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Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: Analysis of the EDIE-2 trial

  • Clare Flach (a1), Paul French (a2), Graham Dunn (a1), David Fowler (a3), Andrew I. Gumley (a4), Max Birchwood (a5), Suzanne L. K. Stewart (a6) and Anthony P. Morrison (a7)...

Abstract

Background

Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables.

Method

Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis.

Results

A significant decrease in the symptom score for case formulation (coefficient =–23, 95% CI –44 to –1.7, P = 0.036) and homework (coefficient =–0.26, 95% CI –0.51 to –0.001, P = 0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient =–0.23, 95% CI –0.47 to 0.005, P = 0.056).

Conclusions

There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.

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Copyright

Corresponding author

Clare Flach, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Email: clare.flach@lshtm.ac.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Yung, AR, McGorry, PD, McFarlane, C, Jackson, HJ, Patton, GC, Rakkar, A. Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull 1996; 22: 283303.
2 Addington, J, Epstein, I, Liu, L, French, P, Boydell, KM, Zipursky, RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res 2011; 125: 5461.
3 McGlashan, TH, Zipursky, RB, Perkins, D, Addington, J, Miller, T, Woods, SW, et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 2006; 163: 790–9.
4 McGorry, PD, Yung, AR, Phillips, LJ, Yuen, HP, Francey, S, Cosgrave, EM, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002; 59: 921–8.
5 Morrison, AP, French, P, Walford, L, Lewis, SW, Kilcommons, A, Green, J, et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 2004; 185: 291–7.
6 Amminger, GP, Schafer, MR, Papageorgiou, K, Klier, CM, Cotton, SM, Harrigan, SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 2010; 67: 146–54.
7 Bechdolf, A, Wagner, M, Ruhrmann, S, Harrigan, S, Putzfeld, V, Pukrop, R, et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012; 200: 22–9.
8 Yung, AR, Phillips, LJ, Nelson, B, Francey, SM, PanYuen, H, Simmons, MB, et al. Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis. J Clin Psychiatry 2011; 72: 430–40.
9 Morrison, AP, French, P, Stewart, SLK, Birchwood, M, Fowler, D, Gumley, AI, et al. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ 2012; 344: e2233.
10 Stafford, MR, Jackson, H, Mayo-Wilson, E, Morrison, AP, Kendall, T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f185.
11 Dunn, G, Fowler, D, Rollinson, R, Freeman, D, Kuipers, E, Smith, B, et al. Effective elements of cognitive behaviour therapy for psychosis: results of a novel type of subgroup analysis based on principal stratification. Psychol Med 2012; 42: 1057–68.
12 Hausman, JA. Specification tests in econometrics. Econometrica 1978; 46: 1251–71.
13 Nagelkerke, N, Fidler, V, Bersen, R, Borgdorff, M. Estimating treatment effects in randomized clinical trials in the presence of non-compliance. Stat Med 2000; 19: 1849–64.
14 Maracy, M, Dunn, G. Estimating dose-response effects in psychological treatment trials: the role of instrumental variables. Stat Methods Med Res 2011; 20: 191215.
15 French, P, Morrison, AP. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis: A Treatment Approach. Wiley, 2004.
16 Morrison, AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychoth 2001; 29: 257–76.
17 Morrison, AP, Barratt, S. What are the components of CBT for psychosis? A Delphi study. Schizophr Bull 2010; 36: 136–42.
18 Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, et al. Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry 2005; 39: 964–71.
19 Mattick, RP, Clarke, JC. Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behav Res Ther 1998; 36: 455–70.
20 Beck, AT, Guth, D, Steer, RA, Ball, R. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Behav Res Ther 1997; 35: 785–91.
21 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association, 2000, 34.
22 Priebe, S, Huxley, P, Knight, S, Evans, S. Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatry 1999; 45: 712.
23 Angrist, JD, Krueger, AB. Instrumental variables and the search for identification: from supply and demand to natural experiments. J Econ Perspect 2001; 15: 6985.
24 Dunn, G, Maracy, M, Tomenson, B. Estimating treatment effects from randomized clinical trials with noncompliance and loss to follow-up: the role of instrumental variable methods. Stat Methods Med Res 2005; 14: 369–95.
25 Maracy, M, Dunn, G. Estimating dose-response effects in psychological treatment trials: the role of instrumental variables. Stat Methods Med Res 2011; 20: 191215.
26 Dunn, G, Bentall, R. Modelling treatment-effect heterogeneity in randomized controlled trials of complex interventions (psychological treatments). Stat Med 2007; 26: 4719–45.
27 Royston, P. Multiple imputation of missing values: update. Stata J 2005; 5: 188201.
28 Chadwick, P, Williams, C, Mackenzie, J. Impact of case formulation in cognitive behaviour therapy for psychosis. Behav Res Ther 2003; 41: 671–80.
29 Dunn, H, Morrison, AP, Bentall, RP. The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis. Clin Psychol Psychoth 2006; 13: 145–52.
30 Grossman, LS, Harrow, M, Rosen, C, Faull, R, Strauss, GP. Sex differences in schizophrenia and other psychotic disorders: a 20-year longitudinal study of psychosis and recovery. Compr Psychiatry 2008; 49: 523–9.
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  • EISSN: 1472-1465
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Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: Analysis of the EDIE-2 trial

  • Clare Flach (a1), Paul French (a2), Graham Dunn (a1), David Fowler (a3), Andrew I. Gumley (a4), Max Birchwood (a5), Suzanne L. K. Stewart (a6) and Anthony P. Morrison (a7)...
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