Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-17T13:19:31.534Z Has data issue: false hasContentIssue false
  • English
  • Français

What is the minimal dose of cognitive behavior therapy for psychosis? An approximation using repeated assessments over 45 sessions

Published online by Cambridge University Press:  23 March 2020

T.M. Lincoln ,
E. Jung ,
M. Wiesjahn  and
B. Schlier
T.M. Lincoln*
Affiliation:
University of Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Germany
E. Jung
Affiliation:
Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Germany
M. Wiesjahn
Affiliation:
Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Germany
B. Schlier
Affiliation:
University of Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Germany
*
*Corresponding author. University of Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany. Tel.: +0049 0 40 42838 5360; fax: +0049 0 40 42838 6170. E-mail address:[email protected](T.M. Lincoln).
Get access

Abstract

Background

The general efficacy of cognitive behavior therapy for psychosis (CBTp) is well established. Although guidelines recommend that CBTp should be offered over a minimum of 16 sessions, the minimal number of sessions required to achieve significant changes in psychopathology has not been systematically investigated. Empirically informed knowledge of the minimal and optimal dose of CBTp is relevant in terms of dissemination and cost-effectiveness.

Methods

We approached the question of what constitutes an appropriate dose by investigating the dose (duration of CBTp) × response (symptomatic improvement) relationship for positive symptoms, negative symptoms and depression. Patients with psychotic disorders (n = 58) were assessed over the course of 45 sessions of CBTp in a clinical practice setting. At baseline and after session 5, 15, 25, and 45, general psychopathology, psychotic symptoms, symptom distress and coping were assessed with self-report questionnaires. Additionally, individually defined target symptoms and coping were assessed after each session.

Results

Significant symptom improvement and reduction of symptom distress took place by session 15, and stayed fairly stable thereafter. The frequency of positive and negative symptoms reached a minimum by session 25.

Conclusions

Our findings support recommendations to provide CBTp over a minimum of 16 sessions and indicate that these recommendations are generalizable to clinical practice settings. However, the findings also imply that 25 sessions are the more appropriate dose. This study contributes to an empirically informed discussion on the minimal and optimal dose of CBTp. It also provides a basis for planning randomized trials comparing briefer and longer versions of CBTp.

Keywords

CBTTreatment durationDisseminationTreatment guidelinesEffectivenessMechanisms of change
Type
Original article
Information
European Psychiatry , Volume 38 , October 2016 , pp. 31 - 39
Copyright
Copyright © Elsevier Masson SAS 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Turner, DTet al.Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. Am J Psychiatry. 2014;171:523–538CrossRefGoogle ScholarPubMed
Wykes, Tet al.Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schiz Bull. 2008;34:523–537CrossRefGoogle ScholarPubMed
Gaebel, Wet al.Praxisleitlinien in psychiatrie und psychotherapie, behandlungsleitlinie schizophrenie. 2006 Steinkopf DarmstadtGoogle Scholar
Kreyenbuhl, Jet al.The schizophrenia patient outcomes research team (PORT): updated treatment recommendations 2009. Schiz Bull. 2010;36:94–103CrossRefGoogle ScholarPubMed
NCCMH, Psychosis and schizophrenia in adults. The nice guideline on treatment and management. Updated edition 2014. Leicester and London: The British Psychological Society and the Royal College of Psychiatrists; 2014 http://www.nice.org.uk2009Google Scholar
NICE, Schizophrenia: core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. NICE clinical guideline 82. London: National Institute for Health and Clinical Excellence; 2009 Available at www.nice.org.uk/CG82Google Scholar
Lincoln, TMet al.Moving from efficacy to effectiveness in CBT for psychosis. A randomized-controlled clinical practice trial. J Consult Clin Psychol. 2012;80:674–686CrossRefGoogle ScholarPubMed
Farhall, Jet al.An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis. Br J Clin Psychol. 2009;48:47–62CrossRefGoogle Scholar
Peters, Eet al.A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatr Scan. 2010;122:302–318CrossRefGoogle Scholar
Berry, KHaddock, GThe implementation of the NICE guidelines for schizophrenia: barriers to the implementation of psychological interventions and recommendations for the future. Psychol Psychother. 2008;81:419–436CrossRefGoogle ScholarPubMed
Kuipers, ECognitive behavioural therapy and family intervention for psychosis-evidence-based but unavailable? The next steps. Psychoanal Psychother. 2011;25:69–74CrossRefGoogle Scholar
Prytys, Met al.Implementing the NICE guideline for schizophrenia recommendations for psychological therapies: a qualitative analysis of the attitudes of CMHT staff. Clin Psychol Psychother. 2011;18:48–59CrossRefGoogle ScholarPubMed
Klingberg, SWittorf, AEvidenzbasierte psychotherapie bei schizophrenen psychosen. Der Nervenarzt. 2012 1–12 10.1007/s00115-012-3553-2CrossRefGoogle Scholar
Lambert, Met al.Integrierte Versorgung von Menschen mit psychotischen Erkrankungen: Das Hamburger ModellAmelung, VEBergmann, FFalkai, PHauth, IJaleel, EMeier, UReichmann, HRoth-Sackenheim, CInnovative konzepte im versorgungsmanagement von zns-patienten. Berlin: Medizinische Wissenschafltiche Verlagsgesellschaft:2010.Google Scholar
Lecomte, TLeclerc, CImplementing cognitive behaviour therapy for psychosis: issues and solutions. Tidsskrift for Norsk Psykologforening. 2007;44:588–597Google Scholar
Kimhy, Det al.Cognitive behavioral therapy for psychosis. Training practices and dissemination in the United States. Psychosis. 2013;5:296–305CrossRefGoogle ScholarPubMed
Fennig, Set al.Diagnosis and six-month stability of negative symptoms in psychotic disorders. Eur Arch Psychiatry Clin Neurosci. 1996;246:63–70CrossRefGoogle ScholarPubMed
Velthorst, Eet al.Adapted cognitive-behavioural therapy required for targeting negative symptoms in schizophrenia: meta-analysis and meta-regression. Psychol Med. 2015;45:453–465CrossRefGoogle ScholarPubMed
Davis, Met al.Psychopharmacology of the negative symptoms: current status and prospects for progress. Eur Neuropsychopharmacol. 2014;24:788–799CrossRefGoogle Scholar
Mehl, Set al.Does cognitive behaviour therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis. Front Psychol. 6 2015 1450CrossRefGoogle ScholarPubMed
Howard, KIet al.The dose-effect relationship in psychotherapy. Am Psychol. 1986;41:159–164CrossRefGoogle ScholarPubMed
Wittchen, HUet al.Strukturiertes klinisches interview fuer DSM-IV.1997 Hogrefe GoettingenGoogle Scholar
Kay, SRet al.The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schiz Bull. 1987;13:261–276CrossRefGoogle Scholar
Lincoln, TKognitive Verhaltenstherapie der Schizophrenie. Ein individuenzentrierter Ansatz zur Veränderung von Wahn, Halluzinationen und Negativsymptomatik. Göttingen: Hogrefe; 2006Google Scholar
Morrison, APet al.Cognitive therapy for psychosis. A formulation-based approach.2004 Brunner-Routledge New YorkCrossRefGoogle Scholar
Kingdon, DTurkington, DCognitive-behavioral therapy of schizophrenia. London: Guilford Press; 1994Google ScholarPubMed
Fowler, Det al.Cognitive behaviour therapy for psychosis. Theory and practice.1995 Wiley ChichesterGoogle Scholar
Chadwick, Pet al.Cognitive therapy for delusions, voices and paranoia.1996 Wiley ChichesterGoogle Scholar
Wittchen, H.-U.et al.Strukturiertes Klinisches Interview für DSM-IV (SKID I und SKID II). Göttingen;Hogrefe: 1997.Google Scholar
Hardt, JThe symptom checklist-27-plus (SCL-27-plus): a modern conceptualization of a traditional screening instrument. GMS Psychosoc Med.5 2008 Doc08Google ScholarPubMed
Stefanis, NCet al.Evidence that three dimensions of psychosis have a distribution in the general population. Psychol Med. 2002;32:347–358CrossRefGoogle ScholarPubMed
Schlier, Bet al.Validation of the community assessment of psychic experiences (CAPE) in a community and clinical sample. Schiz Res. 2015;169:274–279CrossRefGoogle Scholar
Greenwood, KEet al.Choice of outcome in CBT for psychoses (CHOICE): the development of a new service user-led outcome measure of CBT for psychosis. Schiz Bull. 2010;36:126–135CrossRefGoogle ScholarPubMed
Klaghofer, RBrähler, EKonstruktion und teststastische Prüfung einer Kurzform der SCL-90-R. Zeitschrift für Klinische Psychologie und Psychotherapie. 2001;42:115–124Google Scholar
Anderson, EMLambert, MJA survival analysis of clinically significant change in outpatient psychotherapy. J Clin Psychol. 2001;57:875–888CrossRefGoogle ScholarPubMed
Depp, CLebowitz, BDClinical trials: bridging the gap between efficacy and effectiveness. Int Rev Psychiatry. 2007;19:531–539CrossRefGoogle ScholarPubMed
Lincoln, TMet al.Wirksamkeit kognitiver Interventionen in der Reduktion schizophrener Symptomatik. Eine meta-analyse. Psychologische Rundschau. 2008;4:217–232CrossRefGoogle Scholar
Morrison, APet al.Delivering cognitive therapy to people with psychosis in a community health setting: an effectiveness study. Acta Psychiatr Scan. 2004;110:36–44CrossRefGoogle Scholar
Addis, MEet al.Barriers to dissemination of evidence-based practices: addressing practitioners’ concerns about manual-based psychotherapies. Clin Psychol. 1999;6:430–441Google Scholar
Lüllmann, ELincoln, TMThe effect of an educating versus normalizing approach on treatment motivation in patients presenting with delusions: an experimental investigation with analogue patients. Schizophr Res Treatment. 2013 [Article ID 261587]CrossRefGoogle Scholar
Stiles, WBet al.Duration of psychological therapy: relation to recovery and improvement rates in UK routine practice. Br J Psychiatry. 2015;207:115–122CrossRefGoogle ScholarPubMed
Lincoln, TMet al.Who stays, who benefits? Predicting change and dropout in cognitive behavioural therapy for psychosis. Psychiatry Res. 2014;216:198–205CrossRefGoogle Scholar
Dollfus, SSelf-evaluation of negative symptoms (SNS): a new tool for assessing negative symptoms.. Schiz Bull. [in press].Google Scholar
Engel, MLincoln, TMMotivation and pleasure scale-self-report (MAP-SR): validation of the German version of a self-report measure for screening negative symptoms in schizophrenia. Compr Psychiatry. 2016;65:110–115CrossRefGoogle Scholar
Lincoln, TMet al.Can delusions be self-assessed? Concordance between self- and observer-rated delusions in schizophrenia. Psychiatry Res. 2010;178:249–254CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.