The long-term effectiveness of cognitive behavior therapy for psychosis within a routine psychological therapies service

Abstract

Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have considered its long-term effectiveness in routine services. This study reports the outcomes of clients seen in a psychological therapies clinic, set up following positive results obtained from an RCT (Peters et al., 2010). The aims were to evaluate the effectiveness of CBTp, using data from the service’s routine assessments for consecutive referrals over a 12 years period, and assess whether gains were maintained at a 6+ months’ follow-up. Of the 476 consenting referrals, all clients (N = 358) who received ≥5 therapy sessions were offered an assessment at four time points (baseline, pre-, mid-, and end of therapy) on measures assessing current psychosis symptoms, emotional problems, general well-being and life satisfaction. A sub-set (N = 113) was assessed at a median of 12 months after finishing therapy. Following the waiting list (median of 3 months) clients received individualized, formulation-based CBTp for a median number of 19 sessions from 121 therapists with a range of experience receiving regular supervision. Clients showed no meaningful change on any measure while on the waiting list (Cohen’s d <= 0.23). In contrast, highly significant improvements following therapy, all of which were significantly greater than changes during the waiting list, were found on all domains assessed (Cohen’s d: 0.44–0.75). All gains were maintained at follow-up (Cohen’s d: 0.29–0.82), with little change between end of therapy and follow-up (Cohen’s d <= 0.18). Drop-out rate from therapy was low (13%). These results demonstrate the positive and potentially enduring impact of psychological therapy on a range of meaningful outcomes for clients with psychosis. The follow-up assessments were conducted on only a sub-set, which may not generalize to the full sample. Nevertheless this study is the largest of its kind in psychosis, and has important implications for the practice of CBTp in clinical services.

Integrated Trauma-Focused Cognitive-Behavioural Therapy for Post-traumatic Stress and Psychotic Symptoms: A Case-Series Study Using Imaginal Reprocessing Strategies

“…Participants were assessed at five different time points on all measures as part of the routine outcome assessments for the clinic (50): Baseline—when first referred to the service, before going on the waiting list.Pre-therapy – just before starting therapy after having been on the waiting list for a median of 3 months after the baseline assessment (range 0–5 months).Mid-therapy—median of 5 months into therapy (range 2–7 months).Post-therapy—median of 22 months after starting therapy (range 8–35 months); assessments were carried out within a few days or weeks of finishing therapy (range 0–58 days; median = 7 days).Follow-up—median of 9 months after finishing therapy (range 5–18 months).…”

Experiences of outcome monitoring in service users with psychosis: Findings from an Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT‐SMI) demonstration site

“…Feared iatrogenic consequences of outcome monitoring include the impact on the therapeutic relationship and burden of measure completion for service users (Wolpert, ). For people with psychosis in particular, the selection of routine outcome measures (ROMs) warrants careful attention (Peters et al ., ), given well‐reported difficulties engaging this client group (Garety & Rigg, ) and the potential mismatch between service user and therapist‐defined outcomes (Shepherd, ).…”

Service user satisfaction with cognitive behavioural therapy for psychosis: Associations with therapy outcomes and perceptions of the therapist

“… Due to time constraints on the service individuals who attend fewer than five sessions are not followed up for assessment, however, service users who drop‐out after having engaged in therapy (i.e., ≥5 sessions) are treated as therapy completers and invited for all follow‐up assessments; see Peters et al . (). …”