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Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation

Published online by Cambridge University Press:  16 July 2019

Andrea Pozza ,
Sandro Domenichetti  and
Davide Dèttore
Andrea Pozza*
Affiliation:
Department of Health Sciences, University of Florence, Florence, Italy
Sandro Domenichetti
Affiliation:
Adult Mental Health Unit, Azienda USL Toscana Centro, Borgo San Lorenzo, Florence, Italy
Davide Dèttore
Affiliation:
Department of Health Sciences, University of Florence, Florence, Italy
*
*Corresponding author. Email: [email protected]
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Abstract

Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.

Key learning aims

  1. (1) To understand CBT evidence and procedures for young individuals with ARMS.

  2. (2) To reflect on the current limitations in the literature on CBT for ARMS.

  3. (3) To understand the importance and clinical implications of assessing worry in ARMS.

  4. (4) To focus on changes in worry as an outcome after CBT for ARMS.

  5. (5) To reflect on future research directions on the role of worry in CBT for ARMS.

Keywords

cognitive behavioural therapyearly interventionpsychosisschizophreniaworryyoung people
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e36
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Further reading

Fresán, A, León-Ortiz, P, Robles-García, R, Azcárraga, M, Guizar, D, Reyes-Madrigal, F … & de la Fuente-Sandoval, C (2015). Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R). Journal of Psychiatric Research 61, 168–173.CrossRefGoogle Scholar
van der Gaag, M, Nieman, D, & Van den Berg, D (2013). CBT for Those at Risk of a First Episode Psychosis: Evidence-based Psychotherapy for People with an ‘At Risk Mental State’. New York, NY, USA: Routledge.CrossRefGoogle Scholar
van der Gaag, M, Smit, F, Bechdolf, A, French, P, Linszen, DH, Yung, AR, … & Cuijpers, P (2013b). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophrenia Research 149, 56–62.CrossRefGoogle ScholarPubMed
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, … & Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 39, 964–971.CrossRefGoogle ScholarPubMed

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