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Mayer SF, Corcoran C, Kennedy L, Leucht S, Bighelli I. Cognitive behavioural therapy added to standard care for first-episode and recent-onset psychosis. Cochrane Database Syst Rev 2024; 3:CD015331. [PMID: 38470162 PMCID: PMC10929366 DOI: 10.1002/14651858.cd015331.pub2] [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] [Indexed: 03/13/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) can be effective in the general population of people with schizophrenia. It is still unclear whether CBT can be effectively used in the population of people with a first-episode or recent-onset psychosis. OBJECTIVES To assess the effects of adding cognitive behavioural therapy to standard care for people with a first-episode or recent-onset psychosis. SEARCH METHODS We conducted a systematic search on 6 March 2022 in the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, ISRCTN, and WHO ICTRP. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing CBT added to standard care vs standard care in first-episode or recent-onset psychosis, in patients of any age. DATA COLLECTION AND ANALYSIS Two review authors (amongst SFM, CC, LK and IB) independently screened references for inclusion, extracted data from eligible studies and assessed the risk of bias using RoB2. Study authors were contacted for missing data and additional information. Our primary outcome was general mental state measured on a validated rating scale. Secondary outcomes included other specific measures of mental state, global state, relapse, admission to hospital, functioning, leaving the study early, cognition, quality of life, satisfaction with care, self-injurious or aggressive behaviour, adverse events, and mortality. MAIN RESULTS We included 28 studies, of which 26 provided data on 2407 participants (average age 24 years). The mean sample size in the included studies was 92 participants (ranging from 19 to 444) and duration ranged between 26 and 52 weeks. When looking at the results at combined time points (mainly up to one year after start of the intervention), CBT added to standard care was associated with a greater reduction in overall symptoms of schizophrenia (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.08, 20 RCTs, n = 1508, I2 = 68%, substantial heterogeneity, low certainty of the evidence), and also with a greater reduction in positive (SMD -0.22, 95% CI -0.38 to -0.06, 22 RCTs, n = 1565, I² = 52%, moderate heterogeneity), negative (SMD -0.20, 95% CI -0.30 to -0.11, 22 RCTs, n = 1651, I² = 0%) and depressive symptoms (SMD -0.13, 95% CI -0.24 to -0.01, 18 RCTs, n = 1182, I² = 0%) than control. CBT added to standard care was also associated with a greater improvement in the global state (SMD -0.34, 95% CI -0.67 to -0.01, 4 RCTs, n = 329, I² = 47%, moderate heterogeneity) and in functioning (SMD -0.23, 95% CI -0.42 to -0.05, 18 RCTs, n = 1241, I² = 53%, moderate heterogeneity, moderate certainty of the evidence) than control. We did not find a difference between CBT added to standard care and control in terms of number of participants with relapse (relative risk (RR) 0.82, 95% CI 0.57 to 1.18, 7 RCTs, n = 693, I² = 48%, low certainty of the evidence), leaving the study early for any reason (RR 0.87, 95% CI 0.72 to 1.05, 25 RCTs, n = 2242, I² = 12%, moderate certainty of the evidence), adverse events (RR 1.29, 95% CI 0.85 to 1.97, 1 RCT, n = 43, very low certainty of the evidence) and the other investigated outcomes. AUTHORS' CONCLUSIONS This review synthesised the latest evidence on CBT added to standard care for people with a first-episode or recent-onset psychosis. The evidence identified by this review suggests that people with a first-episode or recent-onset psychosis may benefit from CBT additionally to standard care for multiple outcomes (overall, positive, negative and depressive symptoms of schizophrenia, global state and functioning). Future studies should better define this population, for which often heterogeneous definitions are used.
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Affiliation(s)
- Susanna Franziska Mayer
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
| | | | - Liam Kennedy
- Department of Old Age Psychiatry, Carew House, St Vincent's Hospital, Dublin, Ireland
| | - Stefan Leucht
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
- German Center for Mental Health (DZPG), Munich, Germany
| | - Irene Bighelli
- Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, München, Germany
- German Center for Mental Health (DZPG), Munich, Germany
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Langlois T, Sanchez-Rodriguez R, Bourcier A, Lamy P, Callahan S, Lecomte T. Impact of the group intervention "Accept Voices©" for the management of auditory hallucinations. Psychiatry Res 2020; 291:113159. [PMID: 32540685 DOI: 10.1016/j.psychres.2020.113159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY The objective of this study was to evaluate the potential impact of a third wave CBT group intervention for the management of auditory hallucinations in patients with schizophrenia. METHOD 38 patients with schizophrenia presenting with auditory hallucinations, followed in mental health services, participated in six sessions of a group based on acceptance and engagement therapy (ACT). The study followed a repeated single case experimental design (type A-B-A) based on the principle of a control phase followed by an intervention phase and a follow-up phase of similar duration. The various measurements were administered during the control phase, at pre-/post-group and six weeks after the last group session. RESULTS The results show a significant decrease in auditory hallucinations, as measured by the PSYRATS scale, during the treatment and follow-up phase, compared to the control phase. In addition, the participants saw significant reductions in depressive and anxious symptomatology (assessed with CDSS and SEAS), and increases in coping and acceptance in regards to voices (assessed using a study scale and VAAS). The level of Malevolence beliefs about voices (measured with BAVQ-R) also decreased significantly. CONCLUSIONS A brief group intervention based acceptance show promise in the reduction of the intensity of auditory hallucinations, depression and anxiety in patients with schizophrenia, while improving their acceptance.
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Affiliation(s)
- T Langlois
- Centre d'Études et de Recherches en Psychopathologie et Psychopathologie de la Santé, Université de Toulouse, UT2J, France.
| | - R Sanchez-Rodriguez
- Centre d'Études et de Recherches en Psychopathologie et Psychopathologie de la Santé, Université de Toulouse, UT2J, France
| | | | - P Lamy
- Centre médical la Villanelle, Cornebarrieu, France
| | - S Callahan
- Centre d'Études et de Recherches en Psychopathologie et Psychopathologie de la Santé, Université de Toulouse, UT2J, France
| | - T Lecomte
- Université de Montréal, Montréal, Canada
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A Feasibility Study of the Translation of Cognitive Behaviour Therapy for Psychosis into an Australian Adult Mental Health Clinical Setting. BEHAVIOUR CHANGE 2020. [DOI: 10.1017/bec.2020.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThere is evidence that Cognitive Behaviour Therapy for Psychosis (CBTp) is an effective intervention for reducing psychotic symptoms. The recently updated Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines (RANZCP CPG) recommend CBTp for the therapeutic management of schizophrenia and related disorders. Translational research is required to examine how well CBTp can be applied into public mental health services. This feasibility study aimed to provide preliminary evidence on how acceptable, implementable, and adaptable individual or group CBTp may be within a public mental health service in Australia. Twenty-seven participants initially agreed to participate in the study with 16 participants being randomised to either group or individual therapy, 11 starting therapy and 7 completing therapy. The intervention involved approximately 20 h of manualised CBTp. Attendance was higher in the individual therapy. Subjective reports indicated that the therapy was acceptable to all completers. Participants who engaged in individual or group CBTp experienced a similar level of reduction in the severity of hallucinations and delusions. Individual CBTp may be a feasible, acceptable, and effective intervention to include in Australian public mental health services. A pilot trial is now required to provide further evidence for and guidance of how best to translate CBTp protocols to Australian mental health services.
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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: 6] [Impact Index Per Article: 1.2] [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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5
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Individuals' experiences and opinions of psychological therapies for psychosis: A narrative synthesis. Clin Psychol Rev 2016; 43:142-61. [DOI: 10.1016/j.cpr.2015.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/17/2015] [Accepted: 10/29/2015] [Indexed: 11/20/2022]
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Group cognitive behaviour therapy combining early intervention with an exclusive focus on single medication-resistant delusional beliefs: a service evaluation. COGNITIVE BEHAVIOUR THERAPIST 2016. [DOI: 10.1017/s1754470x16000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractCognitive behaviour therapy (CBT) is now the psychological treatment of choice for psychosis but meta-analyses indicate a low effect size on delusions, so further innovations are clearly needed, and group CBT for psychosis (GCBTp) is an under-researched area. This study aimed to service-evaluate the feasibility, satisfaction, safety, and effectiveness of a CBT group specifically targeting medication-resistant single delusions in early psychosis patients (EI-GCBTp). Three separate EI-GCBTp groups were run resulting in a total of 11 medication-resistant early psychosis patients. A within-subjects design tested for group change across two time points: pre-baseline (4 weeks before treatment) to baseline (session 1 of treatment) and sessions 1–8 (the treatment period). Thirteen delusion dimensions were measured from three psychosis-specific questionnaires: The Psychotic Symptom Rating Scale (PSYRATS), Characteristics of Delusion Rating Scale, and the Belief Rating Scale. At least three patients attended each group, satisfaction scores were high, and no harm to patients was identified. With reference to effectiveness, the pre-baseline period showed virtually no change. In contrast, across the EI-GCBTp treatment period, the PSYRATS total demonstrated a statistically significant decrease in delusional severity (p < 0.01), a 31% symptom reduction, and a large effect size (Cohen's d = 1.2, 95% confidence interval = −2.53 to 0.05), statistically significant across four delusion dimensions. EI-GCBTp appears feasible, acceptable, safe, and preliminary uncontrolled effectiveness results suggest merit for larger-scale more rigorous testing of this treatment format for possible dimensional improvements of persistent delusions.
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Saksa JR, Cohen SJ, Srihari VH, Woods SW. Cognitive Behavior Therapy for Early Psychosis: A Comprehensive Review of Individual vs. Group Treatment Studies. Int J Group Psychother 2015; 59:357-83. [DOI: 10.1521/ijgp.2009.59.3.357] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Massé M, Lecomte T. Metacognitive profiles in individuals with a first episode of psychosis and their relation to social functioning and perceived social support. Schizophr Res 2015; 166:60-4. [PMID: 26116327 DOI: 10.1016/j.schres.2015.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
Abstract
Poorer metacognitive abilities are recognized as strong predictors of social functioning deficits in individuals with schizophrenia, but have not been studied in relation to perceived social support. Furthermore, traditional measures of metacognition fail to consider ecological aspects such as the interaction between thinking of one's own or other's mind, and mastery. As a constellation, these abilities may influence domains of social functioning and perceived social support differently. Therefore, this study aimed to establish whether distinct metacognitive profiles exist within a population of individuals with a first psychotic episode, and to determine how such profiles influence individual domains of social functioning and perceived social support. Participants (n=50) were recruited from two early psychosis outpatient clinics in Montreal, Canada. Demographic information, social functioning and perceived social support were measured using self-reported questionnaires, and metacognition was scored from the transcripts of a semi-structured interview designed to avoid leading responses. Cluster analysis revealed three distinct metacognitive profiles: (1) overall better abilities; (2) poor abilities on thinking of one's own and other's mind, but better mastery; and (3) overall poorer abilities. Analyses showed significant differences between profiles only for self-reported intimacy and independent living abilities, with the second profile showing better abilities than the third. Profiles did not simply represent consistently higher or lower functioning across subscales. Although mastery was predictive of social functioning, the ability to think in an increasingly complex manner of one's self and others did not seem to improve functioning in individuals with a first episode of psychosis.
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Affiliation(s)
- Marjolaine Massé
- Université de Montréal, Department of Psychology, C-358, 90 Vincent d'Indy Street, C.P. 6128, Succ. Centre-Ville, Montreal, QC H3C 3J7, Canada
| | - Tania Lecomte
- Université de Montréal, Department of Psychology, C-358, 90 Vincent d'Indy Street, C.P. 6128, Succ. Centre-Ville, Montreal, QC H3C 3J7, Canada.
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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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Balzan RP, Delfabbro PH, Galletly CA, Woodward TS. Metacognitive training for patients with schizophrenia: preliminary evidence for a targeted, single-module programme. Aust N Z J Psychiatry 2014; 48:1126-36. [PMID: 24159051 DOI: 10.1177/0004867413508451] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Metacognitive training is an eight-module, group-based treatment programme for people with schizophrenia that targets the cognitive biases (i.e. problematic thinking styles) thought to contribute to the genesis and maintenance of delusions. The present article is an investigation into the efficacy of a shorter, more targeted, single-module metacognitive training programme, administered individually, which focuses specifically on improving cognitive biases that are thought to be driven by a 'hypersalience of evidence-hypothesis matches' mechanism (e.g. jumping to conclusions, belief inflexibility, reasoning heuristics, illusions of control). It was hypothesised that a more targeted metacognitive training module could still improve performance on these bias tasks and reduce delusional ideation, while improving insight and quality of life. METHOD A sample of 28 patients diagnosed with schizophrenia and mild delusions either participated in the hour-long, single-session, targeted metacognitive training programme (n = 14), or continued treatment as usual (n = 14). All patients were assessed using clinical measures gauging overall positive symptomology, delusional ideation, quality of life and insight, and completed two cognitive bias tasks designed to elucidate the representativeness and illusion of control biases. RESULTS After a 2-week, post-treatment interval, targeted metacognitive training patients exhibited significant decreases in delusional severity and conviction, significantly improved clinical insight, and significant improvements on the cognitive bias tasks, relative to the treatment-as-usual controls. Performance improvements on the cognitive bias tasks significantly correlated with the observed reductions in overall positive symptomology. Patients also evaluated the training positively. CONCLUSIONS Although interpretations of these results are limited due to the lack of an optimally designed, randomised controlled trial and a small sample size, the results are promising and warrant further investigation into targeted versions of the metacognitive training programme.
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Affiliation(s)
- Ryan P Balzan
- School of Psychology, Flinders University, Australia School of Psychology, University of Adelaide, Australia Discipline of Psychiatry, University of Adelaide, Australia
| | | | | | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Canada
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Welfare-Wilson A, Newman R. Cognitive behavioural therapy for psychosis and anxiety. ACTA ACUST UNITED AC 2013; 22:1061-5. [PMID: 24121850 DOI: 10.12968/bjon.2013.22.18.1061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article discusses the effectiveness of a cognitive behavioural therapy (CBT) group for clients with a first episode of psychosis, who were also experiencing comorbid symptoms of anxiety. Clients of 18-35 years of age who reported anxiety symptoms, either as a direct or indirect result of psychotic symptoms, were invited to attend a 12-week CBT-based group. The effectiveness of the intervention was evaluated at screening and 3-month follow-up with the Depression, Anxiety and Stress Scale (DASS-21) (Lovibond and Lovibond, 2004). The results showed a statistically significant improvement in symptoms (depression, p=0.06; anxiety, p=0.05; stress, p=.014), sustainable at 3-month follow-up. The authors concluded that a CBT group for people with a first episode of psychosis that focuses on the management of anxiety can be an effective and viable means of reducing levels of anxiety and associated stress and depression. This model is recommended for use by community mental health teams.
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Sanford N, Lecomte T, Leclerc C, Wykes T, Woodward TS. Change in jumping to conclusions linked to change in delusions in early psychosis. Schizophr Res 2013; 147:207-208. [PMID: 23561297 DOI: 10.1016/j.schres.2013.02.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Nicole Sanford
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; BC Mental Health and Addictions Research Institute, Vancouver, Canada
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Claude Leclerc
- Department of Nursing, University of Trois-Rivières, QC, Canada
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, Canada; BC Mental Health and Addictions Research Institute, Vancouver, Canada.
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Beauchamp MC, Lecomte T, Lecomte C, Leclerc C, Corbière M. Do personality traits matter when choosing a group therapy for early psychosis? Psychol Psychother 2013; 86:19-32. [PMID: 23386553 DOI: 10.1111/j.2044-8341.2011.02052.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed at determining the predictive value of personality traits, based on the Five Factor Model (FFM) of personality, on therapeutic outcomes according to specific group treatments for first episode psychosis: cognitive-behavioural therapy (CBT) or skills training for symptom management (SM). METHODS Individuals experiencing early psychosis were recruited to participate in a randomized- controlled trial (RCT). Participants were randomized to one of two group treatments or to a wait-list control group. Measures included a personality inventory (NEO-FFI) and outcome measures of symptomatology (BPRS-E) and coping strategies (CCS). Pearson correlation analyses were conducted on 78 individuals and linear regression analyses on 66. RESULTS Links were found between personality traits, symptoms, and coping outcome measures, according to specific group treatments. Personality traits were particularly linked to therapeutic changes in active coping strategies, with Conscientiousness accounting for 14% of the variance in the CBT group, Extraversion accounting for 41% of the variance in the SM group, and Openness to experience accounting for 22% of the variance in the control group. CONCLUSIONS Individual differences in personality traits for people experiencing early psychosis should be considered when offering psychosocial treatments, since it appears that those with specific traits might benefit more than others in specific group interventions, particularly for interventions that do not solely aim at improving symptoms.
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Lecomte T, Leclerc C, Wykes T. Group CBT for early psychosis--are there still benefits one year later? Int J Group Psychother 2012; 62:309-21. [PMID: 22468576 DOI: 10.1521/ijgp.2012.62.2.309] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology at the University of Montreal, Canada.
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TCC pour premiers épisodes de psychose : pourquoi la thérapie de groupe obtient les meilleurs résultats ? ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jtcc.2012.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Woodward TS, Munz M, LeClerc C, Lecomte T. Change in delusions is associated with change in "jumping to conclusions". Psychiatry Res 2009; 170:124-7. [PMID: 19906443 DOI: 10.1016/j.psychres.2008.10.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 08/26/2008] [Accepted: 10/23/2008] [Indexed: 11/27/2022]
Abstract
Evidence has been put forward that premature termination of data collection and jumping to conclusions behavior (JTC) is associated with delusions. However, few investigations have attempted to track associations between changes in delusions and changes in JTC measures. In the current study individuals with schizophrenia spectrum disorders completed a version of the JTC task (involving fishing from lakes as opposed to drawing beads from a jar) at two timepoints 12 weeks apart. The results revealed significant negative correlations between change in task performance (number of requested pieces of information) and change in delusion scores over time. This evidence is consistent with the contention that the JTC task is sensitive to the cognitive systems underlying delusions in schizophrenia spectrum disorders.
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Affiliation(s)
- Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
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Morrison AP. Cognitive behaviour therapy for first episode psychosis: Good for nothing or fit for purpose? PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2009. [DOI: 10.1080/17522430903026393] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lysaker PH, Davis LW, Bryson GJ, Bell MD. Effects of cognitive behavioral therapy on work outcomes in vocational rehabilitation for participants with schizophrenia spectrum disorders. Schizophr Res 2009; 107:186-91. [PMID: 19046856 DOI: 10.1016/j.schres.2008.10.018] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/16/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
Designed to help persons with schizophrenia to persist and perform better at job placements, the Indianapolis Vocational Intervention Program (IVIP) is a program of cognitive-behavioral group and individual interventions. While its feasibility has been previously demonstrated, it is unknown whether IVIP assists persons to achieve greater levels of participation in vocational rehabilitation and higher levels of job performance. In this study, 100 participants with schizophrenia or schizoaffective disorder were offered a six month job placement and randomized to receive IVIP (n=50) or support services (n=50) matched for treatment intensity. Number of hours worked was recorded weekly and job performance was assessed biweekly using the Work Behavior Inventory with raters blind to condition. t-tests revealed that participants in the IVIP group worked a significantly greater number of weeks than those in the support condition. Also, repeated measures ANOVA revealed the IVIP group worked more hours across that 26 week period as well. And with regards to work performance, repeated measures of the 56 participants who worked for at least two-thirds of the intervention revealed that participants in the IVIP group had generally better work performance than those in the support condition. Results suggest a connection between cognitive-behavioral interventions and higher levels of work performance in people with schizophrenia.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
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Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. J Nerv Ment Dis 2008; 196:866-75. [PMID: 19077853 DOI: 10.1097/nmd.0b013e31818ee231] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed at determining the effectiveness of group cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness-social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures (baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in improvements on positive and negative symptoms compared with the wait-list control group, with the CBT group having significant effects over time on overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising intervention for individuals with recent onset of psychosis and their mental health professionals.
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O'Connor K, Stip E, Pélissier MC, Aardema F, Guay S, Gaudette G, Van Haaster I, Robillard S, Grenier S, Careau Y, Doucet P, Leblanc V. Treating delusional disorder: a comparison of cognitive-behavioural therapy and attention placebo control. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:182-90. [PMID: 17479527 DOI: 10.1177/070674370705200310] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. METHOD Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). RESULTS Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. CONCLUSION When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs.
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McLeod T, Morris M, Birchwood M, Dovey A. Cognitive behavioural therapy group work with voice hearers. Part 1. ACTA ACUST UNITED AC 2007; 16:248-52. [PMID: 17363859 DOI: 10.12968/bjon.2007.16.4.22995] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study presents a small, randomised control trial of cognitive behavioural interventions within a group setting for the treatment of auditory hallucinations. In a sample of 20 voice hearers, 10 were randomly allocated to an eight-session cognitive behavioural therapy group, and 10 underwent psychiatric 'treatment as usual'. Baseline assessments were undertaken. Measures of control, power, frequency and symptoms of distress and anxiety, were recorded on assessment and on completion of the group. The groups achieved a significant reduction in frequency of auditory hallucinations and in the beliefs about the power of the voice. Satisfaction measures also suggested that the group participants valued the group and benefited from the structured sessions. Universality, the recognition that other people experience very similar problems, was one of the most beneficial factors of the intervention. This study suggests that group cognitive behavioural therapy was helpful in the treatment of auditory hallucinations.
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Affiliation(s)
- Terry McLeod
- Birmingham and Solihull Mental Health Trust/University of Birmingham
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22
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Effects of Cognitive Behavioral Therapy and Vocational Rehabilitation on Metacognition and Coping in Schizophrenia. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2006. [DOI: 10.1007/s10879-005-9003-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2006. [DOI: 10.1007/s10879-005-9006-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lecomte T, Leclerc C. [Group interventions for people with refractory psychosis]. SANTE MENTALE AU QUEBEC 2005; 30:97-115. [PMID: 16170427 DOI: 10.7202/011163ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Various types of group interventions exist for people with severe mental disorders such as schziophrenia. The content and theoretical backgrounds vary according to the therapeutic goals as well as the clientele targeted. This article describes three group interventions : 1) one aiming at improving self-esteem, 2) one aiming at improving competence through stress management, and 3) one aiming at diminushing distress linked to psychotic symptoms with cognitive behavior therapy. Details on how to conduct these three group interventions, as well as their clinical and theoretical relevance for individuals with refractory psychosis will be described.
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Wykes T, Hayward P, Thomas N, Green N, Surguladze S, Fannon D, Landau S. What are the effects of group cognitive behaviour therapy for voices? A randomised control trial. Schizophr Res 2005; 77:201-10. [PMID: 15885983 DOI: 10.1016/j.schres.2005.03.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 03/14/2005] [Accepted: 03/15/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little evidence exists for the effects of psychological treatment on voices even though it is clear that CBT does affect delusions and symptoms overall. This study tested whether a group based on cognitive behavioural principles could produce beneficial effects on hallucinations. AIM To test the effectiveness of group CBT on social functioning and severity of hallucinations. METHOD Participants were included if they had a diagnosis of schizophrenia and experienced distressing auditory hallucinations (rated on the PANSS). They were randomly allocated to group CBT (N = 45) or a control group who received treatment as usual (N = 40). The two main outcomes were social functioning as measured by the Social Behaviour Schedule and the severity of hallucinations as measured by the total score on the Hallucinations Scale of PSYRATS. Assessments were carried out at baseline, 10 weeks (post therapy) and 36 weeks (six months following therapy). RESULTS Mixed random effects models revealed significant improvement in social functioning (effect size 0.63 six months after the end of therapy). There was no general effect of group CBT on the severity of hallucinations. However, there was a large cluster effect of therapy group on the severity of hallucinations such that they were reduced in some but not all of the therapy groups. Improvement in hallucinations was associated with receiving therapy early in the trial and having very experienced therapists (extensive CBT training which included expert supervision for a series of individual cases for at least a year following initial training). CONCLUSION Group CBT does improve social functioning but unless therapy is provided by experienced CBT therapists hallucinations are not reduced.
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Affiliation(s)
- Til Wykes
- Department of Psychology, Institute of Psychiatry, Kings College London, United Kingdom.
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26
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Careau Y, Garcia A. [Principal elements of the psychosocial readaptation program in the hospital setting]. SANTE MENTALE AU QUEBEC 2005; 30:117-24. [PMID: 16170429 DOI: 10.7202/011164ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Yves Careau
- Psychologue, Division des soins continus et spécialisés du Centre hospitalier Douglas
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