title: A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis: The detection and evaluation of psychological therapy (DEPTh) trial.
abstract: Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred.
  
  
  
  This was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6month treatment phase and 12months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points.
  
  
  
  Fifty-seven young people (mean age=16.5years) were randomised to CBT (n=30) or NDRL (n=27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2months, 5months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect=36.71, standard error=16.84, p=0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning.
  
  
  
  Our sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention.
  
  
  
  ANZCTR 12606000101583.
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, UK. Electronic address: helen.stain@durham.ac.uk.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Stain
authors.affiliation: School of Psychological Sciences, University of Manchester, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bucci
authors.affiliation: School of Medicine and Public Health, University of Newcastle, NSW, Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Baker
authors.affiliation: School of Psychiatry, University of New South Wales, NSW, Australia; Schizophrenia Research Institute, NSW, Australia; Department of Psychiatry, Monash University, Vic, Australia.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Carr
authors.affiliation: Institute of Population Health, University of Manchester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Emsley
authors.affiliation: School of Psychology, University of Newcastle, NSW, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Halpin
authors.affiliation: School of Medicine and Public Health, University of Newcastle, NSW, Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Lewin
authors.affiliation: Schizophrenia Research Institute, NSW, Australia; Priority Centre for Translational Neuroscience & Mental Health Research, University of Newcastle, NSW, Australia; Hunter Medical Research Institute, NSW, Australia.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schall
authors.affiliation: School of Medicine and Public Health, University of Newcastle, NSW, Australia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Clarke
authors.affiliation: Western New South Wales Local Health District, NSW, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Crittenden
authors.affiliation: School of Psychology, University of Newcastle, NSW, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: Startup
mesh_terms: D000293:Adolescent; D001307:Auditory Perception; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018579:Patient Selection; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012306:Risk; D016037:Single-Blind Method; D012919:Social Behavior; D016896:Treatment Outcome
keywords: At risk mental state; Intervention; Psychosis; Ultra high risk; Youth