Psychosis

In addition to the abstracts listed below, many additional references on CT of psychosis may be found in this bibliography by ACT Fellow James M. Clairborn, Ph.D., ABPP.

 

Addington, J. Epstein, I., Liu, L., French, P., Boydell, K.M., Zipursky, R.B. “A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis.” Schizophrenia Research,125 (2011): 54-61.

Correspondence Address:
Not Available

Abstract
Background: There has been increasing interest in early detection during the prodromal phase of a psychotic disorder. To date a few treatment studies have been published with some promising results for both pharmacological treatments, using second generation antipsychotics, and psychological interventions, mainly cognitive behavioral therapy. The purpose of this study was to determine first if cognitive behavioral therapy (CBT) was more effective in reducing the rates of conversion compared to a supportive therapy and secondly whether those who received CBT had improved symptoms compared to those who received supportive therapy. Method: Fifty-one individuals at clinical high risk of developing psychosis were randomized to CBT or a supportive therapy for up to 6. months. The sample was assessed at 6, 12 and 18. months post baseline on attenuated positive symptoms, negative symptoms, depression, anxiety and social functioning. Results: Conversions to psychosis only occurred in the group who received supportive therapy although the difference was not significant. Both groups improved in attenuated positive symptoms, depression and anxiety and neither improved in social functioning and negative symptoms. There were no differences between the two treatment groups. However, the improvement in attenuated positive symptoms was more rapid for the CBT group. Conclusions: There are limitations of this trial and potential explanations for the lack of differences. However, both the results of this study and the possible explanations have significant implications for early detection and intervention in the pre-psychotic phase and for designing future treatments. © 2010 Elsevier B.V.

 

Bechdolf, A, Knost, B., Kuntermann, C., Schiller, S., Klosterkotter, J., Hambrecht, M., & Pukrop, R. (2004). A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatrica Scandinavica, 110, 21-28.

Correspondence Address:
Andreas Bechdolf, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany, 50924, andreas.bechdolf@medizin.uni-koeln.de.

Abstract
Objective: Although the efficacy of cognitive-behavioural therapy (CBT) in schizophrenia has been established in a number of studies, no information is available on the differential efficacy of CBT in comparison with patient psychoeduction (PE). Method: Eighty-eight in-patients with schizophrenia were randomized to receive a therapy envelope of 8 weeks including either 16 sessions group CBT or 18 sessions group PE treatment. Assessments took place at baseline, post-treatment and 6 month follow-up. Results: Patients, who received CBT were significantly less rehospitalized than patients in the PE group during the follow-up period. On a descriptive level, CBT resulted in lower relapse rates and higher compliance ratings at post-treatment and at follow-up than PE. Both forms of therapy led to significant psychopathological improvement at post-treatment and at follow-up. Conclusion: The brief group CBT intervention showed some superiority to the PE programme, which could be of considerable clinical and economical importance. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

 

Eack, S. M., Hogarty, G. E., Greenwald, D. P., Hogarty, S. S., & Keshavan, M. S. (2007). Cognitive enhancement therapy improves emotional intelligence in early course schizophrenia: Preliminary effects. Schizophrenia Research, 89, 308-311.

Correspondence Address:
Matcheri S. Keshavan: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, US, 15213, keshavanms@upmc.edu.

Abstract
This research examined the preliminary effects of Cognitive Enhancement Therapy (CET) on social cognition in early course schizophrenia, using an objective, performance-based measure of emotional intelligence. Individuals in the early course of schizophrenia were randomly assigned to either CET (n=18) or Enriched Supportive Therapy (n=20), and assessed at baseline and after 1 year of treatment with the Mayer-Salovey-Caruso Emotional Intelligence Test. A series of analyses of covariance showed highly significant (p=.005) and large (Cohen's d=.96) effects favoring CET for improving emotional intelligence, with the most pronounced improvements occurring in patients' ability to understand and manage their own and others' emotions. These findings lend preliminary support to the previously documented benefits of CET on social cognition in schizophrenia, and suggest that such benefits can be extended to patients in the early course of the illness. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

 

Morrison, A. P., French, P., Walford, L., Lewis, S. W., Kilcommons, A., Green, J., Parker, S., & Bentall, R. P. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: Randomised controlled trial. British Journal of Psychiatry, 185, 291-297.

Correspondence Address:
Anthony P. Morrison, Department of Psychology, University of Manchester, Coupland Street, Manchester, United Kingdom, M13 9PL, tony.morrison@manchester.ac.uk.

Abstract (from the journal abstract)
Background: Advances in the ability to identify people at high risk of developing psychosis have generated interest in the possibility of preventing psychosis. Aims: To evaluate the efficacy of cognitive therapy for the prevention of transition to psychosis. Method: A randomised controlled trial compared cognitive therapy with treatment as usual in 58 patients at ultrahigh risk of developing a first episode of psychosis. Therapy was provided over 6 months, and all patients were monitored on a monthly basis for 12 months. Results: Logistic regression demonstrated that cognitive therapy significantly reduced the likelihood of making progression to psychosis as defined on the Positive and Negative Syndrome Scale over 12 months. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM-IV diagnosis of a psychotic disorder. Analysis of covariance showed that the intervention also significantly improved positive symptoms of psychosis in this population over the 12-month period Conclusions: Cognitive therapy appears to be an acceptable and efficacious intervention for people at high risk of developing psychosis. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

 

Morrison, A. P., French, P., Parker, S., Roberts, M., Stevens, H., Bentall, R. P., & Lewis, S. W. (2007). Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophrenia Bulletin, 33, 682-687.

Correspondence Address:
Anthony P. Morrison, Department of Psychology, University of Manchester, Coupland Street, Manchester, United Kingdom, M13 9PL, tony.morrison@manchester.ac.uk .

Abstract
There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis. A randomized controlled trial compared cognitive therapy (CT) over 6 months with monthly monitoring in 58 patients meeting criteria for ultrahigh risk of developing a first episode of psychosis. Participants were followed up over a 3-year period. Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a 3-year period, but it did not affect transition to psychosis defined using the Positive and Negative Syndrome Scale (PANSS) or probable Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. Follow-up rate at 3 years was 47%. There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of developing psychosis. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

 

Morrison, A. P., Renton, J. C., Williams, S., Dunn, H., Knight, A., Kreutz, M., Nothard, S., Patel, U., & Dunn, G. (2004). Delivering cognitive therapy to people with psychosis in a community mental health setting: An effectiveness study. Acta Psychiatrica Scandinavica, 110, 36-44.

Correspondence Address:
Anthony P. Morrison, Department of Psychology, University of Manchester, Coupland Street, Manchester, United Kingdom, M13 9PL, tony.morrison@manchester.ac.uk .

Abstract
Objective: Cognitive therapy (CT) has been shown to be an efficacious treatment for persistent psychotic symptoms. However, there is some debate regarding whether this is transportable to real life clinical settings. This study aimed to evaluate the effectiveness of CT for psychosis in a community mental health team (CMHT) setting. Method: Patients referred for CT for psychosis were naturalistically allocated (determined by the availability of a therapist) to CT or waiting-list (WL)/treatment-as-usual (TAU). Outcome assessments were performed at WL, pre-CT, post-CT and 1-year follow-up. Data from 59 patients were analysed. Results: Random effects regression analyses showed there was a significant improvement, attributable to CT, on most outcome measures, and that many of the symptomatic improvements were maintained at follow-up. Wilcoxon signed ranks tests indicated that there was a significant reduction in psychiatric hospital use following CT. Conclusion: These results confirm that CT is an effective treatment for psychosis that is generalizable to a community setting. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

 

Rathod, Shanaya, Peter Phiri, and David Kingdon. “Cognitive Behavioral Therapy for Schizophrenia.” Psychiatric Clinics of North America, Vol. 33, Issue 3 (September 2010): 527-536.

Correspondence Address:
Hampshire Partnership NHS Foundation Trust, Melbury Lodge, Winchester, Hampshire SO22 5DG, UK. shanaya.rathod@hantspt-mid.nhs.uk

Abstract
“Cognitive behavioral therapy (CBT) complements medication management and evidence has shown its effectiveness in managing positive and negative symptoms, promoting treatment resistance, and improving insight, compliance, and aggression in schizophrenia. There is emerging evidence in early intervention, comorbid substance misuse, and reducing relapse and hospitalization. CBT is now recommended by most clinical guidelines for schizophrenia. Treatment is based on engaging the patient in a therapeutic relationship, developing an agreed formulation, and then the use of a range of techniques for hallucinations, delusions, and negative symptoms. This article gives an overview of the current status of CBT for schizophrenia.”

 

Temple, S., & Ho, B.-C. (2005). Cognitive therapy for persistent psychosis in schizophrenia: A case-controlled clinical trial. Schizophrenia Research, 74, 195-199.

Correspondence Address:
Scott Temple, Department of Psychiatry, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1911 JPP, Iowa City, IA, US, 52242, scott-temple@uiowa.edu.

Abstract
The results of an open label controlled outcome study are presented, comparing Cognitive Therapy with a treatment-as-usual group. Independent raters assessed symptom severity and psychosocial functioning at baseline, and again at 6 months. Improvements were found for Cognitive Behavior Therapy (CBT) patients in Clinical Global Impression for Improvement (CGI; p<0.03), Global Psychosocial Functioning (p<0.001), the Global Assessment Scale (GAS) ratings (p<0.013), overall symptoms (p<0.049), and delusions (p<0.029). A trend toward significance was found for reductions in negative symptoms (p<0.06). The results suggest the potential utility of cognitive therapy as a companion therapy for schizophrenia in the United States. Limitations of the study include small sample sizes, lack of randomized assignment, and rater nonblindedness to treatment condition. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

 

Wykes, T., Reeder, C., Landau, S., Everitt, B., Knapp, M., Patel, A., & Romeo, R. (2007). Cognitive remediation therapy in schizophrenia: Randomised controlled trial. British Journal of Psychiatry, 190, 421-427.

Correspondence Address:
Til Wykes, Department of Psychology, Institute of Psychiatry, PO Box 77, De Crespigny Park, London, United Kingdom, SE5 8AF, t.wykes@iop.kcl.ac.uk.

Abstract
Background: Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning. Aims: To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia. Method: Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty (n = 85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0, 14 and 40. Results: There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43-2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost. Conclusions: Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal article)