Cognitive Behavior Therapy for psychosis based Guided Self-help (CBTp-GSH) delivered by frontline mental health professionals: Results of a feasibility study

Abstract

Availability of Cognitive Behavior Therapy for psychosis (CBTp) is limited in spite of strong evidence base. The purpose of this study was to determine the feasibility of a CBTp based Guided Self-help (CBTp-GSH) in comparison to Treatment As Usual (TAU). The secondary outcomes were a reduction of symptoms of schizophrenia using Positive and Negative Symptom Scale (PANSS) & Disability (WHO DAS 2.0). A total of 33 adults with a DSM-IV diagnosis of schizophrenia was recruited from community mental health services in Kingston, ON, Canada, and randomly assigned to the 12-16week intervention with TAU (Treatment), or TAU alone (Control). End of therapy (16weeks) comparisons between the two groups were made on an Intention To Treat (ITT) basis. Post-intervention scores on measures of psychopathology were compared using Analysis of Covariance (ANCOVA) to adjust for baseline measurements. Recruitment proved feasible, retention rates were high and participants reported a high level of acceptability. There was significant "treatment group by outcome interaction" for Positive and Negative Symptoms, General Psychopathology, measures of disability, such that individuals who received the Treatment improved more than those in Control group. The results of this feasibility study indicate that CBTp based Guided Self-help is feasible and acceptable to the participants, and it can lead to improvement in psychopathology and the level of disability. Individuals in this study had a moderate degree of psychopathology and relatively low level of disability and, therefore, caution is warranted in applying these results to individuals with severe symptoms and with high levels of disability. An adequately powered randomized controlled trial of the intervention is warranted.

What Constitutes Sufficient Evidence for Case Formulation–Driven CBT for Psychosis? Cumulative Meta-analysis of the Effect on Hallucinations and Delusions

“…Examination of supplementary figure 3 suggested that the trial by Habib et al 47 was a significant outlier because its 95% CI did not overlap with that of the pooled effect size. The effect from one RCT by Naeem et al 49 was also identified as a potential outlier. We therefore assessed heterogeneity when excluding both outliers in an exploratory sensitivity analysis.…”

“…Post hoc investigation established that heterogeneity introduced to the hallucinations comparisons was largely attributable to 2 outliers, one of which adapted CBTp for application in other cultural settings, 47 while the other applied group-based self-help CBTp. 49 Similarly, another RCT of culturally adapted CBTp contributed to heterogeneity in the delusions comparisons. 58 Our earlier review conceptualized case formulation–driven CBTp RCTs as “apples” in comparison to “oranges”; a broader and more inclusive sample of RCTs applying CBTp principles in alternative style.…”

Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review

“…Naeem et al [ 32 ] contests that self-guided CBT (SG-CBT) can be used as an intervention with minimum direct contact. For patients in need of CBT who face obstacles hindering face-to-face attendance, a self-guided platform to access therapy holds many advantages.…”

Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings

“…62 Web-based interventions are yet another alternative to enhance patients' access to CBT for schizophrenia and there is evidence regarding its feasibility and preliminary efficacy. 63 More recently, Naeem et al 64 developed a feasibility study protocol using a self-guided CBT program: this is an intervention which is predominately designed to be conducted without contact with health professionals and which could provide a cheap, flexible and easy tool for CBT implementation. Although their sample included mainly patients with moderate symptomatology and low disability levels, the authors reported a high retention rate and acceptability as well as improved scores regarding disability and positive, negative and general psychopathology.…”