title: Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis.
abstract: This study investigates the predictors of outcome in a secondary analysis of dropout and completer data from a randomized controlled effectiveness trial comparing CBTp to a wait-list group (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at 1-year follow-up. The predictor×group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp+the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and 1-year follow-up after controlling for pre-treatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier.
authors.affiliation: Section for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Von-Melle Park 5, 20146 Hamburg, Germany. Electronic address: tania.lincoln@uni-hamburg.de.
authors.forename: Tania M
authors.initials: TM
authors.lastname: Lincoln
authors.affiliation: Section for Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps University Marburg, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Rief
authors.affiliation: Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Westermann
authors.affiliation: Vitos Haina Forensic Psychiatric Hospital, Haina, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ziegler
authors.affiliation: Clinic Rabenstein, Rehabilitation Clinic for Othopedics, Internal Medicine and Psychosomatics, Nidda, Germany.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Kesting
authors.affiliation: Section for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Von-Melle Park 5, 20146 Hamburg, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Heibach
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Philipps University Marburg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mehl
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012917:Social Adjustment; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
keywords: Adherence; CBT; Dropout; Predictors; Psychosis; Schizophrenia