Family outcomes from a randomized control trial of relapse prevention therapy in first-episode psychosis.
OBJECTIVE
We have previously reported that our combined individual and family cognitive-behavioral therapy (CBT) relapse prevention therapy (RPT) was effective in reducing relapse rates compared to treatment as usual (TAU) within a specialist program for young, first-episode psychosis patients who had reached remission on positive symptoms. Here, we report the outcomes for family participants of DSM-IV-diagnosed first-episode psychosis patients recruited between November 2003 and May 2005 over a 2.5-year follow-up period. The primary hypothesis was that, compared to family members receiving TAU, family participants who received RPT would have significantly improved appraisals of stressors related to caregiving. Secondary hypotheses were that RPT would be associated with reduced expressed emotion and improved psychological distress.


METHODS
Family members were assessed at baseline and at 7-month, 12-month, 18-month, 24-month, and 30-month follow-up on appraisal of caregiving, expressed emotion, and psychological distress using the Experience of Caregiving Inventory, The Family Questionnaire, and the General Health Questionnaire of 28 Items, respectively. The family component of RPT was based on family behavioral therapy for schizophrenia with a specific focus on psychoeducation and CBT for relapse prevention.


RESULTS
Thirty-two families received RPT, and 31 families received TAU. There were significant group effects for aspects of the appraisal of caregiving, including negative symptoms, positive personal experiences, and total positive score on the Experience of Caregiving Inventory. Time effects were evident for emotional overinvolvement and for aspects of the appraisal of caregiving. There were no significant effects for psychological distress.


CONCLUSIONS
The relatives of patients who received RPT perceived less stress related to their relative's negative symptoms and an increase in perceived opportunities to make a positive contribution to the care of their relative compared to carers in the TAU condition. Cognitive-behavioral therapy for relapse prevention showed promise in improving the experience of caregiving for family members of first-episode psychosis patients over a 2.5-year follow-up period.


BACKGROUND
anzctr.org.au Identifier: ACTRN12605000514606.
Gleeson
John F M
JF
University of Melbourne Psychology Clinic, 14-20 Blackwood Street, The University of Melbourne, Victoria, Australia 3010. jgleeson@unimelb.edu.au
Cotton
Sue M
SM
Alvarez-Jimenez
Mario
M
Wade
Darryl
D
Crisp
Kingsley
K
Newman
Belinda
B
Spiliotacopoulos
Daniela
D
McGorry
Patrick D
PD
D000328:Adult; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D019260:Expressed Emotion; D005190:Family / Q000523:psychology*; D005196:Family Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D011618:Psychotic Disorders / Q000628:therapy; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D055502:Secondary Prevention; D013315:Stress, Psychological / Q000628:therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome