Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

Abstract

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis, Psychiatry Research, http://dx.doi.org/10.1016/j. psychres. 2014.02.012 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at one-year follow-up. The predictor x group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp + the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and one-year follow-up after controlling for pretreatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier.

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

“…Studying interpersonal elements of treatment, Lincoln et al 37 reported that lack of insight predicted drop out from cognitive behavior therapy in patients with psychosis. Poor insight was linked to poorer therapeutic alliance with a prescribing psychiatrist in schizophrenia and bipolar disorder.…”

Brief coping strategy enhancement for distressing voices: Predictors of engagement and outcome in routine clinical practice

“…Perivoliotis et al () examined CBTp dropout in a psychosis sample and found that higher levels of delusions at baseline—but not voices or insight—predicted a failure to move past the assessment phase, but none of these variables predicted dropout once therapy had commenced. Lincoln and colleagues () conducted a similar study and found that the strongest dropout predictors were a lack of insight and low social functioning (but not baseline symptom severity, comorbidity, neurocognitive defects, or reasoning biases).…”

Psychodynamic day treatment programme for patients with schizophrenia spectrum disorders: Dynamics and predictors of therapeutic change

“…Although the above-mentioned observed effects of the group psychotherapeutic programme seem to be promising, these programmes are feasible only for a limited proportion of patients with schizophrenia and therapists have to deal with significant dropouts (Lincoln et al, 2014;Simhandl & K€ onig, 2011). In this context, insufficient effort has as yet been devoted to research into which personal variables at a baseline of treatment would predict completion of the psychotherapeutic programme and which patients could better benefit from the programme.…”

“…In this context, insufficient effort has as yet been devoted to research into which personal variables at a baseline of treatment would predict completion of the psychotherapeutic programme and which patients could better benefit from the programme. For example, certain specific variables may play a role, such as being married (Kami nski & Lisiecka, 2002), female sex (Priebe et al, 2011), low number of previous hospitalizations (Mintz, O'Brien, & Luborsky, 1976), or shorter duration of the illness (Lincoln et al, 2014), which were found as good predictors. Also paid work was revealed as a good predictor of clinical improvement in several studies (Bond et al, 2001;Bryson, Lysaker, & Bell, 2002).…”

“…Also paid work was revealed as a good predictor of clinical improvement in several studies (Bond et al, 2001;Bryson, Lysaker, & Bell, 2002). Nevertheless, certain variables such as educational level of the patient (Kami nski & Lisiecka, 2002;Priebe et al, 2011) or psychotic symptoms (Kami nski & Lisiecka, 2002;Lincoln et al, 2014) seem to provide inconsistent results.…”