Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

TY - JOUR

T1 - Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

AU - Lincoln, Tania M

AU - Rief, Winfried

AU - Westermann, Stefan

AU - Ziegler, Michael

AU - Kesting, Marie-Luise

AU - Heibach, Eva

AU - Mehl, Stephanie

N1 - Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

PY - 2014/5/15

Y1 - 2014/5/15

N2 - This study investigates the predictors of outcome in a secondary analysis of dropout and completer data from a randomized controlled effectiveness trial comparing CBTp to a wait-list group (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at 1-year follow-up. The predictor×group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp+the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and 1-year follow-up after controlling for pre-treatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier.

AB - This study investigates the predictors of outcome in a secondary analysis of dropout and completer data from a randomized controlled effectiveness trial comparing CBTp to a wait-list group (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at 1-year follow-up. The predictor×group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp+the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and 1-year follow-up after controlling for pre-treatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier.

KW - Adult

KW - Cognitive Behavioral Therapy

KW - Comorbidity

KW - Female

KW - Forecasting

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Compliance/psychology

KW - Patient Dropouts/psychology

KW - Psychotic Disorders/psychology

KW - Randomized Controlled Trials as Topic

KW - Social Adjustment

KW - Treatment Outcome

KW - Waiting Lists

KW - Young Adult

U2 - 10.1016/j.psychres.2014.02.012

DO - 10.1016/j.psychres.2014.02.012

M3 - SCORING: Journal article

C2 - 24602992

VL - 216

SP - 198

EP - 205

JO - PSYCHIAT RES

JF - PSYCHIAT RES

SN - 0165-1781

IS - 2

ER -