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In phase two of the intervention, a plan for change was developed. Where the person was open to change in substance use, cognitive behavioural techniques from both the psychosis and substance use evidence base were used to formulate a change purple nike free flyknit
plan and to help the patient implement and maintain changes such as reduction or abstinence in one or more substances. Components included identifying and increasing awareness of high risk situations and warning signs for substance use lapse or relapse; developing coping skills for handling such situations, with particular attention to psychosis symptoms and mental health problems highlighted in formulation (for example, strategies for dealing with distressing voices or with depressed mood); coping with cravings and urges; making lifestyle changes as alternatives to substance use; and normalising and responding to lapses and relapses. For those who did not identify substance use as problematic, the intervention was sufficiently flexible to allow therapists to work with other patient led problems. In such cases, the therapist would use motivational interviewing techniques to help the patient to link substance use to their concerns. Three liaison meetings between the patient, the therapist, and the patient’s case manager were scheduled during therapy to communicate progress.