scholarly journals Brain connectivity changes occurring following cognitive behavioural therapy for psychosis predict long-term recovery

2017 ◽  
Vol 7 (1) ◽  
pp. e1001-e1001 ◽  
Author(s):  
L Mason ◽  
E Peters ◽  
S C Williams ◽  
V Kumari
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Affective Processing ◽  
Psychotic Symptoms ◽  
Long Term Outcomes ◽  
Functional Connections ◽  
Affective Symptoms ◽  
Cognitive Behavioural

Abstract Little is known about the psychobiological mechanisms of cognitive behavioural therapy for psychosis (CBTp) and which specific processes are key in predicting favourable long-term outcomes. Following theoretical models of psychosis, this proof-of-concept study investigated whether the long-term recovery path of CBTp completers can be predicted by the neural changes in threat-based social affective processing that occur during CBTp. We followed up 22 participants who had undergone a social affective processing task during functional magnetic resonance imaging along with self-report and clinician-administered symptom measures, before and after receiving CBTp. Monthly ratings of psychotic and affective symptoms were obtained retrospectively across 8 years since receiving CBTp, plus self-reported recovery at final follow-up. We investigated whether these long-term outcomes were predicted by CBTp-led changes in functional connections with dorsal prefrontal cortical and amygdala during the processing of threatening and prosocial facial affect. Although long-term psychotic symptoms were predicted by changes in prefrontal connections during prosocial facial affective processing, long-term affective symptoms were predicted by threat-related amygdalo-inferior parietal lobule connectivity. Greater increases in dorsolateral prefrontal cortex connectivity with amygdala following CBTp also predicted higher subjective ratings of recovery at long-term follow-up. These findings show that reorganisation occurring at the neural level following psychological therapy can predict the subsequent recovery path of people with psychosis across 8 years. This novel methodology shows promise for further studies with larger sample size, which are needed to better examine the sensitivity of psychobiological processes, in comparison to existing clinical measures, in predicting long-term outcomes.

scholarly journals Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication

2005 ◽  
Vol 186 (4) ◽  
pp. 324-330 ◽  
Author(s):  
Lucia R. Valmaggia ◽  
Mark van der Gaag ◽  
Nicholas Tarrier ◽  
Marieke Pijnenborg ◽  
Cees J. Slooff
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Controlled Study ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Cognitive Behavioural ◽  
Supportive Counselling ◽  
Treatment Refractory

BackgroundThere is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.AimsTo investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.MethodManualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.ResultsParticipants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.ConclusionsCognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

Long-term Effects of Cognitive-Behavioural Therapy and Lithium Therapy on Depression in the Elderly

1995 ◽  
Vol 167 (5) ◽  
pp. 653-658 ◽  
Author(s):  
K. C. M. Wilson ◽  
M. Scott ◽  
M. Abou-Saleh ◽  
R. Burns ◽  
J. R. M. Copeland
Keyword(s):  
Maintenance Therapy ◽  
Cognitive Behavioural Therapy ◽  
Rating Scale ◽  
Behavioural Therapy ◽  
Lithium Therapy ◽  
Controlled Study ◽  
Depression Severity ◽  
Cognitive Behavioural

BackgroundWe examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients.MethodThe study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy.ResultsReceiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy.ConclusionsCBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.

scholarly journals Long‐term benefits of digital cognitive behavioural therapy for insomnia: Follow‐up report from a randomized clinical trial

2020 ◽  
Vol 29 (4) ◽  
Author(s):  
Annemarie I. Luik ◽  
Antonia Marsden ◽  
Richard Emsley ◽  
Alasdair L. Henry ◽  
Richard Stott ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cognitive Behavioural

Treatment of Mixed Anxiety-Depression Disorder: Long-Term Outcome

2005 ◽  
Vol 34 (1) ◽  
pp. 95-101 ◽  
Author(s):  
Enrique Echeburúa ◽  
Karmele Salaberría ◽  
Paz de Corral ◽  
Raúl Cenea ◽  
Tomás Berasategui
Keyword(s):  
Drug Therapy ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Control Group ◽  
Standard Drug ◽  
Cognitive Behavioural ◽  
Anxiety Depression ◽  
Depression Disorder

The aim of this paper was to test the long-term contribution of cognitive-behavioural therapy to the treatment of mixed anxiety-depression disorder. Fifty-seven patients, selected according to DSM-IV diagnostic criteria, were assigned to: 1) cognitive-behavioural therapy; 2) combined therapy (drug and cognitive-behavioural therapy); or 3) a standard drug therapy control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 3-, 6- and 12 month follow-ups) was used. Most patients who were treated (71%) in experimental groups showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic modes. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of drug therapy by itself for this disorder. Finally, several topics that may contribute to future research in this field are discussed.

Durability of the effects of cognitive–behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up

1999 ◽  
Vol 174 (6) ◽  
pp. 500-504 ◽  
Author(s):  
Nicholas Tarrier ◽  
Anja Witttkowskj ◽  
Caroline Kinney ◽  
Eilis McCarthy ◽  
Juue Morris ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Psychotic Symptoms ◽  
Cognitive Behavioural ◽  
Supportive Counselling ◽  
One Year

BackgroundPersistent drug-resistant psychotic symptoms are a pervasive problem in the treatment of schizophrenia.AimsTo evaluate the durability of the treatment effects of cognitive–behavioural therapy for chronic schizophrenia one year after treatment termination.MethodA comparison of clinical outcomes was made at one-year follow-up from a randomised trial of cognitive–behavioural therapy, supportive counselling and routine care alone in the treatment of chronic schizophrenia.ResultsSeventy out of the 72 patients (97%) who completed treatment were assessed at follow-up. There were significant differences between the three groups when positive and negative symptoms were analysed by means of ANCOVAs. Between-group comparisons indicated significant differences between cognitive–behavioural therapy and routine care at follow-up for positive symptoms. There was a trend towards significance for both cognitive–behavioural therapy and supportive counselling to be superior to routine care alone on negative symptoms.ConclusionsAt 12-month follow-up the significant advantage of cognitive– behavioural therapy compared to routine care alone remained.

Long-term outcome of Internet-delivered cognitive–behavioural therapy for social phobia: A 30-month follow-up

2009 ◽  
Vol 47 (10) ◽  
pp. 848-850 ◽  
Author(s):  
Per Carlbring ◽  
Lise Bergman Nordgren ◽  
Tomas Furmark ◽  
Gerhard Andersson
Keyword(s):  
Social Phobia ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cognitive Behavioural

scholarly journals Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations

2019 ◽  
Vol 29 ◽  
Author(s):  
Paolo Fusar-Poli ◽  
Andrea De Micheli ◽  
Monica Chalambrides ◽  
Aoife Singh ◽  
Castagnini Augusto ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcomes ◽  
Cognitive Behavioural Therapy ◽  
Unmet Needs ◽  
Behavioural Therapy ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Poor Prognostic Factor ◽  
Cognitive Behavioural

Abstract Aims To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). Methods Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. Results One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. Conclusions BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.

scholarly journals Cognitive Behavioural Therapy for Nightmares for Patients with Persecutory Delusions (Nites): An Assessor-Blind, Pilot Randomized Controlled Trial

2019 ◽  
pp. 070674371984742 ◽  
Author(s):  
Bryony Sheaves ◽  
Emily A. Holmes ◽  
Stephanie Rek ◽  
Kathryn M. Taylor ◽  
Alecia Nickless ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Behavioural Therapy ◽  
Serious Adverse Events ◽  
Persecutory Delusions ◽  
Treatment As Usual ◽  
Cognitive Behavioural

Objective:Nightmares are relatively common in patients experiencing psychosis but rarely assessed or treated. Nightmares may maintain persecutory delusions by portraying fears in sensory-rich detail. We tested the potential benefits of imagery-focused cognitive behavioural therapy (CBT) for nightmares on nightmare severity and persecutory delusions.Method:This assessor-blind parallel-group pilot trial randomized 24 participants with nightmares and persecutory delusions to receive CBT for nightmares delivered over 4 weeks in addition to treatment as usual (TAU) or TAU alone. Assessments were at 0, 4 (end of treatment), and 8 weeks (follow-up). Feasibility outcomes assessed therapy uptake, techniques used, satisfaction, and attrition. The primary efficacy outcome assessed nightmare severity at week 4. Analyses were intention to treat, estimating treatment effect with 95% confidence intervals (CIs).Results:All participants offered CBT completed therapy (mean [SD], 4.8 [0.6] sessions) with high satisfaction, and 20 (83%) participants completed all assessments. Compared with TAU, CBT led to large improvements in nightmares (adjusted mean difference = −7.0; 95% CI, –12.6 to –1.3; d = –1.1) and insomnia (6.3; 95% CI, 2.6 to 10.0; d = 1.4) at week 4. Gains were maintained at follow-up. Suicidal ideation was not exacerbated by CBT but remained stable to follow-up, compared with TAU, which reduced at follow-up (6.8; 95% CI, 0.3 to 3.3; d = 0.7). CBT led to reductions in paranoia (–20.8; 95% CI, –43.2 to 1.7; d = –0.6), although CIs were wide. Three serious adverse events were deemed unrelated to participation (CBT = 2, TAU = 1).Conclusions:CBT for nightmares is feasible and may be efficacious for treating nightmares and comorbid insomnia for patients with persecutory delusions. It shows promise on paranoia but potentially not on suicidal ideation.

scholarly journals Cognitive–behavioural therapy for personal recovery of patients with schizophrenia: A systematic review and meta-analysis

2019 ◽  
Vol 32 (4) ◽  
pp. e100040
Author(s):  
Weiliang Wang ◽  
Yuqiu Zhou ◽  
Nannan Chai ◽  
Dongwei Liu
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Effect Size ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Effect Sizes ◽  
Fundamental Aspect ◽  
Long Term Effects ◽  
Personal Recovery ◽  
Cognitive Behavioural

BackgroundTo date, cognitive–behavioural therapy (CBT) trials have primarily focused on clinical recovery; however, personal recovery is actually the fundamental aspect of the recovery process. The aim of this study was to summarise and synthesise the existing evidence regarding the effectiveness of CBT for personal recovery in patients with schizophrenia.AimThis study aimed to determine the effectiveness of CBT for personal recovery in patients with schizophrenia.MethodsA systematic search of the literature in PsycINFO, PubMed, Cochrane (CENTRAL), Embase and Web of Science (SCI) was conducted to identify randomised controlled trials reporting the impact of CBT interventions on personal recovery in patients with schizophrenia. The estimated effect sizes of the main study outcomes were calculated to estimate the magnitude of the treatment effects of CBT on personal recovery. We also evaluated the CBT’s effect size at the end-of-treatment and long-term (follow-up) changes in some aspects of personal recovery.ResultsTwenty-five studies were included in the analysis. The effect of CBT on personal recovery was 2.27 (95% CI 0.10 to 4.45; I2=0%; p=0.04) at post-treatment and the long-term effect size was 2.62 (95% CI 0.51 to 4.47; I2=0%; p=0.02). During the post-treatment period, the pooled effect size of CBT was 0.01 (95% CI −0.12 to 0.15; I2=33.0%; p>0.05) for quality of life (QoL), 0.643 (95% CI 0.056 to 1.130; I2=30.8%; p<0.01) for psychological health-related QoL, −1.77 (95% CI −3.29 to −0.25; I2=40%; p=0.02) for hopelessness and 1.85 (95% CI 0.69 to 3.01; I2=41%; p<0.01) for self-esteem. We also summarised the effects of CBT on QoL (subscale scores not included in the evaluation of the pooled effect size), self-confidence and connectedness, and all results corresponded to positive effects. However, there was insufficient evidence regarding the long-term effects of CBT on personal recovery.ConclusionsCBT is an effective therapy with meaningful clinical effect sizes on personal recovery and some aspects of personal recovery of schizophrenia after treatment. However, the effect is relatively immediate and rapidly decreases as time progresses. Therefore, in the future, more studies should focus on the mechanism of CBT for personal recovery and the factors that influence the long-term effects of CBT.Trial registration numberCRD42018085643.

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