Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial |
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| Authors: | Mark van der Gaag Dorien H Nieman Judith Rietdijk Sara Dragt Helga K Ising Rianne MC Klaassen Maarten Koeter Pim Cuijpers Lex Wunderink Don H Linszen |
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| Institution: | 1.Department of Clinical Psychology, Vu University, Amsterdam, the Netherlands;;2.Department of Psychosis Research, Parnassia Psychiatric Institute, Den Haag, the Netherlands;;3.Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands;;4.Department of Child and Adolescent Psychiatry, GGZ Rivierduinen, Leiden, the Netherlands;;5.Department of Research and Education, GGZ Friesland, Leeuwarden, the Netherlands |
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| 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.
Key words: cognitive behavioral therapy, ultrahigh risk, cognitive biases, prevention, psychosis, schizophrenia |
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