Internet-based self-help for psychosis: Findings from a randomized controlled trial.

Abstract

Objective: Cognitive–behavioral therapy (CBT) for psychosis is recommended in many national guidelines, but dissemination into routine health care remains poor. This study tests whether an 8-week, CBT-oriented, Internet-based intervention (IBI) for people with psychosis is feasible, effective, and safe compared to care as usual. Method: A sample of 101 people diagnosed with schizophrenia-spectrum disorders (age: M = 40.0, SD = 9.60; sex: 58% female) was randomly assigned to either an IBI for psychosis or a wait-list control condition. The primary outcome was a composite score of the positive factor of the Positive and Negative Syndrome Scale, the Launay Slade Hallucination Scale, and the paranoia checklist (clinicaltrials.gov, NCT02974400). Results: The composite score of psychotic symptom severity decreased more in the IBI condition than in the wait-list condition, reflected in the significant interaction of Time × Condition, F(1, 87.28) = 4.04, p = .047, dbetween = 0.24, 95% CI [−0.15, 0.63]. In the combined sample of participants who received immediate or delayed access to the intervention, the outcome improved further during the 6-month follow up period with a significant main effect of time, F(1, 69.35) = 9.59, p = .003, d = −0.37, 95% CI [−0.66, −0.07]. Participants were satisfied with the intervention (89%), and many used the intervention as defined per protocol (52%; at least four completed modules). Adverse events were infrequent (4.9%). Conclusions: Internet-based, CBT-oriented interventions provide an add-on effect to care as usual and have the potential to narrow the psychological treatment gap in psychosis.

Sleep problems and worrying precede psychotic symptoms during an online intervention for psychosis

“…The absence of group differences regarding the course of composite precursors over time was unexpected given the intervention’s focus on improving these precursors. This null result was particularly surprising in the light of the intervention’s overall effectiveness in the reduction of positive symptoms of psychosis (Westermann et al, 2020). One might argue that the intervention’s effect on psychotic symptoms was hence independent of within‐participant improvements of precursor symptoms, which would partly contradict the rationale of the intervention.…”

“…The study is a registered (https://osf.io/gn8u5) secondary analysis of intermediate assessment data obtained from the EviBaS trial. For results of the main trial, see Westermann et al (2020). The EviBaS main trial is a pre-registered (NCT02974400, clinicaltrials.gov) multi-centre parallel-group assessor-blind randomized controlled trial with an allocation ratio of 1:1 evaluating the feasibility and efficacy of a CBT-based psychological online intervention (EviBaS) for people with psychosis.…”

“…Based on aforementioned studies, Westermann et al (2020) have developed a psychological online intervention (EviBaS) targeting not only psychotic symptoms but also potential precursors of psychosis in guided self‐help modules. The authors successfully evaluated EviBaS in a randomized controlled trial.…”

“…The authors successfully evaluated EviBaS in a randomized controlled trial. The intervention led to a significant reduction in a composite score of positive symptoms (Westermann et al, 2020). As EviBaS covers the treatment of a wide range of precursors, the aim of the present study was to investigate which of the addressed precursors would predict the course of positive symptoms during the intervention.…”

Cognitive Remediation Program for Family Caregivers in Schizophrenia (CIRCUS): Study of the Effectiveness of a Guided AND WEB-BASED Compensatory Cognitive Remediation: A Randomized Pilot Study

“…It is therefore advisable to take a greater interest in web-based psychological interventions. Concerning individuals with schizophrenia, web-based interventions exist including psycho-education [32], CBT [33] psychosocial interventions [34] and CBT for auditory hallucinations [35]. Moreover, interventions are developing for family caregivers of elderly individuals to offset declines in their health and wellbeing [36].…”