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

Tania M Lincoln; Winfried Rief; Stefan Westermann; Michael Ziegler; Marie-Luise Kesting; Eva Heibach; Stephanie Mehl

doi:10.1016/j.psychres.2014.02.012

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

Psychiatry Res. 2014 May 15;216(2):198-205. doi: 10.1016/j.psychres.2014.02.012. Epub 2014 Feb 19.

Authors

Tania M Lincoln¹, Winfried Rief², Stefan Westermann³, Michael Ziegler⁴, Marie-Luise Kesting⁵, Eva Heibach⁶, Stephanie Mehl⁷

Affiliations

¹ Section for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Von-Melle Park 5, 20146 Hamburg, Germany. Electronic address: tania.lincoln@uni-hamburg.de.
² Section for Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps University Marburg, Germany.
³ Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland.
⁴ Vitos Haina Forensic Psychiatric Hospital, Haina, Germany.
⁵ Clinic Rabenstein, Rehabilitation Clinic for Othopedics, Internal Medicine and Psychosomatics, Nidda, Germany.
⁶ Section for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Von-Melle Park 5, 20146 Hamburg, Germany.
⁷ Department of Psychiatry, Faculty of Medicine, Philipps University Marburg, Germany.

PMID: 24602992
DOI: 10.1016/j.psychres.2014.02.012

Abstract

This study investigates the predictors of outcome in a secondary analysis of dropout and completer data from a randomized controlled effectiveness trial comparing CBTp to a wait-list group (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 1-year follow-up. The predictor×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 1-year follow-up after controlling for pre-treatment 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.

Keywords: Adherence; CBT; Dropout; Predictors; Psychosis; Schizophrenia.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Behavioral Therapy*
Comorbidity
Female
Forecasting
Humans
Male
Middle Aged
Patient Compliance / psychology
Patient Compliance / statistics & numerical data
Patient Dropouts / psychology*
Patient Dropouts / statistics & numerical data
Psychotic Disorders / psychology*
Psychotic Disorders / therapy*
Randomized Controlled Trials as Topic
Social Adjustment
Treatment Outcome
Waiting Lists
Young Adult