Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T06:11:02.429Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive behaviour therapy for improving social recovery in psychosis: a report from the ISREP MRC Trial Platform study (Improving Social Recovery in Early Psychosis)

Published online by Cambridge University Press:  01 April 2009

D. Fowler ,
J. Hodgekins ,
M. Painter ,
T. Reilly ,
C. Crane ,
I. Macmillan ,
M. Mugford ,
T. Croudace  and
P. B. Jones
D. Fowler*
Affiliation:
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
J. Hodgekins
Affiliation:
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
M. Painter
Affiliation:
CAMEO, Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, UK
T. Reilly
Affiliation:
Norfolk Early Intervention Service, Norfolk and Waveney Mental Health NHS Foundation Trust, UK
C. Crane
Affiliation:
CAMEO, Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
I. Macmillan
Affiliation:
Norfolk Early Intervention Service, Norfolk and Waveney Mental Health NHS Foundation Trust, UK
M. Mugford
Affiliation:
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
T. Croudace
Affiliation:
Department of Psychiatry, University of Cambridge, Cambridge, UK
P. B. Jones
Affiliation:
CAMEO, Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, UK Department of Psychiatry, University of Cambridge, Cambridge, UK
*
*Address for correspondence: Professor D. Fowler, School of Medicine, Health Policy and Practice, Elizabeth Fry Building, University of East Anglia, Norwich NR4 7TJ, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This study reports on a preliminary evaluation of a cognitive behavioural intervention to improve social recovery among young people in the early stages of psychosis showing persistent signs of poor social functioning and unemployment. The study was a single-blind randomized controlled trial (RCT) with two arms, 35 participants receiving cognitive behaviour therapy (CBT) plus treatment as usual (TAU), and 42 participants receiving TAU alone. Participants were assessed at baseline and post-treatment.

Method

Seventy-seven participants were recruited from secondary mental health teams after presenting with a history of unemployment and poor social outcome. The cognitive behavioural intervention was delivered over a 9-month period with a mean of 12 sessions. The primary outcomes were weekly hours spent in constructive economic and structured activity. A range of secondary and tertiary outcomes were also assessed.

Results

Intention-to-treat analysis on the combined affective and non-affective psychosis sample showed no significant impact of treatment on primary or secondary outcomes. However, analysis of interactions by diagnostic subgroup was significant for secondary symptomatic outcomes on the Positive and Negative Syndrome Scale (PANSS) [F(1, 69)=3.99, p=0.05]. Subsequent exploratory analyses within diagnostic subgroups revealed clinically important and significant improvements in weekly hours in constructive and structured activity and PANSS scores among people with non-affective psychosis.

Conclusions

The primary study comparison provided no clear evidence for the benefit of CBT in a combined sample of patients. However, planned analyses with diagnostic subgroups showed important benefits for CBT among people with non-affective psychosis who have social recovery problems. These promising results need to be independently replicated in a larger, multi-centre RCT.

Keywords

Cognitive behaviour therapypsychosissocial recovery
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 10 , October 2009 , pp. 1627 - 1636
Copyright
Copyright © Cambridge University Press 2009

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

Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy for Depression. Guilford Press: New York.Google Scholar
Beck, AT, Steer, RA (1987). Beck Anxiety Inventory. The Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA (1988). Beck Hopelessness Scale Manual. The Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory-II. The Psychological Corporation: San Antonio, TX.Google Scholar
Beecham, J, Knapp, M (1992). Costing psychiatric interventions. In Measuring Mental Health Needs (ed. Thornicroft, G., Brewin, C. and Wing, J.), pp. 163–183. Gaskell: London.Google Scholar
Birchwood, M (2003). Pathways to emotional dysfunction in first episode psychosis. British Journal of Psychiatry 182, 373–375.CrossRefGoogle ScholarPubMed
Butler, G (1999). Overcoming Social Anxiety: A Self-Help Guide using Cognitive-Behavioural Techniques. Constable & Robinson: London.Google Scholar
Cannon, M, Jones, P, Gilvarry, C, Rifkin, L, McKenzie, K, Foerster, A, Murray, RM (1997). Premorbid social functioning in schizophrenia and bipolar disorder: similarities and differences. American Journal of Psychiatry 154, 1544–1550.Google ScholarPubMed
Carpenter, WT, Strauss, JS (1991). The prediction of outcome in schizophrenia. IV: Eleven-year follow-up of the Washington IPSS cohort. Journal of Nervous and Mental Disease 179, 517–525.CrossRefGoogle ScholarPubMed
Durham, RC, Guthrie, M, Morton, V, Reid, DA, Treliving, RL, Fowler, D, MacDonald, R (2003). Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. British Journal of Psychiatry 182, 303–311.CrossRefGoogle ScholarPubMed
Fowler, D, Freeman, D, Smith, B, Kuipers, E, Bebbington, P, Bashforth, H, Coker, S, Hodgekins, J, Gracie, A, Dunn, G, Garety, P (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine 36, 1–11.CrossRefGoogle ScholarPubMed
Fowler, D, Garety, PA, Kuipers, E (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Wiley: Chichester.Google Scholar
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google ScholarPubMed
Gumley, A, O'Grady, M, McNay, L, Reilly, J, Power, K, Norrie, J (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomised controlled trial of cognitive behavioural therapy. Psychological Medicine 33, 419–431.CrossRefGoogle ScholarPubMed
Harrison, G, Croudace, T, Mason, P, Glazebrook, C, Medley, I (1996). Predicting the long-term outcome of schizophrenia. Psychological Medicine 26, 697–705.CrossRefGoogle ScholarPubMed
Heinrichs, DW, Hanlon, TE, Carpenter, BN (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–398.CrossRefGoogle ScholarPubMed
Hogarty, GE, Goldberg, SC, Schooler, NR, Ulrich, RF (1974). Drug and sociotherapy in the aftercare of schizophrenic patients. II: Two-year relapse rates. Archives of General Psychiatry 31, 603–608.CrossRefGoogle ScholarPubMed
Hogarty, GE, Kornblith, SJ, Greenwald, P, DiBarry, AL, Cooley, S, Ulrich, RF, Carter, M, Flesher, S (1997). Three-year trials of personal therapy with schizophrenics living with or independent of family. I: Description of study and effects on relapse rates. American Journal of Psychiatry 154, 1504–1513.CrossRefGoogle ScholarPubMed
Jablensky, A, Sartorious, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelson, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 20, 1–97.CrossRefGoogle ScholarPubMed
Jarbin, H, Ott, Y, Von Knorring, AL (2003). Adult outcome of social function in adolescent-onset schizophrenia and affective psychosis. Journal of the American Academy of Child and Adolescent Psychiatry 42, 176–183.CrossRefGoogle ScholarPubMed
Johnstone, EC, Macmillan, JF, Frith, CD, Benn, DK, Crow, TJ (1990). Further investigation of the predictors of outcome following first schizophrenic episodes. British Journal of Psychiatry 157, 182–189.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Macmillan, I, Howells, L, Kale, K, Hackmann, C, Taylor, G, Hill, K, Bradford, S, Fowler, D (2007). Social and symptomatic outcomes of first-episode bipolar psychoses in an early intervention service. Early Intervention in Psychiatry 1, 79–87.CrossRefGoogle Scholar
Mueser, KT, Salyers, MP, Mueser, PR (2001). A prospective analysis of work in schizophrenia. Schizophrenia Bulletin 27, 281–296.CrossRefGoogle ScholarPubMed
Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, O'Carroll, M, Barnes, TR (2000). A randomised controlled trial of cognitive-behavioural therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry 57, 165–172.CrossRefGoogle ScholarPubMed
Short, S (2006). Review of the UK 2000 Time Use Survey. Office for National Statistics: London.Google Scholar
Slade, M, Phelan, M, Thornicroft, G, Parkman, S (1996). The Camberwell Assessment of Need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill. Social Psychiatry and Psychiatric Epidemiology 31, 109–113.CrossRefGoogle ScholarPubMed
Strauss, JS, Carpenter, WT (1977). Prediction of outcome in schizophrenia. III: Five year outcome and its predictors. Archives of General Psychiatry 34, 159–163.CrossRefGoogle ScholarPubMed
Tsai, SM, Chen, C, Kuo, C, Lee, J, Lee, H, Strakowski, SM (2001). 15 year outcome of treated bipolar affective disorder. Journal of Affective Disorders 63, 215–220.CrossRefGoogle Scholar
Turkington, D, Kingdon, D, Turner, T (2002). Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. British Journal of Psychiatry 180, 523–527.CrossRefGoogle ScholarPubMed
Werry, JS, McClellan, JM, Chard, L (1991). Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. Journal of the American Academy of Child and Adolescent Psychiatry 30, 457–446.CrossRefGoogle ScholarPubMed
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523–537.CrossRefGoogle ScholarPubMed