Autonomy, psychological reactance and engagement with early intervention in psychosis services

McAndrew, Katie and Rose, Helena and Nickson, Amy (2025) Autonomy, psychological reactance and engagement with early intervention in psychosis services. PhD thesis, Lancaster University.

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Abstract

Promoting autonomy in healthcare is an important ethical consideration and has been found to improve service user trust, empowerment and engagement. Paper one is a systematic literature review and meta-ethnography exploring the experiences of shared decision making for individuals with psychosis, their families and clinicians involved in their care. Three databases were systematically searched (MEDLINE, CINALH and psycINFO) and 12 papers identified for inclusion, a further paper was found through backwards and forwards citation searching totalling 13 papers which are included in the synthesis. Three third order constructs and three sub-constructs were identified. These are: (1) Shared Decision Making is the (Impossible) Ideal, (2) The Therapeutic Alliance, (3) Interpersonal and Professional Power, (3a) Power structures (3b) Who knows best? and (3c) Knowledge is Power. Paper two was a cross-sectional quantitative study which aimed to investigate whether autonomy predicted engagement in early intervention in psychosis services in the UK, mediated by psychological reactance. Psychological reactance theory argues that when an individual’s freedom is threatened, they are motivated to restore their sense of autonomy through autonomy asserting behaviours. The present study aimed to investigate if this theory extended to impacting upon engagement in early intervention in psychosis services by exploring whether perceived autonomy predicted engagement with early intervention services, mediated by psychological reactance. Questionnaires were distributed across two NHS trusts and through social media and psychosis fora. Data was analysed through use of correlations and a serial mediated regression analysis. Results indicated that perceived autonomy did positively predict engagement however, psychological reactance did not mediate this relationship and had no significant relationship with either autonomy or engagement. Section three includes an extended discussion of some of the key issues highlighted in papers one and two.