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.
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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