Treating Delusional Disorder: A Comparison of Cognitive-Behavioural Therapy and Attention Placebo Control

Abstract

Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). Results: Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs.

Co-ingestion of carbohydrate with branched-chain amino acids or l-leucine does not preferentially increase serum IGF-1 and expression of myogenic-related genes in response to a single bout of resistance exercise

“…The index of effect size utilized was partial Eta squared (η2), which estimates the proportion of variance in the dependent variable that can be explained by the independent variable. Partial Eta squared effects sizes were determined to be: weak = 0.17, medium = 0.24, strong = 0.51, very strong => 0.70 as previously described by (O'Connor et al, 2007). In addition, for all statistical analyses not meeting the sphericity assumption for the withinsubjects analyses, a Greenhouse-Geisser correction factor was applied to the degrees of freedom in order to increase the critical F-value to a level that would prevent the likelihood of committing a type I error.…”

Cognitive and Meta-cognitive Dimensions of Psychoses

“…For example, degree of conviction varies not only across people with delusions but also across time and moods within people. 29 The presence of OVI is generally indicated by a strong intellectual investment in a fixed idea not shared by others, where the content of the idea is bizarre (that is, not arising from everyday life experiences). The treatment resistance of people with OVI to behavioural treatments was noted early on in clinical trials 30,31 and still poses problems.…”

Le rôle du raisonnement inductif dans le trouble délirant

“…Néanmoins, les thérapies cognitives comme le MEC ne ciblent pas spécifiquement l'intrusion comme une croyance capitale, malgré qu'il y ait de plus en plus de preuves qu'une partie des troubles obsessionnels caractérisés par des idées surévaluées puissent partager davantage de caractéristiques avec des troubles schizotypiques et des croyances délirantes, qu'avec un trouble d'anxiété à proprement dit. De plus, l'intensité de la conviction des croyances obsessionnelles peut être fortement liée à des comportements cliniques tel que d'éprouver de la difficulté à résister aux rituels (Grenier et al, 2006b). Pour cette raison, une autre forme de thérapie cognitive nommée « Approche basée sur les inférences » (ABI) (traduction libre de « Inference Based Approach » (IBA) : O'Connor et al, 2005) conçoit la pensée intrusive initiale dans le TOC comme une inférence obsessionnelle (arrivant sous forme de doute).…”

“…De manière générale, les recherches cliniques ont établi que l'approche TCC est efficace lorsque les participants sont comparés à un groupe contrôle en attente de thérapie ou à des patients non traités. Par contre, la taille d'effet diminue considérablement si la TCC est comparée à d'autres formes actives de traitement (O'Connor et al, 2006b, sous presse), le taux de refus de traitement demeurant élevé.…”