Predictors of Adherence to Cognitive-Behavioural Therapy in First-Episode Psychosis

Abstract

Treatment delay may decrease adherence with CBT in FEP patients. Reducing DUP and promoting insight early in the course of psychosis are likely to enhance adherence with CBT.

First-Episode Psychosis and Disengagement From Treatment: A Systematic Review

“…In a study investigating cannabis use as a risk factor for treatment dropout, participants were considered to have disengaged if they had dropped out of treatment for more than one month and were not receiving treatment elsewhere (16). Álvarez-Jiménez and others (17) investigated predictors of adherence to cognitive-behavioral therapy within an FEP program. Individuals who did not initiate the intervention, terminated against the therapists' advice, or did not complete 80% of the treatment protocol were considered nonadherent.…”

Assessing Suitability for Short-Term Cognitive-Behavioral Therapy in Psychiatric Outpatients with Psychosis

“…Findings concerning this question have been inconsistent. [6][7][8][9][10][11][12] There is also evidence suggesting that women with psychosis may benefit from CBT more than men, controlling for illness severity. 6,11 Psychological characteristics such as insight may be more helpful than demographic or clinical variables in evaluating if an individual is suitable for CBT.…”

“…6,11 Psychological characteristics such as insight may be more helpful than demographic or clinical variables in evaluating if an individual is suitable for CBT. Studies of CBT in acute and chronic psychosis indicate that greater insight is associated with improved outcomes, 7,10 treatment adherence, 12 and therapeutic alliance. 9,13,14 However, insight has also been found to predict medication adherence 15 and better outcomes for psychosis in general, 16,17 suggesting that insight may be a general prognostic factor in psychosis.…”

Determinants of adherence to treatment in first-episode psychosis: a comprehensive review

“…40 In a study by Alvarez-Jimenez et al, 39 negative symptoms did not predict nonadherence to individual CBT. It is possible that the greater attention provided by the therapist in an individual setting counteracted negative symptoms, which would explain these different results.…”

“…31,38 For CBT, patients who did not start treatment, left without therapist advice, or attended fewer than 80% of appointments were considered nonadherent. 39 Another study used attendance of five or fewer out of 12 CBT sessions as the cutoff point for nonadherence. 40 For medication adherence, subjective and objective measures were used.…”