A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis: The detection and evaluation of psychological therapy (DEPTh) trial

Helen J Stain; Sandra Bucci; Amanda L Baker; Vaughan Carr; Richard Emsley; Sean Halpin; Terry Lewin; Ulrich Schall; Vanessa Clarke; Kylie Crittenden; Mike Startup

doi:10.1016/j.schres.2016.08.008

A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis: The detection and evaluation of psychological therapy (DEPTh) trial

Schizophr Res. 2016 Oct;176(2-3):212-219. doi: 10.1016/j.schres.2016.08.008. Epub 2016 Aug 20.

Authors

Affiliations

¹ School of Medicine, Pharmacy and Health, Durham University, UK. Electronic address: helen.stain@durham.ac.uk.
² School of Psychological Sciences, University of Manchester, UK.
³ School of Medicine and Public Health, University of Newcastle, NSW, Australia.
⁴ School of Psychiatry, University of New South Wales, NSW, Australia; Schizophrenia Research Institute, NSW, Australia; Department of Psychiatry, Monash University, Vic, Australia.
⁵ Institute of Population Health, University of Manchester, UK.
⁶ School of Psychology, University of Newcastle, NSW, Australia.
⁷ Schizophrenia Research Institute, NSW, Australia; Priority Centre for Translational Neuroscience & Mental Health Research, University of Newcastle, NSW, Australia; Hunter Medical Research Institute, NSW, Australia.
⁸ Western New South Wales Local Health District, NSW, Australia.

PMID: 27554197
DOI: 10.1016/j.schres.2016.08.008

Abstract

Background: Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred.

Method: This was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6month treatment phase and 12months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points.

Results: Fifty-seven young people (mean age=16.5years) were randomised to CBT (n=30) or NDRL (n=27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2months, 5months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect=36.71, standard error=16.84, p=0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning.

Conclusion: Our sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention.

Trial registration: ANZCTR 12606000101583.

Keywords: At risk mental state; Intervention; Psychosis; Ultra high risk; Youth.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Auditory Perception
Cognitive Behavioral Therapy*
Female
Follow-Up Studies
Humans
Male
Patient Selection
Psychotic Disorders / psychology
Psychotic Disorders / therapy*
Quality of Life
Risk
Single-Blind Method
Social Behavior
Treatment Outcome

Associated data

ANZCTR/ACTRN12606000101583