Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial

M. van der Gaag, D.H. Nieman, J. Rietdijk, S. Dragt, H.K. Ising, R.M.C. Klaassen, M.W.J. Koeter, P. Cuijpers, L. Wunderink, D.H. Linszen

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Abstract

Background: Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive. Objective: A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT] for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help-seeking UHR subjects. Methods: A total of 201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months. Results: In the CBTuhr condition, 10 patients transitioned to psychosis compared with 22 in the TAU condition (χ (1) 5.575, P . 03). The number needed to treat (NNT) was 9 (95% confidence interval [CI]: 4.7-89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% CI: 3.7-71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency (χ (1) 3.338, P . 06). Conclusions: Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis. © The Author 2012.
Original languageEnglish
Pages (from-to)1180-1188
Number of pages9
JournalSchizophrenia Bulletin
Volume38
Issue number6
DOIs
Publication statusPublished - 2012

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    van der Gaag, M., Nieman, D. H., Rietdijk, J., Dragt, S., Ising, H. K., Klaassen, R. M. C., Koeter, M. W. J., Cuijpers, P., Wunderink, L., & Linszen, D. H. (2012). Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial. Schizophrenia Bulletin, 38(6), 1180-1188. https://doi.org/10.1093/schbul/sbs105