Moving from efficacy to effectiveness in cognitive behavioral therapy for psychosis: a randomized clinical practice trial.
OBJECTIVE
Randomized controlled trials have attested the efficacy of cognitive behavioral therapy (CBT) in reducing psychotic symptoms. Now, studies are needed to investigate its effectiveness in routine clinical practice settings.


METHODS
Eighty patients with schizophrenia spectrum disorders who were seeking outpatient treatment were randomized to a specialized cognitive behavioral intervention for psychosis (CBTp; n = 40) or a wait list (n = 40). The CBTp group was assessed at baseline, posttreatment, and 1-year follow-up. The wait list group was assessed at baseline, after a 4-month waiting period, at posttreatment, and after 1 year. The primary outcome measure was the Positive and Negative Syndrome Scale (PANSS).


RESULTS
The CBTp group showed significant improvement over the wait list group for the total PANSS score at posttreatment-postwaiting. CBTp was also superior to the wait list group in regard to the secondary outcomes positive symptoms, general psychopathology, depression, and functioning, but not in regard to negative symptoms. The number of dropouts during the treatment phases was low (11.3%). Participants perceived the treatment as helpful (98%) and considered themselves improved (92%). Significant pre- and posttreatment effect sizes varied between 0.77 for general psychopathology and 0.38 for delusional conviction. The positive effects of treatment could be maintained at 1-year follow-up, although the number of patients who had deteriorated was higher than at postassessment.


CONCLUSIONS
Large proportions of patients in clinical practice settings benefit from CBTp. The efficacy of CBTp can be generalized to clinical practice despite the differences in patients, therapists, and deliverance.
Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg, Germany. tania.lincoln@uni-hamburg.de
Tania M
TM
Lincoln
Michael
M
Ziegler
Stephanie
S
Mehl
Marie-Luise
ML
Kesting
Eva
E
Lüllmann
Stefan
S
Westermann
Winfried
W
Rief
D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome; D014850:Waiting Lists