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Katsushima M, Shimizu E. Brief Cognitive Behavioral Therapy for Depression and Anxiety in Patients with Schizophrenia in Psychiatric Home Nursing Service: Pilot Randomized Controlled Trial. Behav Sci (Basel) 2024; 14:680. [PMID: 39199076 PMCID: PMC11351661 DOI: 10.3390/bs14080680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/21/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024] Open
Abstract
This pilot randomized controlled trial (RCT) aimed to explore whether depression and anxiety could be reduced by psychiatric home nursing supporters offering brief cognitive behavioral therapy for psychosis (CBTp) at home, using a workbook for patients with schizophrenia. Eighteen patients with schizophrenia treated in a psychiatric home nursing service were randomly assigned to two groups: one group received CBTp in addition to usual care (TAU + CBTp group; n = 9) and the other received only usual care (TAU group; n = 9); two patients were excluded due to hospitalization or withdrawal of consent. Eight weekly CBTp sessions were conducted; anxiety/depression, quality of life, self-esteem, and overall functioning were assessed at baseline, week 9, and week 13. There was no significant difference in the primary and secondary evaluations. The effect size was 0.84 for primary evaluation indicating a large effect. This study showed that nurses and occupational therapists can provide CBTp in psychiatric home nursing for patients with schizophrenia to potentially alleviate anxiety and depression compared to standard psychiatric home nursing service alone. Therefore, larger RCTs with larger sample sizes are recommended.
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Affiliation(s)
- Masayuki Katsushima
- Department of Rehabilitation, Faculty of Health Care and Medical Sports, Teikyo Heisei University, Ichihara 290-0193, Chiba, Japan
- Research Center for Child Mental Development, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba 260-8670, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba 260-0856, Chiba, Japan;
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2
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Jaffé ME, Loew SB, Meyer AH, Lieb R, Dechent F, Lang UE, Huber CG, Moeller J. Just Not Enough: Utilization of Outpatient Psychotherapy Provided by Clinical Psychologists for Patients With Psychosis and Bipolar Disorder in Switzerland. Health Serv Insights 2024; 17:11786329241229950. [PMID: 38348355 PMCID: PMC10860477 DOI: 10.1177/11786329241229950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Treatment guidelines state that evidence-based psychotherapy is effective for people with psychosis and bipolar disorder and should be offered during every phase of the treatment process. However, research has indicated a lack of outpatient psychotherapeutic services for this patient group, for example, in the United States or Germany. We extend this finding by presenting survey data from Switzerland. We surveyed 112 inpatients with a diagnosis of a schizophrenia spectrum disorder or bipolar disorder and assessed outpatient treatment over the 5 years prior to their index hospitalization by using retrospective self-reports. The survey focused on psychotherapy provided by clinical psychologists. Results indicate that only 23.2% of participants retrospectively reported having utilized any outpatient psychotherapy within the reporting period and only 8% of participants reported having received a number of outpatient sessions that reaches recommended levels of psychotherapy. Exploratory analyses did not detect a significant association between self-reported utilization of outpatient psychotherapy sessions and most demographic, psychiatric, and psychological attributes, but patients with a bipolar disorder diagnosis (vs schizophrenia spectrum diagnosis) reported having utilized outpatient treatment more often. These findings are preliminary. When replicated they highlight the need for increased access to outpatient psychotherapy and better alignment between guideline recommendations and outpatient supply.
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Affiliation(s)
- Mariela E Jaffé
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Sou Bouy Loew
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Andrea H Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Frieder Dechent
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
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3
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Grossman MJ, Doell FK, Watson-Gaze J, Baer LH, Martins F, Kidd SA. Increasing Access to CBT for Psychosis: Development, Feasibility, and Acceptability of a Specialized Outpatient Service. Community Ment Health J 2022; 58:1448-1456. [PMID: 35301615 DOI: 10.1007/s10597-022-00956-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/01/2022] [Indexed: 01/27/2023]
Abstract
Despite the increasing demand for cognitive behavioural therapy for psychosis (CBTp), the existing literature is lacking in terms of models for sustainable implementation. The aims of this study were to: (a) describe the development of a specialized CBTp Service; (b) report demographic characteristics and referral patterns over 1 year to examine feasibility; and (c) review feedback from participants in group-based CBTp to examine acceptability. Data were analyzed from 126 referrals (M = 35.52, SD = 13.06, 59.5% men) to an outpatient CBTp Service at the Centre for Addiction and Mental Health (Toronto, Ontario) between January 2019 to January 2020. Anonymous feedback was obtained from 54 individuals who completed group-based CBTp. Positive symptoms and distressing emotions were the main reasons for referral. Over half of eligible referrals scheduled an intake assessment and 70% of individuals who completed this assessment attended further treatment. Primary reasons for service refusal were scheduling conflicts and illness-related barriers. The total service wait-time was two months, with the longest delay between dates of referral and initial contact. Satisfaction with the quality of CBTp and its components was rated high among group members. Although variable wait-times and engagement levels were identified across stages of the referral process, the CBTp Service demonstrates preliminary feasibility and acceptability, and provides a model of service delivery to incorporate within future CBTp implementation efforts in Canada.
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Affiliation(s)
- Michael J Grossman
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Faye K Doell
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - James Watson-Gaze
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lawrence H Baer
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Felicia Martins
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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4
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Ridenour JM, Garrett M. Intent to Understand the Meaning of Psychotic Symptoms During Patient-Psychiatrist Interactions. Am J Psychother 2022:appipsychotherapy20220034. [DOI: 10.1176/appi.psychotherapy.20220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jeremy M. Ridenour
- Erikson Institute for Education, Research, and Advocacy, Austen Riggs Center, Stockbridge, Massachusetts (Ridenour); Department of Clinical Psychiatry, State University of New York Downstate Medical Center, and Psychoanalytic Association of New York, New York City (Garrett)
| | - Michael Garrett
- Erikson Institute for Education, Research, and Advocacy, Austen Riggs Center, Stockbridge, Massachusetts (Ridenour); Department of Clinical Psychiatry, State University of New York Downstate Medical Center, and Psychoanalytic Association of New York, New York City (Garrett)
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5
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Kimhy D, Jones N, Dixon L. Investing in a Research Workforce With Personal Experience of Serious Mental Illness. JAMA Psychiatry 2022; 79:841-842. [PMID: 35921083 DOI: 10.1001/jamapsychiatry.2022.2026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,NY MIRECC, The James J. Peters VA Medical Center, Bronx, New York
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, New York, New York.,Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York
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6
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Hardy KV, Espil FM, Smith CL, Furuzawa A, Lean M, Zhao Z, Godzikovskaya J, Gilbert A, Loewy RL. Training early psychosis community clinicians in CBT for psychosis: Implementation and feasibility. Early Interv Psychiatry 2021; 15:697-704. [PMID: 32583602 DOI: 10.1111/eip.13010] [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] [Received: 01/15/2020] [Revised: 04/22/2020] [Accepted: 05/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Cognitive behavioural therapy (CBT) has demonstrated efficacy for treating of psychotic symptoms and is recommended as an evidence-based practice (EBP) in early psychosis services. Despite this recommendation, there is limited information about the feasibility of training community clinicians, working in an early psychosis service, to competence in the delivery of this intervention. METHOD Fifty clinicians working in an early psychosis service across five programs in Northern California were trained in CBT for psychosis (CBTp) between 2010 and 2014. Following the training, clinicians attended weekly group consultation and submitted taped sessions for review. Tapes were rated for competency using the Cognitive Therapy Scale-Revised (CTS-R). Clinicians who achieved competence were engaged in a train-the-trainer model to support ongoing sustainability of the training program. RESULTS Data from 40 clinicians were reviewed for achievement of competence. Over the training period 18 clinicians achieved competence while 20 clinicians left the service before achieving competence and 12 were still in the process of achieving competence at the point of data analysis. It took on average 54 weeks (range 17-130 weeks) and an average of six tape reviews (range 3-18) to train clinicians to competency. CONCLUSIONS Community clinicians working in an early psychosis program can be trained to competence in CBTp following an initial didactic period and ongoing weekly group consultation, although staff turnover hindered implementation. Challenges and opportunities for future implementation in community sites are presented in the context of further expansion of early psychosis services in the United States.
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Affiliation(s)
- Kate V Hardy
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Melanie Lean
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Zhen Zhao
- Felton Institute, San Francisco, California, USA
| | | | - Al Gilbert
- Felton Institute, San Francisco, California, USA
| | - Rachel L Loewy
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, California, USA
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7
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Kopelovich SL, Hughes M, Monroe-DeVita MB, Peterson R, Cather C, Gottlieb J. Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Dubreucq J, Ycart B, Gabayet F, Perier CC, Hamon A, Llorca PM, Boyer L, Godin O, Bulzacka E, Andrianarisoa M, Aouizerate B, Berna F, Brunel L, Capdevielle D, Chereau I, D'Amato T, Dubertret C, Faget C, Mallet J, Misdrahi D, Passerieux C, Rey R, Richieri R, Schandrin A, Schürhoff F, Urbach M, Vidailhet P, Giraud-Baro E, Fond G. Towards an improved access to psychiatric rehabilitation: availability and effectiveness at 1-year follow-up of psychoeducation, cognitive remediation therapy, cognitive behaviour therapy and social skills training in the FondaMental Advanced Centers of Expertise-Schizophrenia (FACE-SZ) national cohort. Eur Arch Psychiatry Clin Neurosci 2019; 269:599-610. [PMID: 30963264 DOI: 10.1007/s00406-019-01001-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/21/2019] [Indexed: 01/21/2023]
Abstract
Psychosocial Interventions (PIs) have shown positive effects on clinical and functional outcomes of schizophrenia (SZ) in randomized controlled trials. However their effectiveness and accessibility remain unclear to date in "real world" schizophrenia. The objectives of the present study were (i) to assess the proportion of SZ outpatients who benefited from PIs between 2010 and 2015 in France after an Expert Center Intervention in a national multicentric non-selected community-dwelling sample; (ii) to assess PIs' effectiveness at 1-year follow-up. 183 SZ outpatients were recruited from FondaMental Advanced Centers of Expertise for Schizophrenia cohort. Baseline and 1-year evaluations included sociodemographic data, current treatments, illness characteristics and standardized scales for clinical severity, adherence to treatment, quality of life, a large cognitive battery, and daily functioning assessment. Only 7 (3.8%) received a PI before the evaluation, and 64 (35%) have received at least one PI during the 1-year follow-up. Having had at least one PI during the follow-up has been associated in multivariate analyses with significantly higher improvement in positive and negative symptoms (respectively p =0.031; p = 0.011), mental flexibility (TMT B, p = 0.029; C-VF, p = 0.02) and global functioning (p =0.042). CBT and SST were associated with higher cognitive improvements, while CRT was associated with clinical improvement. These results have not been demonstrated before and suggest that the effect of each PI is larger than its initial target. The present study has confirmed the PIs' effectiveness in a large sample of community-dwelling SZ outpatients at 1 year follow-up. Efforts to improve access to PI should be reinforced in public health policies.
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Affiliation(s)
- Julien Dubreucq
- Fondation FondaMental, Créteil, France. .,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France. .,Réseau Handicap Psychique (GCSMS RéHPsy), 26 Avenue Marcellin Berthelot, 38100, Grenoble, France.
| | - B Ycart
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - F Gabayet
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - C C Perier
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - A Hamon
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - P M Llorca
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, 63003, Clermont- Ferrand Cedex 1, France
| | - L Boyer
- Fondation FondaMental, Créteil, France.,School of Medicine, Aix-Marseille Univ, La Timone Medical Campus, EA 3279, Marseille, France.,CEReSS, Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - O Godin
- Fondation FondaMental, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France
| | - E Bulzacka
- Fondation FondaMental, Créteil, France.,Translational Psychiatry team, INSERM U955, Créteil, France.,Paris Est University, DHU Pe- PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - M Andrianarisoa
- Fondation FondaMental, Créteil, France.,Translational Psychiatry team, INSERM U955, Créteil, France.,Paris Est University, DHU Pe- PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, 33076, Bordeaux, France.,Université de Bordeaux, Bordeaux, France.,Bordeaux Sleep Clinique, Research Unit, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Bordeaux, 33000, France.,Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, 33000, Bordeaux, France
| | - F Berna
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, INSERM U1114, Strasbourg, France
| | - L Brunel
- Fondation FondaMental, Créteil, France.,Translational Psychiatry team, INSERM U955, Créteil, France.,Paris Est University, DHU Pe- PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, 63003, Clermont- Ferrand Cedex 1, France
| | - T D'Amato
- Fondation FondaMental, Créteil, France.,Université Claude Bernard Lyon, 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39-95 bd Pinel, 69678, Bron Cedex, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.,Sorbonne Paris Cité, Faculté de médecine, Inserm U894, Université Paris Diderot, Paris, France
| | - C Faget
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle universitaire de psychiatrie, Marseille, France
| | - J Mallet
- Fondation FondaMental, Créteil, France.,AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France.,Sorbonne Paris Cité, Faculté de médecine, Inserm U894, Université Paris Diderot, Paris, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, 33076, Bordeaux, France.,Bordeaux Sleep Clinique, Research Unit, Pellegrin University Hospital, Bordeaux University, USR CNRS 3413 SANPSY, Bordeaux, 33000, France.,CNRS UMR 5287-INCIA, Talence, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France.,Service de psychiatrie d'adulte, UFR des Sciences de la Santé Simone Veil, Centre Hospitalier de Versailles, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - R Rey
- Fondation FondaMental, Créteil, France.,Université Claude Bernard Lyon, 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39-95 bd Pinel, 69678, Bron Cedex, France
| | - R Richieri
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle universitaire de psychiatrie, Marseille, France
| | - A Schandrin
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France.,Translational Psychiatry team, INSERM U955, Créteil, France.,Paris Est University, DHU Pe- PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - M Urbach
- Fondation FondaMental, Créteil, France.,Service de psychiatrie d'adulte, UFR des Sciences de la Santé Simone Veil, Centre Hospitalier de Versailles, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - P Vidailhet
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, INSERM U1114, Strasbourg, France
| | - E Giraud-Baro
- Fondation FondaMental, Créteil, France.,Réseau Handicap Psychique (GCSMS RéHPsy), 26 Avenue Marcellin Berthelot, 38100, Grenoble, France
| | - G Fond
- Fondation FondaMental, Créteil, France.,School of Medicine, Aix-Marseille Univ, La Timone Medical Campus, EA 3279, Marseille, France.,CEReSS, Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France
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9
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Kopelovich SL, Strachan E, Sivec H, Kreider V. Stepped Care as an Implementation and Service Delivery Model for Cognitive Behavioral Therapy for Psychosis. Community Ment Health J 2019; 55:755-767. [PMID: 30623294 DOI: 10.1007/s10597-018-00365-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA.
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA
| | - Harry Sivec
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Valerie Kreider
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
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10
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Morrison AP. Should people with psychosis be supported in choosing cognitive therapy as an alternative to antipsychotic medication: A commentary on current evidence. Schizophr Res 2019; 203:94-98. [PMID: 29606545 DOI: 10.1016/j.schres.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 01/19/2023]
Abstract
Evidence from randomised controlled trials suggest that both antipsychotic medication and cognitive behaviour therapy (CBT) can be helpful to people with a diagnosis of a schizophrenia spectrum disorder. On this basis, many clinical guidelines recommend that people with psychosis should be offered both antipsychotic medication and CBT and that they should be collaboratively involved in the decisions about which treatment options they choose. The reality of service provision is often very different, with data regarding the availability of such treatment options and the extent of user involvement in decision making suggesting that medication is much more widely available and that service users are often not involved in these decisions, despite retaining decision making capacity. Many patients choose not to take antipsychotic medication, often due to inefficacy or side effects, but there is little evidence regarding whether CBT can be effective as an alternative to antipsychotic medication. However, several recent trials suggest that CBT without medication may be a safe and acceptable option for people with psychosis. The implications for clinical practice and future research are considered and it is recommended that informed choices that include the option to try CBT without antipsychotic medication are supported.
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Affiliation(s)
- Anthony P Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
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11
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Greenwood K, Alford K, O’Leary I, Peters E, Hardy A, Cavanagh K, Field AP, de Visser R, Fowler D, Davies M, Papamichail A, Garety P. The U&I study: study protocol for a feasibility randomised controlled trial of a pre-cognitive behavioural therapy digital 'informed choice' intervention to improve attitudes towards uptake and implementation of CBT for psychosis. Trials 2018; 19:644. [PMID: 30458850 PMCID: PMC6247503 DOI: 10.1186/s13063-018-3023-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/26/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND At least 40% of people with psychosis have persistent distressing symptoms despite optimal medication treatment. Cognitive behaviour therapy for psychosis (CBTp) is the only NICE-recommended individual therapy for psychosis, with effects on symptoms, distress and quality of life. Yet <10% of service-users receive it and 94% of trusts struggle to provide it. Of those offered it, 22-43% refuse or do not attend. We have developed a new pre-CBTp informed choice intervention to address knowledge and attitudes that influence uptake and implementation and now want to test it in a feasibility trial. METHODS The design is a two-arm, feasibility randomised controlled trial (RCT), with 1:1 randomisation, stratified by participant group and site. Participants are 40 psychosis patients and 40 clinicians, who are ambivalent towards uptake or implementation of CBTp. Sites are community and inpatient services in Sussex and London. The intervention is a pre-CBT digital psychoeducation intervention designed to address identified knowledge and attitudinal barriers to uptake and implementation of CBTp, incorporating behaviour change mechanisms, and supported by animated introductory, patient and clinician stories. The comparator is the NHS choices website for CBT. The primary aim is to assess clinical feasibility (recruitment, randomisation, acceptability, use, delivery, outcome measurement, retention). A secondary aim is a preliminary evaluation of efficacy. Outcomes will be assessed at baseline, post intervention, and one-month follow-up (blind to treatment arm). The primary efficacy outcome is likelihood of offering/taking up CBTp. Secondary outcomes include knowledge and attitudes towards CBTp, illness perceptions, empowerment, psychological wellbeing (patients only) and CBTp implementation (clinicians only). Use of the intervention and CBT behaviours during the follow-up period will be recorded and captured in a feedback questionnaire. Use, acceptability and experience of outcome assessment will be explored in qualitative interviews with participants (n = 6 per group). The efficacy evaluation will report descriptive data, key model parameters and 95% highest probability density intervals in a Bayesian growth model. DISCUSSION This is the first feasibility trial of a digital 'informed choice' decision aid for the implementation of CBTp. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a large multi-site trial will be warranted. TRIAL REGISTRATION ISRCTN registry, ISRCTN53107879 . Registered prospectively on 2 August 2017.
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Affiliation(s)
- Kathryn Greenwood
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Katie Alford
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RP UK
| | - Ian O’Leary
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- PICuP Clinic, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8NZ UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Richard de Visser
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - David Fowler
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Matthew Davies
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Alexandra Papamichail
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
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A Model to Transform Psychosis Milieu Treatment Using CBT-Informed Interventions. COGNITIVE AND BEHAVIORAL PRACTICE 2017. [DOI: 10.1016/j.cbpra.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lincoln TM, Jung E, Wiesjahn M, Schlier B. What is the minimal dose of cognitive behavior therapy for psychosis? An approximation using repeated assessments over 45 sessions. Eur Psychiatry 2016; 38:31-39. [PMID: 27642702 DOI: 10.1016/j.eurpsy.2016.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The general efficacy of cognitive behavior therapy for psychosis (CBTp) is well established. Although guidelines recommend that CBTp should be offered over a minimum of 16 sessions, the minimal number of sessions required to achieve significant changes in psychopathology has not been systematically investigated. Empirically informed knowledge of the minimal and optimal dose of CBTp is relevant in terms of dissemination and cost-effectiveness. METHODS We approached the question of what constitutes an appropriate dose by investigating the dose (duration of CBTp)×response (symptomatic improvement) relationship for positive symptoms, negative symptoms and depression. Patients with psychotic disorders (n=58) were assessed over the course of 45 sessions of CBTp in a clinical practice setting. At baseline and after session 5, 15, 25, and 45, general psychopathology, psychotic symptoms, symptom distress and coping were assessed with self-report questionnaires. Additionally, individually defined target symptoms and coping were assessed after each session. RESULTS Significant symptom improvement and reduction of symptom distress took place by session 15, and stayed fairly stable thereafter. The frequency of positive and negative symptoms reached a minimum by session 25. CONCLUSIONS Our findings support recommendations to provide CBTp over a minimum of 16 sessions and indicate that these recommendations are generalizable to clinical practice settings. However, the findings also imply that 25 sessions are the more appropriate dose. This study contributes to an empirically informed discussion on the minimal and optimal dose of CBTp. It also provides a basis for planning randomized trials comparing briefer and longer versions of CBTp.
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Affiliation(s)
- T M Lincoln
- University of Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Hamburg, Germany.
| | - E Jung
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Marburg, Germany
| | - M Wiesjahn
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Marburg, Germany
| | - B Schlier
- University of Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Hamburg, Germany
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Khazaal Y, Chatton A, Dieben K, Huguelet P, Boucherie M, Monney G, Lecardeur L, Salamin V, Bretel F, Azoulay S, Pesenti E, Krychowski R, Costa Prata A, Bartolomei J, Brazo P, Traian A, Charpeaud T, Murys E, Poupart F, Rouvière S, Zullino D, Parabiaghi A, Saoud M, Favrod J. Reducing Delusional Conviction through a Cognitive-Based Group Training Game: A Multicentre Randomized Controlled Trial. Front Psychiatry 2015; 6:66. [PMID: 25972817 PMCID: PMC4412136 DOI: 10.3389/fpsyt.2015.00066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/14/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE "Michael's game" (MG) is a card game targeting the ability to generate alternative hypotheses to explain a given experience. The main objective was to evaluate the effect of MG on delusional conviction as measured by the primary study outcome: the change in scores on the conviction subscale of the Peters delusions inventory (PDI-21). Other variables of interest were the change in scores on the distress and preoccupation subscales of the PDI-21, the brief psychiatric rating scale, the Beck cognitive insight scale, and belief flexibility assessed with the Maudsley assessment of delusions schedule (MADS). METHODS We performed a parallel, assessor-blinded, randomized controlled superiority trial comparing treatment as usual plus participation in MG with treatment as usual plus being on a waiting list (TAU) in a sample of adult outpatients with psychotic disorders and persistent positive psychotic symptoms at inclusion. RESULTS The 172 participants were randomized, with 86 included in each study arm. Assessments were performed at inclusion (T1: baseline), at 3 months (T2: post-treatment), and at 6 months after the second assessment (T3: follow-up). At T2, a positive treatment effect was observed on the primary outcome, the PDI-21 conviction subscale (p = 0.005). At T3, a sustained effect was observed for the conviction subscale (p = 0.002). Further effects were also observed at T3 on the PDI-21 distress (p = 0.002) and preoccupation subscales (p = 0.001), as well as on one of the MADS measures of belief flexibility ("anything against the belief") (p = 0.001). CONCLUSION The study demonstrated some significant beneficial effect of MG.
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Affiliation(s)
- Yasser Khazaal
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Anne Chatton
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Karen Dieben
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Philippe Huguelet
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Maria Boucherie
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Gregoire Monney
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Laurent Lecardeur
- Service de Psychiatrie, CHU de Caen, Université de Caen Basse-Normandie, UMR6301 ISTCT, ISTS Team , Caen , France
| | | | - Fethi Bretel
- Service de Psychiatrie Ambulatoire et de Réhabilitation du Pôle Rouen Rive Droite, Centre Hospitalier du Rouvray, Centre de Jour Saint-Gervais , Rouen , France
| | | | | | | | | | - Javier Bartolomei
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Perrine Brazo
- Service de Psychiatrie, CHU de Caen, Université de Caen Basse-Normandie, UMR6301 ISTCT, ISTS Team , Caen , France
| | - Alexei Traian
- Centre Medico-Psychologique B, Centre Hospitalier Universitaire , Clermont-Ferrand , France
| | - Thomas Charpeaud
- Service de Psychiatrie, Centre Hospitalier de Vichy , Vichy , France
| | - Elodie Murys
- Unité Mobile de Psychiatrie, Centre Hospitalier Princess Grace , Monaco , Monaco
| | | | | | - Daniele Zullino
- Geneva University Hospitals, Geneva University , Geneva , Switzerland
| | - Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS 'Mario Negri' Institute for Pharmacological Research , Milan , Italy
| | - Mohamed Saoud
- CRESOP, Centre Hospitalier le Vinatier , Bron , France ; EA 4615, Université de Lyon , Lyon , France ; Université Lyon 1 , Lyon , France
| | - Jérôme Favrod
- School of Nursing Sciences La Source, University of Applied Sciences and Arts of Western Switzerland , Lausanne , Switzerland
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Tarrier N. CBT for psychosis: effectiveness, diversity, dissemination, politics, the future and technology. World Psychiatry 2014; 13:256-7. [PMID: 25273294 PMCID: PMC4219062 DOI: 10.1002/wps.20161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Heibach E, Brabban A, Lincoln TM. How much priority do clinicians give to cognitive behavioral therapy in the treatment of psychosis and why? ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cpsp.12074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kimhy D, Jobson-Ahmed L, Ben-David S, Ramadhar L, Malaspina D, Corcoran CM. Cognitive insight in individuals at clinical high risk for psychosis. Early Interv Psychiatry 2014; 8:130-7. [PMID: 23343417 PMCID: PMC3640765 DOI: 10.1111/eip.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 11/10/2012] [Indexed: 11/30/2022]
Abstract
AIM Reduced cognitive insight has been associated with psychotic symptoms, in particular with the presence of delusions; however, there is little information about whether such reductions are present in at-risk individuals prior to the onset of threshold psychotic symptoms. METHOD We conducted a cross-sectional comparison of cognitive insight (as indexed by the Beck Cognitive Insight Scale) in 62 help-seeking individuals at clinical high risk for psychosis, Fifty-nine individuals with schizophrenia-spectrum disorders and 37 healthy controls (HC). In patients, we evaluated associations of insight with positive symptoms, including later transition to psychosis in high-risk patients. RESULTS Individuals with schizophrenia reported significantly higher self-certainty scores than the at-risk patients and HCs, with the at-risk patients scoring intermediate to the individuals with schizophrenia and controls. Similarly, individuals with schizophrenia scored significantly higher on self-reflectiveness, with no differences between the at-risk patients and controls. In individuals with schizophrenia, delusions were significantly correlated with self-certainty. In at-risk patients, cognitive insight was not associated with positive symptom severity and did not differentiate those at-risk patients who later developed psychosis from those who did not. However, post hoc analyses suggested that at-risk patients with marked unusual thought content (approaching threshold psychosis) had lower self-reflectiveness; whereas those with high suspiciousness had significantly higher self-certainty. CONCLUSIONS The findings are discussed in the context of normal developmental processes occurring during adolescence, their putative links to neurobiological functioning, and their implications for treatment and future research.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, New York, USA; Center of Prevention and Evaluation, New York State Psychiatric Institute, New York, New York, USA
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