Cognitively oriented psychotherapy for early psychosis (COPE): A 1‐year follow‐up

Abstract

Objectives. Cognitively oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and at preventing or alleviating secondary morbidity in the wake of the first psychotic episode. Design.A total of 80 people participated in the initial trial and completed assessments on a range of outcome measures. Post-treatment assessment results from a non-randomized controlled trial of COPE have been previously reported. The present paper describes the results obtained from 51 patients who attended a followup assessment 1 year subsequent to the end-of-treatment assessment.Method. The 51 patients formed three groups: (1) those who were offered and accepted COPE; (2) those who were offered COPE but refused it, and continued to receive other services from the Early Psychosis Prevention and Intervention Centre (EPPIC) (refusal subjects); and (3) those who were offered neither COPE nor any other continuing treatment from EPPIC (control subjects).Results. At 1-year follow-up, there was only one significant difference and this was between the COPE and refusal groups on the Integration/Sealing Over (I/SO) measure (p = .008). End-of-treatment differences were mostly sustained over the 1-year follow-up period. When the complete sample of 80 was considered, there were no differences between the three groups in terms of hospital admissions, community episodes, or time taken to first in-patient re-admission.Conclusions. The study was weakened by the poor follow-up rates in the two control groups. This reduced power to detect differences between groups on the seven major measures. However, the relapse data gathered on the complete set of 80 patients were discouraging and suggest that the present formulation of COPE does not confer any advantage to those patients receiving the therapy over those not receiving the therapy.

Cognitive behaviour therapy for first episode psychosis: Good for nothing or fit for purpose?

“…However, they only did better than the refusers for adaptation to illness. At 1 year follow-up, the only difference that remained was the CBT group having significantly better adaptation to illness in comparison with refusers (Jackson et al, 2001). At 4 year follow-up, there were no significant differences between groups (Jackson et al, 2005).…”

Group CBT for Early Psychosis—Are There Still Benefits One Year Later?

“…This does not allow us to establish whether the changes we found were due to the intervention or to change over time that might be experienced by all with early psychosis. A high attrition rate has been reported in other studies, particularly in randomized controlled trials with early psychosis (Jackson et al, 2001). Individuals with early psychosis are documented to be hard to engage in psychiatric services, often leading chaotic and transient lifestyles, involving substance abuse and school, employment, and housing instability, making their participation in a RCT over 12 months even more diffi cult (Addington & Addington, 1998;Jackson et al, 2005;Spidel, Lecomte, & Leclerc, 2006).…”

Ethical Considerations of Screening and Early Intervention for Clinical High-Risk Psychosis

“…Although such psychotherapeutic techniques may not have the direct risks that are typically associated with pharmacological interventions (e.g., side effects), there is still the risk of wasting the time and money of persons engaging in these treatment opportunities. For example, in one study that looked at a cognitive therapy intervention, Cognitively Oriented Psychotherapy for Early Psychosis, no benefits were found in at-risk individuals compared to control persons after a 1-year follow-up (Jackson et al, 2001). However, in another study, individuals at clinical high risk for psychosis who received 6 months of cognitive therapy showed significantly lower rates of transition to full-threshold psychosis than controls (Morrison et al, 2004).…”