Study explores mechanisms of psychotherapy in individuals at very high risk of psychosis

In the current issue of Psychotherapy and Psychosomatics a study explores the mechanisms of psychotherapy in subjects at very high risk of psychosis. Cognitive-behavioral therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome.

In this study, a sample of 268 UHR participants received 6 months of CBT with case management in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms. Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of attenuated psychotic symptoms were investigated.

In the first month, a higher number of sessions and more assessment of symptoms predicted an increase in attenuated psychotic symptoms, while after 3 months, a higher number of sessions and more monitoring predicted a decrease in the level of attenuated psychotic symptoms. More therapeutic focus on attenuated psychotic symptoms predicted an overall increase in attenuated psychotic symptoms.

Findings indicate that the association between intensity/content of CBT with case management and severity of attenuated psychotic symptoms in a sample of ultra high risk participants depends on the length of time in treatment. CBT with case management may positively impact the severity of attenuated psychotic symptoms later in the course of treatment. Therefore, it would seem important to keep ultra high risk young people engaged in treatment beyond this initial period. Regarding the specific content of CBT with case management, a therapeutic focus on attenuated psychotic symptoms may not necessarily be beneficial in reducing the severity of attenuated psychotic symptoms, a possibility in need of further investigation.