An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis.
OBJECTIVE
The efficacy of cognitive behaviour therapies for psychosis (CBTp) has been sufficiently established for its inclusion in some national treatment guidelines. However, treatment efficacy does not guarantee effectiveness in routine practice, where clinician expertise and patient mix may be different. Thus, we evaluated the applicability, acceptability and effectiveness of CBTp when offered routinely in a public mental health service.


METHODS
A prospectively recruited representative sample (N=94) of patients with psychotic disorders from a geographic catchment area in Melbourne, Australia, was randomized to CBTp or treatment as usual.


METHODS
The CBTp intervention included psychoeducation, positive symptom, and co-morbid problem components. Therapists collaboratively negotiated goals with patients and utilized treatment components from a manual. Intention-to-treat analyses used data at baseline, 9 months and 18 months.


RESULTS
Working alliance and client satisfaction measures indicated excellent acceptability. Both groups improved to a similar degree on the Positive And Negative Syndrome Scale, with no advantage for the CBTp group. The most frequent CBTp components implemented were co-morbid disorders/personal issues and personalized psychoeducation; working with persisting symptoms was the main focus in relatively few sessions.


CONCLUSIONS
The lack of advantage for the CBTp group may be due to: the infrequent focus on positive symptoms (the most replicated outcome domain for CBTp); the unselected nature of the patients (rather than those with distressing symptoms or referred by clinicians); or, to insufficient therapist expertise.
Farhall
John
J
School of Psychological Science, La Trobe University, Melbourne, Australia. j.farhall@latrobe.edu.au
Freeman
Nerelie C
NC
Shawyer
Frances
F
Trauer
Tom
T
D000328:Adult; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D008297:Male; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome