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London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis

II: Predictors of outcome

Published online by Cambridge University Press:  03 January 2018

Philippa Garety ,
David Fowler ,
Elizabeth Kuipers ,
Daniel Freeman ,
Graham Dunn ,
Paul Bebbington ,
Clare Hadley  and
Steven Jones
Philippa Garety*
Affiliation:
United Medical and Dental School, London
David Fowler
Affiliation:
School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
Elizabeth Kuipers
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Daniel Freeman
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Graham Dunn
Affiliation:
School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester MI3 9PT
Paul Bebbington
Affiliation:
Department of Social and Community Psychiatry, University College London, Archway Wing 1st Floor, Whittington Hospital, Highgate Hill, London N19 5NF
Clare Hadley
Affiliation:
Department of Clinical Psychology, Leeds University, 15 Hyde Terrace, Leeds LS2 9LT
Steven Jones
Affiliation:
United Medical and Dental, Department of Clinical Psychology, Rochdale Healthcare NHS Trust, Birch Hill Hospital, Rochdale OL12 9QB, UK
*
Professor Philippa Garety, United Medical and Dental School, Department of Psychology, St Thomas' Hospital, London SE1 7EH
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Abstract

Background

Despite growing evidence of the effectiveness of cognitive–behavioural therapy (CBT) for psychosis, typically only about 50% of patients show a positive response to treatment. This paper reports the first comprehensive investigation of factors which predict treatment outcome.

Method

In a randomised controlled trial of CBT for medication-resistant psychosis (see Part I) measures were taken at baseline of demographic, clinical and cognitive variables. Changes over time were assessed on the Brief Psychiatric Rating Scale and the relationship between potential predictor variables and outcome was investigated using analysis of variance and covariance.

Results

A number of baseline variables were identified as predictors of good outcome in the CBT group. Key predictors were a response indicating cognitive flexibility concerning delusions (P=0.005) and the number of recent admissions (P=0.002). Outcome was less predictable in the control group and was not predicted by any cognitive variable.

Conclusions

Good outcome is strongly predicted in patients with persistent delusions by a cognitive measure, while this was not the case in controls. Thus we argue that positive outcome in CBT is due in part to specific effects on delusional thinking.

Type
Papers
Information
The British Journal of Psychiatry , Volume 171 , Issue 5 , November 1997 , pp. 420 - 426
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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Footnotes

†

Part 1, ‘Effects of the treatment phase’, published in October 1997 (171, 319–327).

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