title: Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial.
abstract: BACKGROUND
  Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive.
  
  
  OBJECTIVE
  A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT] for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help-seeking UHR subjects.
  
  
  METHODS
  A total of 201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months.
  
  
  RESULTS
  In the CBTuhr condition, 10 patients transitioned to psychosis compared with 22 in the TAU condition (χ(2) (1) = 5.575, P = .03). The number needed to treat (NNT) was 9 (95% confidence interval [CI]: 4.7-89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% CI: 3.7-71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency (χ(2) (1) = 3.338, P = .06).
  
  
  CONCLUSIONS
  Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis.
authors.affiliation: Department of Clinical Psychology, Vu University, Van der Boechorstsraat 1, 1081 BT Amsterdam, The Netherlands. m.vander.gaag@vu.nl
authors.forename: Mark
authors.initials: M
authors.lastname: van der Gaag
authors.forename: Dorien H
authors.initials: DH
authors.lastname: Nieman
authors.forename: Judith
authors.initials: J
authors.lastname: Rietdijk
authors.forename: Sara
authors.initials: S
authors.lastname: Dragt
authors.forename: Helga K
authors.initials: HK
authors.lastname: Ising
authors.forename: Rianne M C
authors.initials: RM
authors.lastname: Klaassen
authors.forename: Maarten
authors.initials: M
authors.lastname: Koeter
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Lex
authors.initials: L
authors.lastname: Wunderink
authors.forename: Don H
authors.initials: DH
authors.lastname: Linszen
mesh_terms: D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000517:prevention & control* / Q000628:therapy; D012306:Risk; D012559:Schizophrenia / Q000517:prevention & control*; D016896:Treatment Outcome