Cognitive–behavioural therapy in first-episode and early schizophrenia

Tarrier, Nicholas; Lewis, Shôn; Haddock, Gillian; Bentall, Richard P.; Drake, Richard; Kinderman, Peter; Kingdon, David; Siddle, Ronald; Everitt, Julie; Leadley, Karen; Benn, Andy; Grazebrook, Katy; Haley, C.; Akhtar, Shabbir; Davies, Linda; Palmer, Steve; Dunn, Graham

doi:10.1192/bjp.184.3.231

Cited by 232 publications

(148 citation statements)

References 28 publications

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“…Further details can be found elsewhere. 75,76 THERAPEUTIC PROCESS EVALUATION NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Case Studymentioning

confidence: 99%

“…75,76 Briefly, from an ITT analysis, there was no evidence of an effect on speed of recovery over the first 6 weeks of treatment. However, at the 18-month follow-up, both psychological treatment groups had a superior outcome in terms of symptoms (as measured using the PANSS) compared with the control group, although there was no effect on relapse rates.…”

Section: Case Studymentioning

confidence: 99%

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Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme

Dunn

Emsley

Liu

et al. 2015

Health Technol Assess

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BackgroundThe development of the capability and capacity to evaluate the outcomes of trials of complex interventions is a key priority of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC). The evaluation of complex treatment programmes for mental illness (e.g. cognitive–behavioural therapy for depression or psychosis) not only is a vital component of this research in its own right but also provides a well-established model for the evaluation of complex interventions in other clinical areas. In the context of efficacy and mechanism evaluation (EME) there is a particular need for robust methods for making valid causal inference in explanatory analyses of the mechanisms of treatment-induced change in clinical outcomes in randomised clinical trials.ObjectivesThe key objective was to produce statistical methods to enable trial investigators to make valid causal inferences about the mechanisms of treatment-induced change in these clinical outcomes. The primary objective of this report is to disseminate this methodology, aiming specifically at trial practitioners.MethodsThe three components of the research were (1) the extension of instrumental variable (IV) methods to latent growth curve models and growth mixture models for repeated-measures data; (2) the development of designs and regression methods for parallel trials; and (3) the evaluation of the sensitivity/robustness of findings to the assumptions necessary for model identifiability. We illustrate our methods with applications from psychological and psychosocial intervention trials, keeping the technical details to a minimum, leaving the reporting of the more theoretical and mathematically demanding results for publication in appropriate specialist journals.ResultsWe show how to estimate treatment effects and introduce methods for EME. We explain the use of IV methods and principal stratification to evaluate the role of putative treatment effect mediators and therapeutic process measures. These results are extended to the analysis of longitudinal data structures. We consider the design of EME trials. We focus on designs to create convincing IVs, bearing in mind assumptions needed to attain model identifiability. A key area of application that has become apparent during this work is the potential role of treatment moderators (predictive markers) in the evaluation of treatment effect mechanisms for personalised therapies (stratified medicine). We consider the role of targeted therapies and multiarm trials and the use of parallel trials to help elucidate the evaluation of mediators working in parallel.ConclusionsIn order to demonstrate both efficacy and mechanism, it is necessary to (1) demonstrate a treatment effect on the primary (clinical) outcome, (2) demonstrate a treatment effect on the putative mediator (mechanism) and (3) demonstrate a causal effect from the mediator to the outcome. Appropriate regression models should be applied for (3) or alternative IV procedures, which account for unmeasured confounding, provided that a valid instrument can be identified. Stratified medicine may provide a setting where such instruments can be designed into the trial. This work could be extended by considering improved trial designs, sample size considerations and measurement properties.FundingThe project presents independent research funded under the MRC–NIHR Methodology Research Programme (grant reference G0900678).

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“…Further details can be found elsewhere. 75,76 THERAPEUTIC PROCESS EVALUATION NIHR Journals Library www.journalslibrary.nihr.ac.uk…”

Section: Case Studymentioning

confidence: 99%

Section: Case Studymentioning

confidence: 99%

Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme

Dunn

Emsley

Liu

et al. 2015

Health Technol Assess

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“…K. Morrison 2009;A. P. Morrison et al 2011;Rathod et al 2008;Tarrier et al 2004). Certain psychosocial treatments, such as cognitive behaviour therapy (CBT) , have been shown to have a beneficial effect on positive and negative symptoms, mood, social functioning and social anxiety and is effective in reducing readmissions to hospital, duration of admission and symptom severity (Lysaker et al 2010), (Wykes et al 2008).…”

Section: Introductionmentioning

confidence: 99%

Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China

Guo

Wang

et al. 2014

Psychol. Med.

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“…They will also be asked to complete a simple service receipt schedule (based on our previous work with the SoCRATES trial 377 …”

Section: Phase 2 Follow-up Assessmentsmentioning

confidence: 99%

“…35 Thus, part of the recovery process involves the challenges of remaining optimistic and fulfilling full potential and well-being. While there is clearly a strong evidence base for CBTP, including much of our own work, [36][37][38][39][40][41] research indicates that CBTP does not significantly reduce suicide behaviour; 42 thus, the development of CBT for suicide prevention is a priority. There are also other limitations with respect to the delivery of CBTP mentioned above, so alternative modes of delivery need to be explored.…”

Section: Introductionmentioning

confidence: 99%

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Cognitive–behavioural therapy in first-episode and early schizophrenia

Abstract: Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction.

Cited by 232 publications

References 28 publications

Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme

Evaluation and validation of social and psychological markers in randomised trials of complex interventions in mental health: a methodological research programme

Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

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