists and patients with a diagnosis of depression or schizophrenia talk about suicidal ideation in outpatient settings. Current analyses focus on the conflict between psychiatrists’ ‘risk assessment’, typically delivered in a ‘checklist’ style, and patients’ troubles talk.
Specifying interactional markers of schizophrenia
While physical health problems rely mainly on patient reports and physical examination, many psychiatric symptoms are, by their very nature, interactional. Prima facie, conversation analysis provides a useful approach to mapping the specific interactional problems that appear to characterise schizophrenic symptomatology. I focus on the points in naturalistic interaction where clinicians (and carers when co-present) orient to apparent anomalies in routine conversational structures. I explore the possibility of combining the structural analysis of talk with the content of talk in the context of psychotic symptoms (e.g. the content of bizarre beliefs) to further our understanding of some of the basic deficits underlying schizophrenia.
Recent grants:
Therapeutic Relationships in Community Mental Health Care (1999-2002) with S. Priebe.
St. Bartholomew's Joint Research Board
A Randomised Controlled Trial Evaluating A New Psychiatric Day Hospital For Acute Treatment: One-Year Follow-Up (2000-2003) with S. Priebe & J. Beecham.
NHS Executive
Towards More Effective Community Care for People with Psychosis (2002-2005) with J.Bullenkamp, L. Hansson, S. Priebe, W. Rössler, F. Torres & D. Wiersma.
European Commission FPV
Implementation Of Routine Outcome Management In Community Mental Health Centres (2003 – 2004) with S.Priebe
Department Of Health
Doctor-patient communication in the treatment of schizophrenia: Is it related to treatment outcome?
(2006-2008) with S. Priebe and Vanessa Pinfold, Rethink
Medical Research Council
Publications:
McCabe, R., Heath C., Burns, T. & Priebe, S. (2002) Engagement of patients with psychosis in the medical consultation: A conversation analytic study. British Medical Journal, 325:1148-1151 (http://bmj.com/cgi/content/full/325/7373/1148).
McCabe R & Priebe S. (2003) Are therapeutic relationships in psychiatry explained by patients' symptoms? Factors influencing patient ratings. European Psychiatry, 18(5): 220-5.
McCabe, R., Leudar, I. & Antaki, C. (2004) Do people with schizophrenia display theory of mind deficits in naturalistic interaction? Psychological Medicine, 34:401-12.
McCabe, R. & Priebe, S. (2004) The therapeutic relationship in the treatment of severe mental illness: A review of methods and findings. International Journal of Social Psychiatry, 50(2): 115-128.
McCabe, R. & Priebe, S. (2004) Explanatory models of schizophrenia patients: A comparison of patients from four cultural backgrounds. British Journal of Psychiatry, 185: 25-30.
McCabe, R. (2004) On the inadequacies of theory of mind explanations of schizophrenia: Alternative accounts of alternative problems. Theory and Psychology, 14(5): 738-52.
McGuire, R., McCabe, R. & Priebe, S. (2007) The development of a new Scale to Assess the Therapeutic Relationship (STAR) in community mental health care. Psychological Medicine, 37: 85-96.
Kallert, T.W., Priebe, S., McCabe, R. et al. (in press) Are day hospitals effective for acutely ill psychiatric patients? Journal of Clinical Psychiatry
Hassan, I., McCabe, R. & Priebe, S. (in press) Professional-Patient Communication in the Treatment of Mental Illness: A Review. Communication and Medicine
McCabe, R., Saidi, M. & Priebe, S. (in press) Patient-reported outcomes in schizophrenia. British Journal of Psychiatry
