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Seward N, Vansteelandt S, Moreno-Agostino D, Patel V, Araya R. Understanding the effects of a complex psychological intervention on symptoms of depression in Goa, India: findings from a causal mediation analysis. Br J Psychiatry 2023; 222:67-73. [PMID: 36004665 PMCID: PMC10895505 DOI: 10.1192/bjp.2022.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Understanding how and under what circumstances a highly effective psychological intervention, improved symptoms of depression is important to maximise its clinical effectiveness. AIMS To address this complexity, we estimate the indirect effects of potentially important mediators to improve symptoms of depression (measured with the Patient Health Questionnaire (PHQ-9)) in the Healthy Activity Program trial. METHOD Interventional in(direct) effects were used to decompose the total effect of the intervention on PHQ-9 scores into the direct and indirect effects. The following indirect effects were considered: characteristics of sessions, represented by the number of sessions and homework completed; behavioural activation, according to an adapted version of the Behavioural Activation for Depression Scale - Short Form; and extra sessions offered to participants who did not respond to the intervention. RESULTS Of the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.1, bias-corrected 95% CI -3.2 to -1.5), 34% was mediated through improved levels of behavioural activation (mean difference: -0.7, bias-corrected 95% CI -1.2 to -0.4). There was no evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment. CONCLUSIONS Findings from our robust mediation analyses confirmed the importance of targeting behavioural activation. Contrary to published literature, our findings suggest that neither the number of sessions nor proportion of homework completed improved outcomes. Moreover, in this context, alternative treatments other than extra sessions should be considered for patients who do not respond to the intervention.
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Affiliation(s)
- Nadine Seward
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium; and Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - Darío Moreno-Agostino
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Centre for Longitudinal Studies, UCL Social Research Institute, University College London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA
| | - Ricardo Araya
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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2
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Agbor C, Kaur G, Soomro FM, Eche VC, Urhi A, Ayisire OE, Kilanko A, Babalola F, Eze-Njoku C, Adaralegbe NJ, Aladum B, Oyeleye-Adegbite O, Anugwom GO. The Role of Cognitive Behavioral Therapy in the Management of Psychosis. Cureus 2022; 14:e28884. [PMID: 36225466 PMCID: PMC9541382 DOI: 10.7759/cureus.28884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/07/2022] Open
Abstract
Cognitive behavioral therapy for psychosis (CBTp) as a modality of treatment is gaining attention. A number of authors have reported their experiences, including challenges, in administering CBTp for psychotic patients. With CBTp still evolving a lot more research is ongoing to fine-tune its benefits while mitigating the limitations to its use. The objectives of this review are to determine the role of CBTp in the overall improvement of a patient's quality of life, ascertain the number of hospitalizations with acute symptoms after the start of CBTp; and address the common drawbacks to CBTp in the management of psychosis. It was found that cognitive behavioral therapy (CBT) use can prevent the first episode of psychosis in ultra-high risk (UHR) and is effective in improving depression, self-esteem, and psychological well-being. Its use was associated with positive changes in thinking and mood, and sleep quality leading to improved everyday life. Patients who underwent CBT had fewer hospitalizations with a higher number of voluntary hospitalizations as compared to patients with usual care, who underwent a higher number of involuntary hospitalizations. Drawbacks included cost-ineffectiveness and resource limitation.
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3
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Sauvé G, Buck G, Lepage M, Corbière M. Minds@Work: A New Manualized Intervention to Improve Job Tenure in Psychosis Based on Scoping Review and Logic Model. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:515-528. [PMID: 34331191 DOI: 10.1007/s10926-021-09995-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
Introduction A significant proportion of people experiencing psychosis are unemployed, despite a strong desire to work. Current supported employment programs appear effective in helping them obtain employment, yet job tenure remains an arduous challenge. The objective of this study was to review the literature and model the results to inform the development of a new manualized group psychosocial intervention-'Minds@Work'-aimed specifically at improving job tenure in psychosis. Methods The study was registered on the Open Science Framework platform ( https://osf.io/he68z ). The literature was searched in Medline, Embase, PsycInfo and Cochrane Library databases for studies examining predictors of job tenure in psychosis and existing occupational psychosocial interventions. Data were extracted using a pre-established form and synthesized using logic models. Results A total of 94 studies were included and their findings were modeled using different categories: intervention typologies, mechanisms of action, predictors of job tenure, outcomes and contextual factors. The 'Minds@Work' program was built based on these modeled findings and aimed to target specific predictors of job tenure while addressing some of the limitations of existing interventions. The program uses evidence-based techniques and is divided into 9 modules covering 4 themes: positive psychology (motivation, character strengths, self-compassion), neurocognitive remediation (attention, memory, problem-solving), cognitive biases training (jumping to conclusions, defeatists beliefs, theory of mind, attributional styles) and socioemotional coping skills (emotion regulation, communication). Conclusions Once validated, this new program is meant to be used either as a stand-alone intervention or integrated in supported employment initiatives, by employment specialists or healthcare workers.
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Affiliation(s)
- Geneviève Sauvé
- Department of Psychology, Université du Québec À Montréal, 100 Sherbrooke West, Montreal, QC, H2X 3P2, Canada
| | - Gabriella Buck
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Marc Corbière
- Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada.
- Department of Education - Career Counselling, Université du Québec À Montréal, Pavilion N, 1205 Saint-Denis, Montreal, QC, H2X 3R9, Canada.
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4
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Can we predict who will benefit from cognitive-behavioural therapy? A systematic review and meta-analysis of machine learning studies. Clin Psychol Rev 2022; 97:102193. [DOI: 10.1016/j.cpr.2022.102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022]
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5
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Varese F, Douglas M, Dudley R, Bowe S, Christodoulides T, Common S, Grace T, Lumley V, McCartney L, Pace S, Reeves T, Morrison AP, Turkington D. Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series. Psychol Psychother 2021; 94:247-265. [PMID: 32914542 DOI: 10.1111/papt.12304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/27/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). DESIGN Case series. METHODS A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6-month intervention window. Participants were assessed four times over a 12-month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental-health and recovery measures. RESULTS Sixteen participants engaged in the intervention and were included in last-observation-carried-forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post-traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. CONCLUSIONS The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. PRACTITIONER POINTS Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma. Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices. Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Maggie Douglas
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | | | - Tim Grace
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Victoria Lumley
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Laura McCartney
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sonia Pace
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Reeves
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anthony P Morrison
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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6
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Jacobsen P, Tan M. Provision of National Institute for Health and Care Excellence-adherent cognitive behavior therapy for psychosis from inpatient to community settings: A national survey of care pathways in NHS mental health trusts. Health Sci Rep 2020; 3:e198. [PMID: 33102790 PMCID: PMC7577664 DOI: 10.1002/hsr2.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Manting Tan
- Department of PsychologyUniversity of BathBathUK
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7
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Building capacity to provide innovative interventions for early psychosis in mental health professionals. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Despite international guidelines, cognitive behavioural therapy for early psychosis (CBTep) is still under-used in daily clinical practice, mainly due to the lack of specific skills among mental health professionals. The aim of the study was to evaluate the feasibility and efficacy of a CBTep training course and to investigate the impact of trainees’ variables on the level of skills acquisition. An intensive and graded CBTep training programme consisting of 112 hours of plenary lectures, 30 hours of group supervision and 3 months of practical training was offered to mental health professionals of 65 Italian community Mental Health Centers (CMHCs). CBT expert psychologists were used as the comparison group. Participants underwent pre-planned exams to test the level of skills acquisition and were requested to complete a satisfaction survey. The vast majority of participants (93%) completed the training with medium–high evaluation scores and reported to be highly satisfied with the course. CMHCs staff members achieved high scores in the examinations and no major differences between them and CBT expert psychologists were found in most of the final exam scores. Our results support the feasibility and the efficacy of the training to build specific CBTep capacity in a large cohort of professionals working in Italian Generalist Mental Health Services.
Key learning aims
(1)
To understand the capacity building of a short training programme in CBT for early psychosis dedicated to community mental health professionals.
(2)
To consider the optimal characteristics of a CBT training programme for early psychosis.
(3)
To reflect on the feasibility of a CBT training programme for early psychosis in the context of Italian Community Mental Health Services.
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8
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Gooding PA, Pratt D, Awenat Y, Drake R, Elliott R, Emsley R, Huggett C, Jones S, Kapur N, Lobban F, Peters S, Haddock G. A psychological intervention for suicide applied to non-affective psychosis: the CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol. BMC Psychiatry 2020; 20:306. [PMID: 32546129 PMCID: PMC7298803 DOI: 10.1186/s12888-020-02697-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis. METHODS The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6 months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders. DISCUSSION This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be efficacious. TRIAL REGISTRATION ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
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Affiliation(s)
- Patricia A Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK.
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Rachel Elliott
- Manchester Centre for Health Economics, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Steven Jones
- Lancashire Care NHS Foundation Trust, Lancashire, UK
- University of Lancaster, Lancaster, UK
| | - Navneet Kapur
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
| | - Fiona Lobban
- Lancashire Care NHS Foundation Trust, Lancashire, UK
- University of Lancaster, Lancaster, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Coupland Building 1, Oxford Road, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Trust (formerly Manchester Mental Health and Social Care Trust), Manchester, UK
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9
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Ruiz-Iriondo M, Salaberría K, Polo-López R, Iruin Á, Echeburúa E. Improving clinical symptoms, functioning, and quality of life in chronic schizophrenia with an integrated psychological therapy (IPT) plus emotional management training (EMT): A controlled clinical trial. Psychother Res 2019; 30:1026-1038. [PMID: 31651213 DOI: 10.1080/10503307.2019.1683634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: This paper describes the results of testing a multi-component psychological therapy that includes integrated psychological therapy (IPT), together with an adaptation of emotional management therapy (EMT), versus treatment as usual (TAU), delivered in a community mental health setting for individual with chronic schizophrenia. We investigated the effectiveness of a psychological intervention on clinical symptoms, cognitive and social functioning, as well as the feasibility of treatment and its acceptance. Method: 77 outpatients were recruited, 42 in the experimental group, who were treated with IPT + EMT, and 35 participants in control condition (TAU), both during 8 months. The subjects of both groups were assessed pre and postreatment. Results: Treatment attendance was 98% in experimental group and none of patients required hospital admission during therapy, meanwhile 11 patients from the TAU group withdrew and 3 were hospitalized during therapy. After therapy, patients in the experimental group compared to TAU, reduced clinical symptoms and improved cognitive functioning and quality of life. Conclusion: Psychological therapy seems to be a feasible intervention even in the chronic stages of the disease.
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Affiliation(s)
- Maria Ruiz-Iriondo
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
| | - Karmele Salaberría
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
| | - Rocio Polo-López
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain
| | - Álvaro Iruin
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Guipúzcoa Mental Health Network, Basque Health Service-Osakidetza, Gipuzkoa, Spain
| | - Enrique Echeburúa
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
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10
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Garrett M, Ahmed AO, Athineos C, Cruz L, Harris K, Del Pozzo J, Forster V, Gallego J. Identifying psychological resistances to using logic in cognitive-behavioral therapy for psychosis (CBTp) that limit successful outcomes for patients. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2019.1632377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michael Garrett
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anthony O. Ahmed
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
| | - Christina Athineos
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
| | - Lisa Cruz
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
| | - Kelly Harris
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
| | - Jill Del Pozzo
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
| | - Victoria Forster
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
| | - Juan Gallego
- Department of Psychiatry, Weill Cornell Medicine, NewYork-Presbyterian/Westchester, White Plains, NY, USA
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11
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Freeman D, Taylor KM, Molodynski A, Waite F. Treatable clinical intervention targets for patients with schizophrenia. Schizophr Res 2019; 211:44-50. [PMID: 31326234 DOI: 10.1016/j.schres.2019.07.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/19/2019] [Accepted: 07/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment approaches for patients with psychosis need major improvement. Our approach to improvement is twofold: target putative causal mechanisms for psychotic experiences that are treatable and also that patients wish treated. This leads to greater treatment engagement and clinical benefit. To inform mental health service provision we assessed the presence of treatable causal mechanisms and patient treatment preferences. METHODS Patients with non-affective psychosis attending NHS mental health services completed assessments of paranoia, hallucinations, anxious avoidance, worry, self-esteem, insomnia, analytic reasoning, psychological well-being, and treatment preferences. RESULTS 1809 patients participated. Severe paranoia was present in 53.4% and frequent voices in 48.2%. Of the causal mechanisms, severe worry was present in 67.7%, avoidance at agoraphobic levels in 64.5%, analytic reasoning difficulties in 55.9%, insomnia in 50.1%, poor psychological well-being in 44.3%, strongly negative self-beliefs in 36.6%, and weak positive self-beliefs in 19.2%. Treatment target preferences were: feeling happier (63.2%), worrying less (63.1%), increasing self-confidence (62.1%), increasing activities (59.6%), improving decision-making (56.5%), feeling safer (53.0%), sleeping better (52.3%), and coping with voices (45.3%). Patients with current paranoia and/or hallucinations had higher levels of the causal factors and of wanting these difficulties treated. CONCLUSIONS Patients with non-affective psychosis have high levels of treatable problems such as agoraphobic avoidance, worry, low self-esteem, and insomnia and they would like these difficulties treated. Successful treatment of these difficulties is also likely to decrease psychotic experiences such as paranoia.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK.
| | - Kathryn M Taylor
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Andrew Molodynski
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
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12
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Measuring adherence in social recovery therapy with people with first episode psychosis. Behav Cogn Psychother 2019; 48:82-90. [PMID: 31379311 DOI: 10.1017/s1352465819000432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The SUPEREDEN3 study, a phase II randomized controlled trial, suggests that social recovery therapy (SRT) is useful in improving functional outcomes in people with first episode psychosis. SRT incorporates cognitive behavioural therapy (CBT) techniques with case management and employment support, and therefore has a different emphasis to traditional CBT for psychosis, requiring a new adherence tool. AIMS This paper describes the SRT adherence checklist and content of the therapy delivered in the SUPEREDEN3 trial, outlining the frequency of SRT techniques and proportion of participants who received a full therapy dose. It was hypothesized that behavioural techniques would be used frequently, consistent with the behavioural emphasis of SRT. METHOD Research therapists completed an adherence checklist after each therapy session, endorsing elements of SRT present. Data from 1236 therapy sessions were reviewed to determine whether participants received full, partial or no therapy dose. RESULTS Of the 75 participants randomized to receive SRT, 57.3% received a full dose, 24% a partial dose, and 18.7% received no dose. Behavioural techniques were endorsed in 50.5% of sessions, with cognitive techniques endorsed in 34.9% of sessions. CONCLUSIONS This report describes an adherence checklist which should be used when delivering SRT in both research and clinical practice. As hypothesized, behavioural techniques were a prominent feature of the SRT delivered in SUPEREDEN3, consistent with the behavioural emphasis of the approach. The use of this adherence tool would be considered essential for anyone delivering SRT looking to ensure adherence to the model.
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13
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Gee B, Notley C, Byrne R, Clarke T, Hodgekins J, French P, Fowler D. Young people's experiences of Social Recovery Cognitive Behavioural Therapy and treatment as usual in the PRODIGY trial. Early Interv Psychiatry 2018; 12:879-885. [PMID: 27600941 DOI: 10.1111/eip.12381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/28/2016] [Indexed: 11/29/2022]
Abstract
AIM The PRODIGY trial is an ongoing randomized controlled trial of Social Recovery Cognitive Behavioural Therapy (SRCBT), a new intervention designed to improve social functioning in young people at risk of long-term social disability due to severe and complex mental health problems. The aim of this qualitative sub-study was to understand trial participants' experiences of SRCBT and the control condition, treatment as usual. METHODS Trial participants were aged 16-25 years with socially disabling severe and complex mental health problems. A purposive sample of trial participants took part in in-depth qualitative interviews which were transcribed verbatim and analysed thematically. RESULTS Participants from the SRCBT arm valued the relationship with their therapist, the flexibility of intervention delivery and the cognitive and behavioural techniques taught. They viewed SRCBT as challenging but worthwhile. Participants from the treatment as usual arm reported receiving little support, both prior to and during their participation in the trial. Participants from both arms valued opportunities to talk about their difficulties during trial participation. Increased activity was an important goal of participants from both arms and most expressed high motivation and little hopelessness. CONCLUSIONS Currently available services do not meet the needs of some young people with socially disabling mental health problems. Motivation to change appears high at this early stage of disorder, supporting the potential value of intervening early to prevent longer term social disability. SRCBT was well accepted by participants and so is a promising intervention to meet this objective.
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Affiliation(s)
- Brioney Gee
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Tim Clarke
- Child, Family and Young People Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
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14
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Hartmann JA, McGorry PD, Schmidt SJ, Amminger GP, Yuen HP, Markulev C, Berger GE, Chen EYH, de Haan L, Hickie IB, Lavoie S, McHugh MJ, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma SK, Yung AR, Nelson B. Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:292-299. [PMID: 28903120 DOI: 10.1159/000477551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/12/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. METHODS A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. RESULTS In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. CONCLUSIONS Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.
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Affiliation(s)
- Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
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15
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Hussain S, Imran N, Hotiana UA, Mazhar N, Asif A. Illness Perceptions in Patients of Schizophrenia: A Preliminary Investigation from Lahore, Pakistan. Pak J Med Sci 2017; 33:829-834. [PMID: 29067048 PMCID: PMC5648947 DOI: 10.12669/pjms.334.13128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objective: Patient’s perception of their illness influences their healthcare decisions. The objectives of this study were to explore patient’s own beliefs about their illness (Schizophrenia) and perceived social support, and its impact on their attitudes toward pharmacological treatment in Lahore, Pakistan. Methods: This study was conducted at Mayo Hospital Lahore from March to September 2016. Hundred individuals suffering from Schizophrenia completed four questionnaires; a socio-demographic questionnaire, the Illness Perception Questionnaire for Schizophrenia(IPQ-S), Drug attitude Inventory-10 (DAI) and Multidimensional Scale of Perceived Social Support (PSS). Results: Stress, family problems, lack of friends & financial worries were endorsed strongly by patients as cause of their mental illness. Ambiguity regarding their mental illness duration and personal control was observed. Patients’ perceived significant negative consequences, negative emotional response, as well as had poor understanding of their mental illness and treatment effectiveness. Statistically significant gender differences in treatment control and illness coherence subscales of IPQS were observed. Drug attitude inventory was positively correlated with Treatment control subscale (p < .01) and negatively correlated with Illness coherence subscale of IPQS (p < .05). The negative consequences subscale and perceived social support was negatively correlated (p < .01). Conclusion: Patient’s perception about their own illness is predictor of their drug taking attitude and perceived social support. Study results should help to develop new interventions to correct inaccurate beliefs in patients with schizophrenia to improve illness outcome.
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Affiliation(s)
- Sadia Hussain
- Ms. Sadia Hussain, MSc Psychology. Intern Psychologist, Academic Department of Psychiatry & Behavioural Sciences King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Nazish Imran
- Dr. Nazish Imran, MBBS; FRCPsych; MRCPsych (London). Associate Professor, Child & Family Psychiatry Department. King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Usman Amin Hotiana
- Dr. Usman Amin Hotiana, MBBS; FCPS (Psy). Assistant Professor, King Edward Medical University/Mayo Hospital, Lahore, Pakistan Academic Department of Psychiatry & Behavioral Sciences
| | - Nauman Mazhar
- Dr. Nauman Mazhar, MBBS; MD(Psy); FCPS(Psy)Senior Registrar, Department of Psychiatry Services Hospital, Lahore, Pakistan
| | - Aftab Asif
- Prof. Aftab Asif, MBBS; MRCPsych Professor of Psychiatry, Academic Department of Psychiatry & Behavioural Sciences, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
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16
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Morrison AP. A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1295098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anthony P. Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
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17
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Ginestet CE, Emsley R, Landau S. Dose-response modeling in mental health using stein-like estimators with instrumental variables. Stat Med 2017; 36:1696-1714. [PMID: 28222485 PMCID: PMC5434902 DOI: 10.1002/sim.7265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 11/25/2022]
Abstract
A mental health trial is analyzed using a dose–response model, in which the number of sessions attended by the patients is deemed indicative of the dose of psychotherapeutic treatment. Here, the parameter of interest is the difference in causal treatment effects between the subpopulations that take part in different numbers of therapy sessions. For this data set, interactions between random treatment allocation and prognostic baseline variables provide the requisite instrumental variables. While the corresponding two‐stage least squares (TSLS) estimator tends to have smaller bias than the ordinary least squares (OLS) estimator; the TSLS suffers from larger variance. It is therefore appealing to combine the desirable properties of the OLS and TSLS estimators. Such a trade‐off is achieved through an affine combination of these two estimators, using mean squared error as a criterion. This produces the semi‐parametric Stein‐like (SPSL) estimator as introduced by Judge and Mittelhammer (2004). The SPSL estimator is used in conjunction with multiple imputation with chained equations, to provide an estimator that can exploit all available information. Simulated data are also generated to illustrate the superiority of the SPSL estimator over its OLS and TSLS counterparts. A package entitled SteinIV implementing these methods has been made available through the R platform. © 2017 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Cedric E Ginestet
- Biostatistics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, U.K.,MRC North West Hub for Trials Methodology Research, Liverpool, U.K
| | - Sabine Landau
- Biostatistics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, U.K
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18
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Subjective Experiences of the Benefits and Key Elements of a Cognitive Behavioral Intervention Focused on Community Work Outcomes in Persons With Mental Illness. J Nerv Ment Dis 2017; 205:66-73. [PMID: 27741081 DOI: 10.1097/nmd.0000000000000601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
New research suggests that group-based cognitive behavioral therapy (CBT) may help improve employment outcomes in persons with mental illness, yet the effects and potential key elements facilitating change in such interventions are unclear. Using a mixed methods approach, this study examined the perspectives of persons with mental illness after participating in a pilot study of the "CBT for Work Success" intervention. Findings demonstrate that participants valued the intervention and perceived that it assisted them in achieving work goals. Therapeutic effects included improved self-efficacy, work motivation, enhanced sense of self as workers, and increased beliefs that work success is attainable. CBT for Work Success elements perceived to be important in facilitating work goals included cognitive restructuring, behavioral coping strategies, problem solving work barriers, meaningful reflection on oneself as a worker, and important factors associated with the group process. The authors discuss the implications of these findings and future research directions.
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19
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Dunn G, Emsley R, Liu H, Landau S, Green J, White I, Pickles A. Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme. Health Technol Assess 2016; 19:1-115, v-vi. [PMID: 26560448 DOI: 10.3310/hta19930] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The development of the capability and capacity to evaluate the outcomes of trials of complex interventions is a key priority of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). The evaluation of complex treatment programmes for mental illness (e.g. cognitive-behavioural therapy for depression or psychosis) not only is a vital component of this research in its own right but also provides a well-established model for the evaluation of complex interventions in other clinical areas. In the context of efficacy and mechanism evaluation (EME) there is a particular need for robust methods for making valid causal inference in explanatory analyses of the mechanisms of treatment-induced change in clinical outcomes in randomised clinical trials. OBJECTIVES The key objective was to produce statistical methods to enable trial investigators to make valid causal inferences about the mechanisms of treatment-induced change in these clinical outcomes. The primary objective of this report is to disseminate this methodology, aiming specifically at trial practitioners. METHODS The three components of the research were (1) the extension of instrumental variable (IV) methods to latent growth curve models and growth mixture models for repeated-measures data; (2) the development of designs and regression methods for parallel trials; and (3) the evaluation of the sensitivity/robustness of findings to the assumptions necessary for model identifiability. We illustrate our methods with applications from psychological and psychosocial intervention trials, keeping the technical details to a minimum, leaving the reporting of the more theoretical and mathematically demanding results for publication in appropriate specialist journals. RESULTS We show how to estimate treatment effects and introduce methods for EME. We explain the use of IV methods and principal stratification to evaluate the role of putative treatment effect mediators and therapeutic process measures. These results are extended to the analysis of longitudinal data structures. We consider the design of EME trials. We focus on designs to create convincing IVs, bearing in mind assumptions needed to attain model identifiability. A key area of application that has become apparent during this work is the potential role of treatment moderators (predictive markers) in the evaluation of treatment effect mechanisms for personalised therapies (stratified medicine). We consider the role of targeted therapies and multiarm trials and the use of parallel trials to help elucidate the evaluation of mediators working in parallel. CONCLUSIONS In order to demonstrate both efficacy and mechanism, it is necessary to (1) demonstrate a treatment effect on the primary (clinical) outcome, (2) demonstrate a treatment effect on the putative mediator (mechanism) and (3) demonstrate a causal effect from the mediator to the outcome. Appropriate regression models should be applied for (3) or alternative IV procedures, which account for unmeasured confounding, provided that a valid instrument can be identified. Stratified medicine may provide a setting where such instruments can be designed into the trial. This work could be extended by considering improved trial designs, sample size considerations and measurement properties. FUNDING The project presents independent research funded under the MRC-NIHR Methodology Research Programme (grant reference G0900678).
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Affiliation(s)
- Graham Dunn
- Centre for Biostatistics, Institute of Population Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,Medical Research Council North West Hub for Trials Methodology Research, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,Medical Research Council North West Hub for Trials Methodology Research, UK
| | - Hanhua Liu
- Centre for Biostatistics, Institute of Population Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Sabine Landau
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Ian White
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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20
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Ruggeri M, Bonetto C, Lasalvia A, Fioritti A, de Girolamo G, Santonastaso P, Pileggi F, Neri G, Ghigi D, Giubilini F, Miceli M, Scarone S, Cocchi A, Torresani S, Faravelli C, Cremonese C, Scocco P, Leuci E, Mazzi F, Pratelli M, Bellini F, Tosato S, De Santi K, Bissoli S, Poli S, Ira E, Zoppei S, Rucci P, Bislenghi L, Patelli G, Cristofalo D, Meneghelli A. Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants. Schizophr Bull 2015; 41:1192-203. [PMID: 25995057 PMCID: PMC4535643 DOI: 10.1093/schbul/sbv058] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.
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Affiliation(s)
- Mirella Ruggeri
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy;
| | - Chiara Bonetto
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Antonio Lasalvia
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angelo Fioritti
- Department of Mental Health, Azienda ULSS Bologna, Bologna, Italy
| | - Giovanni de Girolamo
- Scientific Direction, St John of God Clinical Research Centre of Brescia, Brescia, Lombardia, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy and Azienda Ospedaliera Padova, Italy
| | | | - Giovanni Neri
- Department of Mental Health, Azienda ULSS Modena, Modena, Italy; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Italy
| | | | | | | | - Silvio Scarone
- Department of Psychiatry, University of Milano, Milano, Italy
| | - Angelo Cocchi
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | | | - Carlo Faravelli
- Department of Psychiatry, University of Firenze, Firenze, Italy
| | - Carla Cremonese
- Department of Mental Health, Azienda Ospedaliera Padova, Padova, Italy
| | - Paolo Scocco
- Department of Mental Health, Azienda ULSS 16, Padova, Italy
| | | | | | | | | | - Sarah Tosato
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Katia De Santi
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sarah Bissoli
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Sara Poli
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Elisa Ira
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Silvia Zoppei
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Paola Rucci
- Department of Mental Health, Azienda ULSS Bologna, Bologna, Italy; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Italy
| | - Laura Bislenghi
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | - Giovanni Patelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | - Doriana Cristofalo
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Anna Meneghelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
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Goldsmith LP, Lewis SW, Dunn G, Bentall RP. Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. Psychol Med 2015; 45:2365-2373. [PMID: 25805118 PMCID: PMC4501302 DOI: 10.1017/s003329171500032x] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 11/03/2015] [Accepted: 02/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The quality of the therapeutic alliance (TA) has been invoked to explain the equal effectiveness of different psychotherapies, but prior research is correlational, and does not address the possibility that individuals who form good alliances may have good outcomes without therapy. METHOD We evaluated the causal effect of TA using instrumental variable (structural equation) modelling on data from a three-arm, randomized controlled trial of 308 people in an acute first or second episode of a non-affective psychosis. The trial compared cognitive behavioural therapy (CBT) over 6 weeks plus routine care (RC) v. supportive counselling (SC) plus RC v. RC alone. We examined the effect of TA, as measured by the client-rated CALPAS, on the primary trial 18-month outcome of symptom severity (PANSS), which was assessed blind to treatment allocation. RESULTS Both adjunctive CBT and SC improved 18-month outcomes, compared to RC. We showed that, for both psychological treatments, improving TA improves symptomatic outcome. With a good TA, attending more sessions causes a significantly better outcome on PANSS total score [effect size -2.91, 95% confidence interval (CI) -0.90 to -4.91]. With a poor TA, attending more sessions is detrimental (effect size +7.74, 95% CI +1.03 to +14.45). CONCLUSIONS This is the first ever demonstration that TA has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental. These effects may extend to other therapeutic modalities and disorders.
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Affiliation(s)
| | - S. W. Lewis
- Institute of Brain Behaviour and Mental Health, Institute of Population Health, University of Manchester; Manchester Mental Health and Social Care Trust, Manchester, UK
| | - G. Dunn
- Institute of Brain Behaviour and Mental Health, Institute of Population Health, University of Manchester; Manchester Mental Health and Social Care Trust, Manchester, UK
| | - R. P. Bentall
- Department of Psychological Sciences, Liverpool University, Liverpool, UK
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22
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Flach C, French P, Dunn G, Fowler D, Gumley AI, Birchwood M, Stewart SLK, Morrison AP. Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: analysis of the EDIE-2 trial. Br J Psychiatry 2015; 207:123-9. [PMID: 25999337 DOI: 10.1192/bjp.bp.114.153320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. METHOD Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis. RESULTS A significant decrease in the symptom score for case formulation (coefficient = -23, 95% CI -44 to -1.7, P = 0.036) and homework (coefficient = -0.26, 95% CI -0.51 to -0.001, P = 0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient = -0.23, 95% CI -0.47 to 0.005, P = 0.056). CONCLUSIONS There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
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Affiliation(s)
- Clare Flach
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Paul French
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Graham Dunn
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - David Fowler
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Andrew I Gumley
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Max Birchwood
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Suzanne L K Stewart
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Anthony P Morrison
- Clare Flach, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; Paul French, PhD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Manchester, and Department of Psychological Sciences, Liverpool University, Liverpool; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester; David Fowler, MSc, School of Psychology, University of Sussex, Brighton; Andrew I. Gumley, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Max Birchwood, DSc, Division of Mental Health and Wellbeing, University of Warwick, Warwick; Suzanne L. K. Stewart, PhD, Department of Psychology, University of Chester, Chester; Anthony P. Morrison, ClinPsyD, Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, and School of Psychological Sciences, University of Manchester, Manchester, UK
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Mechelli A, Prata D, Kefford C, Kapur S. Predicting clinical response in people at ultra-high risk of psychosis: a systematic and quantitative review. Drug Discov Today 2015; 20:924-7. [DOI: 10.1016/j.drudis.2015.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/22/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
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So SHW, Chan AP, Chong CSY, Wong MHM, Lo WTL, Chung DWS, Chan SS. Metacognitive training for delusions (MCTd): effectiveness on data-gathering and belief flexibility in a Chinese sample. Front Psychol 2015; 6:730. [PMID: 26124726 PMCID: PMC4467068 DOI: 10.3389/fpsyg.2015.00730] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/16/2015] [Indexed: 01/06/2023] Open
Abstract
Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy of a four-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions (JTC) bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after 4 weeks of treatment as usual (TAU). Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. JTC and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to TAU, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. JTC bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approaches.
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Affiliation(s)
- Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong Hong Kong, China
| | - Arthur P Chan
- Early Intervention Service for First Episode Psychosis, Kwai Chung Hospital Hong Kong, China
| | | | | | - William Tak-Lam Lo
- Early Intervention Service for First Episode Psychosis, Kwai Chung Hospital Hong Kong, China
| | | | - Sandra S Chan
- Department of Psychiatry, The Chinese University of Hong Kong Hong Kong, China
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Lecomte T, Leclerc C, Wykes T, Nicole L, Abdel Baki A. Understanding process in group cognitive behaviour therapy for psychosis. Psychol Psychother 2015; 88:163-77. [PMID: 25065676 DOI: 10.1111/papt.12039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/12/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group cognitive behaviour therapy for psychosis (GCBTp) has shown to be effective in diminishing symptoms, as well as in improving other psychosocial dimensions such as self-esteem. But little is known regarding the processes that generate these therapeutic improvements and might be harnessed to further improve its effectiveness. OBJECTIVES The current study aimed at investigating these processes, particularly those linked to interpersonal relationships. DESIGN The participants were all assessed at baseline, were given 24 sessions of GCBTp over the course of 3 months and were assessed again at post-treatment as well as 6 months later (9 months from baseline). METHOD Sixty-six individuals with early psychosis took part in a study of GCBTp where therapist alliance and group cohesion were assessed at three time points during the therapy, and punctual (each session) self-perceptions on symptoms and optimism were collected. RESULTS Improvements in symptoms (BPRS), self-esteem (SERS-SF) and in self-perceived therapeutic improvements (CHOICE) were linked to specific aspects of the alliance, group cohesion, as well as optimism. The variables retained were not always overall scores, suggesting the importance of the variables at key moments during the therapy. CONCLUSIONS The results clearly demonstrate the importance of the alliance and group cohesion, together significantly explaining improvements measured at post-therapy or follow-up. PRACTITIONER POINTS This study has attempted to focus mostly on relational aspects, as well as on self-perceptions, in the context of a GCBTp for individuals with early psychosis. This study also showed that these therapeutic relationships are especially useful when they are more stable and at specific moments during the therapy, namely when more difficult psychological work is done.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, University of Montreal, Québec, Canada
| | - Claude Leclerc
- Department of Nursing, University of Quebec at Trois-Rivieres, Québec, Canada
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, University of London, UK
| | - Luc Nicole
- Programme PEP (Premiers Episodes Psychotiques), Montreal University Institute of Mental Health (IUSMM), Montreal, Québec, Canada
| | - Amal Abdel Baki
- Programme JAP (Jeunes Adultes Psychotiques), Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
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26
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Marcus E, Garety P, Weinman J, Emsley R, Dunn G, Bebbington P, Freeman D, Kuipers E, Fowler D, Hardy A, Waller H, Jolley S. A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis. J Behav Ther Exp Psychiatry 2014; 45:459-66. [PMID: 25011076 PMCID: PMC4157321 DOI: 10.1016/j.jbtep.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/18/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp. METHODS Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later. RESULTS The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects. LIMITATIONS We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample. CONCLUSIONS The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.
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Affiliation(s)
- Elena Marcus
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Philippa Garety
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - John Weinman
- King's College London, Institute of Pharmaceutical Science, 5th Floor Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Paul Bebbington
- Division of Psychiatry, University College, London, 67-73 Riding House Street, London W1W 7EJ, UK.
| | - Daniel Freeman
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Elizabeth Kuipers
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Pevensey Building, Falmer BN1 9QH, UK.
| | - Amy Hardy
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Helen Waller
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Suzanne Jolley
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
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Lincoln TM, Hartmann M, Köther U, Moritz S. Do People With Psychosis Have Specific Difficulties Regulating Emotions? Clin Psychol Psychother 2014; 22:637-46. [DOI: 10.1002/cpp.1923] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Tania M. Lincoln
- Clinical Psychology and Psychotherapy; Institute of Psychology, University of Hamburg; Hamburg 20246 Germany
| | - Maike Hartmann
- Clinical Psychology and Psychotherapy; Institute of Psychology, University of Hamburg; Hamburg 20246 Germany
| | - Ulf Köther
- Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf; Hamburg D-20246 Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy; University Medical Center Hamburg-Eppendorf; Hamburg D-20246 Germany
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Byrne RE, Morrison AP. Young people at risk of psychosis: their subjective experiences of monitoring and cognitive behaviour therapy in the early detection and intervention evaluation 2 trial. Psychol Psychother 2014; 87:357-71. [PMID: 23983132 DOI: 10.1111/papt.12013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 06/24/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore participants' experiences of 'enhanced monitoring' and cognitive behaviour therapy (CBT) within a randomized controlled trial evaluating early detection and prevention of psychosis ('early detection and intervention evaluation [EDIE] 2'). DESIGN Semi-structured qualitative interviews were conducted with a sample of participants at the end of their involvement with the trial. METHODS Ten young people were interviewed; six males and four females, with a mean age of 27.5. Nine participants identified themselves as White British and one Black British. All participants had received 'enhanced monitoring' during the trial, and 8 of 10 also received CBT. Interviews were transcribed verbatim and analysed using thematic analysis to identify central themes within and among participants' accounts. RESULTS Three super-ordinate thematic areas were identified: 'a chance to talk', monitoring-specific themes, and CBT-specific themes. The central theme ('a chance to talk') was drawn from across all participants' accounts and represents the most consistently valued attribute of participants' experiences of the EDIE 2 trial. Sub-themes of this topic were identified as follows: interpersonal engagement, informality and normalization, and 'opening up'. Sub-themes related to monitoring include the following: clarity and reassurance, 'a therapeutic process', and challenges. CBT experience was most consistently conceptualized as 'rethinking things', and two additional CBT-specific sub-themes were identified: hard work and moving forward. CONCLUSIONS Our findings suggest that for young people at risk of psychosis, a normalizing psychosocially oriented assessment and monitoring process may have benefits for many, while CBT may help to reduce the negative impact of unusual psychological experiences for both the short- and long term. PRACTITIONER POINTS Young people considered at risk of psychosis highly value normalizing, collaborative, and flexible approaches when engaging with research or clinical staff. All of our participants highlighted the primary value of their engagement with staff members as having a 'chance to talk' about their experiences and difficulties. CBT seems to be widely acceptable among 'at-risk' participants, though further research is required to establish the 'key ingredients' of effective CBT for 'at-risk' individuals. Valued CBT-related outcomes highlighted by participants included improved psychosocial understanding of their difficulties, improved coping ability, and greater optimism for the future.
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Affiliation(s)
- Rory E Byrne
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK; The University of Manchester, UK
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29
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Weck F, Grikscheit F, Jakob M, Höfling V, Stangier U. Treatment failure in cognitive-behavioural therapy: Therapeutic alliance as a precondition for an adherent and competent implementation of techniques. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 54:91-108. [DOI: 10.1111/bjc.12063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 06/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Florian Weck
- Department of Clinical Psychology and Psychotherapy; Goethe-University; Frankfurt Germany
| | - Florian Grikscheit
- Department of Clinical Psychology and Psychotherapy; Goethe-University; Frankfurt Germany
| | - Marion Jakob
- Department of Clinical Psychology and Psychotherapy; Goethe-University; Frankfurt Germany
| | - Volkmar Höfling
- Department of Clinical Psychology and Psychotherapy; Goethe-University; Frankfurt Germany
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy; Goethe-University; Frankfurt Germany
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Iyassu R, Jolley S, Bebbington P, Dunn G, Emsley R, Freeman D, Fowler D, Hardy A, Waller H, Kuipers E, Garety P. Psychological characteristics of religious delusions. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1051-61. [PMID: 24379014 PMCID: PMC4173112 DOI: 10.1007/s00127-013-0811-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/16/2013] [Indexed: 12/03/2022]
Abstract
PURPOSE Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the perceptual, cognitive, affective and behavioural mechanisms held to maintain delusions in cognitive models of psychosis, as these form the key treatment targets in cognitive behavioural therapy. We compared religious delusions to delusions with other content. METHODS Comprehensive measures of symptoms and psychological processes were completed by 383 adult participants with delusions and a schizophrenia spectrum diagnosis, drawn from two large studies of cognitive behavioural therapy for psychosis. RESULTS Binary logistic regression showed that religious delusions were associated with higher levels of grandiosity (OR 7.5; 95 % CI 3.9-14.1), passivity experiences, having internal evidence for their delusion (anomalous experiences or mood states), and being willing to consider alternatives to their delusion (95 % CI for ORs 1.1-8.6). Levels of negative symptoms were lower. No differences were found in delusional conviction, insight or attitudes towards treatment. CONCLUSIONS Levels of positive symptoms, particularly anomalous experiences and grandiosity, were high, and may contribute to symptom persistence. However, contrary to previous reports, we found no evidence that people with religious delusions would be less likely to engage in any form of help. Higher levels of flexibility may make them particularly amenable to cognitive behavioural approaches, but particular care should be taken to preserve self-esteem and valued aspects of beliefs and experiences.
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Affiliation(s)
- Robel Iyassu
- />PO77 Department of Psychology, King’s College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF UK
| | - Suzanne Jolley
- />PO77 Department of Psychology, King’s College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF UK
| | | | - Graham Dunn
- />Health Sciences Research Group, School of Community Based Medicine, University of Manchester, Manchester, UK
| | - Richard Emsley
- />Health Sciences Research Group, School of Community Based Medicine, University of Manchester, Manchester, UK
| | - Daniel Freeman
- />Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Fowler
- />School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Amy Hardy
- />PO77 Department of Psychology, King’s College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF UK
| | - Helen Waller
- />PO77 Department of Psychology, King’s College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF UK
| | - Elizabeth Kuipers
- />PO77 Department of Psychology, King’s College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF UK
| | - Philippa Garety
- />PO77 Department of Psychology, King’s College London, Institute of Psychiatry, University of London, Denmark Hill, London, SE5 8AF UK
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Affiliation(s)
- Rory E Byrne
- Rory E. Byrne, Psychology Services, Harrop House, Greater Manchester West Mental Health NHS Foundation Trust, Bury New Road, Manchester M25 3BL, UK.
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Associations between therapy skills and patient experiences of change processes in cognitive behavioral therapy for psychosis. Psychiatry Res 2013; 210:702-9. [PMID: 23992793 DOI: 10.1016/j.psychres.2013.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/01/2013] [Accepted: 08/08/2013] [Indexed: 11/23/2022]
Abstract
Despite the promising findings in relation to the efficacy of cognitive behavioral therapy for psychosis (CBTp), little attention has been paid to the therapy skills necessary to deliver CBTp and to the influence of such skills on processes underlying therapeutic change. Our study investigated the associations between general and technical therapy skills and patient experiences of change processes in CBTp. The study sample consisted of 79 patients with psychotic disorders who had undergone CBTp. We randomly selected one tape-recorded therapy session from each of the cases. General and technical therapy skills were assessed by the Cognitive Therapy Scale for Psychosis. The Bern Post Session Report for Patients was applied to measure patient experiences of general change processes in the sense of Grawe's psychological therapy. General skills, such as feedback and understanding, explained 23% of the variance of patients' self-esteem experience, but up to 10% of the variance of mastery, clarification, and contentment experiences. The technical skill of guided discovery consistently showed negative associations with patients' alliance, contentment, and control experiences. The study points to the importance of general therapy skills for patient experiences of change processes in CBTp. Some technical skills, however, could detrimentally affect the therapeutic relationship.
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A pilot evaluation of therapist training in cognitive therapy for psychosis: therapy quality and clinical outcomes. Behav Cogn Psychother 2013; 43:478-89. [PMID: 24360498 DOI: 10.1017/s1352465813001100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Historically, it has been difficult to demonstrate an impact of training in psychological interventions for people with psychosis on routine practice and on patient outcomes. A recent pilot evaluation suggested that postgraduate training in Cognitive Behavioural Therapy for Psychosis (CBTp) increased the delivery of competent therapy in routine services. In this study, we evaluated clinical outcomes for patients receiving therapy from therapists who successfully completed training, and their association with ratings of therapist competence and therapy content. AIMS To characterize the therapy delivered during training and to inform both a calculation of effect size for its clinical impact, and the development of competence benchmarks to ensure that training standards are sufficient to deliver clinical improvement. METHOD Paired patient-reported outcome measures (PROMS) were extracted from anonymized therapy case reports, and were matched with therapy ratings for each therapist. RESULTS Twenty clients received a course of competent therapy, including a high frequency of active therapy techniques, from nine therapists. Pre-post effect size for change in psychotic symptoms was large (d = 1.0) and for affect, medium (d = 0.6), but improved outcomes were not associated with therapist competence or therapy content. CONCLUSIONS Therapists trained to research trial standards of competence achieved excellent clinical outcomes. Therapy effect sizes suggest that training costs may be offset by clinical benefit. Larger, methodologically stringent evaluations of training are now required. Future research should assess the necessary and sufficient training required to achieve real-world clinical effectiveness, and the cost-effectiveness of training.
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Eisner E, Drake R, Barrowclough C. Assessing early signs of relapse in psychosis: Review and future directions. Clin Psychol Rev 2013; 33:637-53. [DOI: 10.1016/j.cpr.2013.04.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 03/08/2013] [Accepted: 04/03/2013] [Indexed: 01/25/2023]
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Datta J, Petticrew M. Challenges to evaluating complex interventions: a content analysis of published papers. BMC Public Health 2013; 13:568. [PMID: 23758638 PMCID: PMC3699389 DOI: 10.1186/1471-2458-13-568] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 05/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is continuing interest among practitioners, policymakers and researchers in the evaluation of complex interventions stemming from the need to further develop the evidence base on the effectiveness of healthcare and public health interventions, and an awareness that evaluation becomes more challenging if interventions are complex.We undertook an analysis of published journal articles in order to identify aspects of complexity described by writers, the fields in which complex interventions are being evaluated and the challenges experienced in design, implementation and evaluation. This paper outlines the findings of this documentary analysis. METHODS The PubMed electronic database was searched for the ten year period, January 2002 to December 2011, using the term "complex intervention*" in the title and/or abstract of a paper. We extracted text from papers to a table and carried out a thematic analysis to identify authors' descriptions of challenges faced in developing, implementing and evaluating complex interventions. RESULTS The search resulted in a sample of 221 papers of which full text of 216 was obtained and 207 were included in the analysis. The 207 papers broadly cover clinical, public health and methodological topics. Challenges described included the content and standardisation of interventions, the impact of the people involved (staff and patients), the organisational context of implementation, the development of outcome measures, and evaluation. CONCLUSIONS Our analysis of these papers suggests that more detailed reporting of information on outcomes, context and intervention is required for complex interventions. Future revisions to reporting guidelines for both primary and secondary research may need to take aspects of complexity into account to enhance their value to both researchers and users of research.
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Affiliation(s)
- Jessica Datta
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
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Hutton P. Cognitive-behavioural therapy for schizophrenia: a critical commentary on the Newton-Howes and Wood meta-analysis. Psychol Psychother 2013; 86:139-45. [PMID: 23674465 DOI: 10.1111/papt.12009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 04/15/2013] [Indexed: 11/27/2022]
Abstract
Newton-Howes and Wood (published online, this journal, 8 Dec 2011) report the results of their systematic review and meta-analysis of clinical trials of cognitive-behavioural therapy (CBT) for schizophrenia. They ran a random effects analysis of endpoint data from trials where participants were randomly allocated to receive either CBT or a control therapy, which could be inactive (e.g., befriending) or active (e.g., analytic supportive psychotherapy), found no difference between the groups and concluded 'it (CBT) does not outperform supportive therapy in effecting change in phenomenology.' Such a conclusion is premature, if not unwarranted, for a number of reasons, including basic mistakes, lack of transparency, and failure to consider dose.
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Affiliation(s)
- Paul Hutton
- Psychology Department, Greater Manchester West Mental Health Foundation NHS Trust, Manchester, UK.
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Freeman D, Dunn G, Garety P, Weinman J, Kuipers E, Fowler D, Jolley S, Bebbington P. Patients' beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis. Psychol Med 2013; 43:269-277. [PMID: 22781166 PMCID: PMC3544544 DOI: 10.1017/s0033291712001225] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is evidence that patients with schizophrenia benefit from standard cognitive behaviour therapy (CBT) only if active techniques are used ('full therapy'). By contrast, attending sessions but not proceeding beyond engagement and assessment strategies ('partial therapy'), or simply not attending sessions ('no therapy'), is not associated with better outcomes. The factors leading to full therapy are unknown. We hypothesized that patients' initial ideas about the nature and extent of their problems would predict use of CBT. A match between patients' views of their problems and the principles underlying treatment would lead to better outcomes. METHOD Ninety-two patients with a recent relapse of psychosis completed the Illness Perception Questionnaire (IPQ) before receiving CBT. We examined whether their illness perceptions predicted the take-up of therapy. RESULTS Patients who did not attend sessions believed their problems would not last as long as those who attended them. Those who attended sessions but did not proceed to full therapy had a lower sense of control over their problems and a more biological view of their causes. Patients who took up full therapy were more likely to attribute the cause of their problems to their personality and state of mind. The take-up of therapy was predicted neither by levels of psychiatric symptoms nor by insight. CONCLUSIONS People with psychosis who have psychologically orientated views of their problems, including the potential to gain control over them, may be more likely to engage fully and do well with standard CBT for psychosis, irrespective of the severity of their problems.
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Affiliation(s)
- D Freeman
- Department of Psychiatry, Oxford University, UK.
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Van den Berg DPG, Van der Vleugel BM, Staring ABP, De Bont PAJ, Jongh AD. EMDR in Psychosis: Guidelines for Conceptualization and Treatment. JOURNAL OF EMDR PRACTICE AND RESEARCH 2013. [DOI: 10.1891/1933-3196.7.4.208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A significant proportion of clients with psychosis have experienced childhood trauma and suffer from comorbid posttraumatic stress disorder. Research indicates that exposure to distressing early life events plays an important role in the emergence and persistence of psychotic symptoms—either directly or indirectly. The Two Method Approach of EMDR conceptualization and recent findings on reprocessing of psychosis-related imagery fit with the existing cognitive models of psychosis. This article presents a series of preliminary guidelines for conceptualizing EMDR treatment in psychosis, which are based on both theory and clinical experience and are illustrated with case examples. Several obstacles and related treatment strategies for using EMDR in psychosis are described. EMDR in psychosis can very well be combined with other standard interventions such as psychotropic medication and cognitive behavioral therapy.
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Increasing access to psychological therapies for people with psychosis: Predictors of successful training. Behav Res Ther 2012; 50:457-62. [DOI: 10.1016/j.brat.2012.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 11/17/2022]
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Ruggeri M, Bonetto C, Lasalvia A, De Girolamo G, Fioritti A, Rucci P, Santonastaso P, Neri G, Pileggi F, Ghigi D, Miceli M, Scarone S, Cocchi A, Torresani S, Faravelli C, Zimmermann C, Meneghelli A, Cremonese C, Scocco P, Leuci E, Mazzi F, Gennarelli M, Brambilla P, Bissoli S, Bertani ME, Tosato S, De Santi K, Poli S, Cristofalo D, Tansella M. A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial. Trials 2012; 13:73. [PMID: 22647399 PMCID: PMC3464965 DOI: 10.1186/1745-6215-13-73] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/30/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services. METHODS/DESIGN The Psychosis early Intervention and Assessment of Needs and Outcome (PIANO) trial is part of a larger research program (Genetics, Endophenotypes and Treatment: Understanding early Psychosis - GET UP) which aims to compare, at 9 months, the effectiveness of a multi-component psychosocial intervention versus treatment as usual (TAU) in a large epidemiologically based cohort of patients with FEP and their family members recruited from all public community mental health centers (CMHCs) located in two entire regions of Italy (Veneto and Emilia Romagna), and in the cities of Florence, Milan and Bolzano. The GET UP PIANO trial has a pragmatic cluster randomized controlled design. The randomized units (clusters) are the CMHCs, and the units of observation are the centers' patients and their family members. Patients in the experimental group will receive TAU plus: 1) cognitive behavioral therapy sessions, 2) psycho-educational sessions for family members, and 3) case management. Patient enrollment will take place over a 1-year period. Several psychopathological, psychological, functioning, and service use variables will be assessed at baseline and follow-up. The primary outcomes are: 1) change from baseline to follow-up in positive and negative symptoms' severity and subjective appraisal; 2) relapse occurrences between baseline and follow-up, that is, episodes resulting in admission and/or any case-note records of re-emergence of positive psychotic symptoms. The expected number of recruited patients is about 400, and that of relatives about 300. Owing to the implementation of the intervention at the CMHC level, the blinding of patients, clinicians, and raters is not possible, but every effort will be made to preserve the independency of the raters. We expect that this study will generate evidence on the best treatments for FEP, and will identify barriers that may hinder its feasibility in 'real-world' clinical settings, patient/family conditions that may render this intervention ineffective or inappropriate, and clinical, psychological, environmental, and service organization predictors of treatment effectiveness, compliance, and service satisfaction.
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Affiliation(s)
- Mirella Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni De Girolamo
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
- IRCCS Centro S.Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Angelo Fioritti
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
- Department of Mental Health, Azienda ULSS, Bologna, Italy
| | - Paola Rucci
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
| | | | - Giovanni Neri
- Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Verona, Italy
| | | | - Daniela Ghigi
- Department of Mental Health, Azienda ULSS, Rimini, Italy
| | | | - Silvio Scarone
- Department of Mental Health, Azienda ULSS S. Paolo, Milan, Italy
| | - Angelo Cocchi
- Department of Mental Health, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Milan Programma 2000, Italy
| | | | - Carlo Faravelli
- Department of Psychology, University of Firenze, Florence, Italy
| | - Christa Zimmermann
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Anna Meneghelli
- Department of Mental Health, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Milan Programma 2000, Italy
| | - Carla Cremonese
- Department of Psychiatry, University of Padova, Padova, Italy
| | - Paolo Scocco
- Department of Psychiatry, University of Padova, Padova, Italy
| | | | - Fausto Mazzi
- Department of Mental Health, Azienda ULSS, Modena, Italy
| | | | - Paolo Brambilla
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- DISM, Inter-University Center for Behavioural Neurosciences, University of Udine, Udine, Italy
| | - Sarah Bissoli
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Maria Elena Bertani
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Katia De Santi
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sara Poli
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Michele Tansella
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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