Cognitive behavior therapy (CBT) delivered in routine clinical practice significantly improves depression in psychosis patients, with smaller improvements for emotional and cognitive variables, the results of a UK study indicate.

CBT for psychosis reduces symptoms, particularly in medication-resistant patients, leading to recommendations that the treatment be used as an adjunct to medication in all psychosis patients. However, it may be more important to assess distress and disability, as opposed to symptoms, as the primary outcome of CBT in psychosis.

Emmanuelle Peters, from King’s College London, and colleagues therefore randomly assigned 74 psychosis outpatients to a treatment as usual (TAU) waiting list control group or immediate CBT for psychosis provided by non-expert clinicians.

The treatment group received 6 months of therapy and were followed up 3 months later. TAU patients underwent CBT after 9 months, becoming a delayed therapy TAU group.

While Positive and Negative Symptom Scale (PANSS) positive scores reduced significantly after delayed therapy versus the waiting list period, at an average of 2.8 points, CBT did not have a significant effect in the immediate therapy group.

Negative scores on the PANSS did not improve significantly with treatment, although a significant 2.0-point difference between the combined immediate and delayed treatment group and the control waiting list group at followup.

The combined therapy group had a significant 3.1-point reduction in PANSS general scores compared with the waiting list group at the end of therapy, as well as significant reductions in depression and anxiety scores (2.8 and 3.2 points, respectively), and in the likelihood of being suicidal, at an odds ratio of 0.009. However, depression was the only variable to remain significantly reduced in the combined therapy group at the final followup.

In terms of social and cognitive functioning, there were significant improvements on the Hayling test for the delayed therapy group versus the waiting list group at both the end of therapy and followup, but not for the immediate therapy group. Social and Occupational Functioning Assessment Scale scores improved significantly in the combined therapy group compared with the waiting list group at the end of therapy.

On the Beliefs About Voices Questionnaire–Revised, there was a significant reduction in the omnipotence variable with combined therapy versus the waiting list group at the end of followup, while resistance scores reduced significantly by the end of therapy.

Immediate therapy led to significant reductions in negative beliefs about the controllability of thoughts compared with the waiting list group at both time points. There were no significant differences between treatment and waiting list groups in terms of self-esteem, insight, and the number of days spent in hospital, the team reports in the journal Acta Psychiatrica Scandinavica.

They conclude: “The results showed that the only robust and enduring improvements in a trial of CBT for psychosis carried out by non-expert therapists were in depression.”

Source: Medwire News