Abstract
The study aimed to determine the clinical and neuropsychological predictors of responsiveness to cognitive behavioural therapy for psychosis (CBTp). Sixty patients with schizophrenia or schizoaffective disorder and 25 healthy individuals took part in the study. Thirty patients (25 protocol completers) received CBTp in addition to standard care (SC); 30 patients (18 protocol completers) received SC only. All patients were assessed on symptoms using the Positive and Negative Syndrome Scale (PANSS) and clinical and neuropsychological function before and after CBTp. Symptoms and self-esteem improved to a greater extent in the CBTp+SC than SC control group. Greater pre-therapy coping ability and the self-reflectiveness dimension of cognitive insight at baseline predicted improvement in symptoms in the CBTp+SC group, but not the SC control group, explaining up to 21% of the variance in symptom improvement. Pre-therapy neuropsychological function, duration of illness, clinical insight and gender did not predict CBTp responsiveness. Being able to have a range of coping strategies and reflect on one's experiences while refraining from overconfidence in one's interpretations before therapy is conducive to better CBTp responsiveness.
Highlights
The extent to which neuropsychological and clinical factors determine responsiveness to cognitive behavioural therapy (CBT) for individuals with a psychotic disorder remains unclear
Tarrier and his colleagues (1998) found that the likelihood of a 50% improvement in positive symptoms was predicted by a shorter duration of illness in those receiving CBT for psychosis (CBTp) compared to routine care or supportive counselling, while Garety et al (1997) found no relationships between length of illness or age of onset and outcome, but observed that a greater number of admissions in the previous five years was related to improvement in positive symptoms
As the aforementioned correlational analyses showed that pre-therapy Coping Orientation to Problems Experience (COPE) total, BCI self-reflectiveness and BCI composite index scores correlated with symptom change following CBTp (Results, Section 3.3), multiple regression analyses were performed to determine which pre-therapy clinical variable contributed more strongly to the variance in the criterion variable in the CBTp+standard care (SC) group
Summary
The extent to which neuropsychological and clinical factors determine responsiveness to cognitive behavioural therapy (CBT) for individuals with a psychotic disorder remains unclear. Naeem et al (2008) combined the results of two relatively large RCTs of CBTp versus treatment as usual in the Insight trial (N= 422) and versus befriending in the London Newcastle trial (N=90), and in the Insight trial, reported that lower pre-therapy general psychopathology predicted the greater likelihood of a good treatment outcome in the CBTp group, defined as a 25% improvement in general psychopathology Tarrier and his colleagues (1998) found that the likelihood of a 50% improvement in positive symptoms was predicted by a shorter duration of illness in those receiving CBTp compared to routine care or supportive counselling, while Garety et al (1997) found no relationships between length of illness or age of onset and outcome, but observed that a greater number of admissions in the previous five years was related to improvement in positive symptoms. It was hypothesized that symptoms and cognitive insight would improve following CBTp, since improvement in symptoms was associated with greater cognitive insight in two previous studies (Granholm et al, 2002; Perivoliotis et al, 2010)
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