Recent Study Suggests CBT for Psychosis Should Be All or Nothing

Psychotic symptoms can be difficult to treat for a variety of reasons. Many individuals with psychosis do not comply with medication protocols and experience a worsening of symptoms. Other people do not realize any symptom reduction from pharmacological treatment and due to economic constraints or lack of social support are unable to find other forms of help. Therapies designed to help individuals with psychosis can be effective when delivered correctly and when clients comply with the therapists’ recommendations. One such approach is cognitive behavioral therapy for psychosis (CBT-P). This multifaceted approach involves a variety of complex techniques, including a strong therapeutic alliance and specific strategies designed to reduce the psychologically distressing symptoms of psychosis. However, individuals who begin CBT-P sometimes fail to continue the treatment. Although research has been conducted on CBT-P in its entirety, until now, no study has examined the effects of CBT-P when administered only in part to individuals with psychosis.

To address this issue, Graham Dunn of the Health Sciences Research Group at the School of Community-Based Medicine at the University of Manchester evaluated data from the Psychological Prevention of Relapse in Psychosis trial. This trial compared treatment as usual (TAU) to CBT-P in individuals with psychosis. Dunn analyzed data gathered throughout the treatment period and again at 12 and 24 months posttreatment. All of the therapists involved in the trial were specially trained to deliver CBT-P. Regardless of this factor, Dunn found that less than half of the clients who began CBT-P finished it. But those who did complete the treatment saw significant improvement.

“Treatment was effective if, and only if, clients received full therapy,” said Dunn. “Gains were large, and both clinically and statistically significant.” However, the participants who dropped out of treatment did not receive any benefits, even from partial therapy. This suggests that the goals of initial therapy, such as therapeutic bond and trust, were not as meaningful to these clients as the techniques implemented in later sessions. In fact, Dunn found that the individuals who dropped out of therapy early had a worsening of psychotic symptoms. Although the full delivery of CBT-P was highly effective, determining what obstacles prevent people from continuing such a beneficial approach should be explored in future studies.

Reference:
Dunn, G., Fowler, D., Rollinson, R., Freeman, D., Kuipers, E. (2012). Effective elements of cognitive behaviour therapy for psychosis: Results of a novel type of subgroup analysis based on principal stratification. Psychological Medicine 42.5, 1057-1068.

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  • WILL

    WILL

    June 16th, 2012 at 11:43 PM

    They always say complete the full course of medication even if you recover in between. Guess its true for therapy too!

  • QP

    QP

    June 17th, 2012 at 11:50 PM

    I think therapy methods need a little add-on here: a motivational add-on to the therapy sessions. If the positives of therapy treatment are seen only for those who complete the course and a lot of people are dropping out then we need to devise a motivational dimension to the treatment so that people do no drop out, and they reap the benefits of a full program!

  • Irene

    Irene

    June 18th, 2012 at 4:20 AM

    I can definitely see the benefits of seeing it through, but we have to remember that many patients face a great many obstacles when it comes to completing any course of treatment.

    Transportation can be a huge obstacle for many patients, as can affordability of services. Many don’t have the support system that is needed in the home to encourage them to take their medications and attend their sessions.

    Sad, but many of these patients who would benefit so much from a full course of treatment are the very patients who have the most working against them in terms of staying with a program and seeing it through to the end.

  • Solomon

    Solomon

    June 18th, 2012 at 11:08 AM

    That’s pretty harsh to say that it should be all or nothing don’t you think?
    Isn’t something better than nothing at all?

  • georgia

    georgia

    June 19th, 2012 at 4:29 AM

    With this sort of CBT that is very specific to meet the needs of patients who exhibit signs of psychosis, is there a specific time frame for completion of the program? I think that for a lot of patients when they don’t have small incremental steps to keep focused on, then they completely lose focus of their proposed treatment plan and become to feel a little overwhelmed. I know that for many it would be difficult to give a time frome, but even if they could work with their therapist to come up with a time frame for completion that feels reasonable and doable then maybe this could keep many more patients involved in their treatment and committed to seeing it through until the end.

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