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Cognitive Behavioral Therapy for Psychosis (CBTp): Multicenter Randomized Clinical Trial on Specific Efficacy

39 Pages Posted: 3 Sep 2018

See all articles by Stefan Klingberg

Stefan Klingberg

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Andreas Wittorf

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Christoph Meisner

University of Tuebingen, Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biometry

Georg Wiedemann

Klinikum-Fulda gAG - Department of Psychiatry and Psychotherapy

Andreas Bechdolf

Vivantes Klinikum am Urban; University of Cologne, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Bernhard Mueller

University of Duisburg-Essen, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Michael Wagner

University of Bonn, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Stephanie Mehl

University of Marburg, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Birgit Conradt

University of Duesseldorf, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Jutta Herrlich

Goethe University Frankfurt - Department of Psychiatry and Psychotherapy

Gudrun Sartory

University of Wuppertal

Klaus Hesse

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Gerhard Buchkremer

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy

Wolfgang Wölwer

University of Duesseldorf, Faculty of Medicine, Department of Psychiatry and Psychotherapy

More...

Abstract

Background: Cognitive behavioral therapy for psychosis (CBTp) is a specific form of psychotherapy recommended in evidence-based treatment guidelines for patients with psychosis. However, it remains unclear whether CBTp is more efficacious than unspecific psychotherapies such as supportive therapy (ST).

Methods: This multicenter, single blind, randomized clinical trial used a parallel group design to compare CBTp and ST. In total, 330 patients with persistent positive symptoms were included. Participants received 20 sessions of CBTp or ST over a 9-month period. Therapy was provided in six outpatient clinics at university psychiatry departments. The primary endpoint was the severity of positive symptoms (Positive and Negative Syndrome Scale-positive) until post-treatment at 9 months after inclusion. Analysis was carried out by intention to treat with multilevel linear modeling.

Findings: There was a between group effect size of g=0·33 (0·11-0·55) in favor of CBTp for positive symptoms, with pre-post effect sizes of g=0·93 (0·70-1·15) for CBTp and g=0·62 (0·40-0·84) for ST. CBTp showed favorable effects for hallucinations and social functioning, but not for negative symptoms and readmission rates. Ratings of the therapeutic relationship, number of adverse events, and antipsychotic medication did not differ between the groups. Positive symptoms decreased in both groups until the 24 month follow-up, with a between group difference of g=0·09 (-0·23-0·39). Interpretation: CBTp is more efficacious than ST in patients with persistent positive symptoms. CBTp effects cannot be explained by therapeutic attention alone. This indicates CBTp has specific mechanisms of action, and further supports the unrestricted recommendation of CBTp for the treatment of psychosis.

Trial Registration Number: ISRCTN29242879

Funding Statement: The study was funded by the German ministry of education and research (grant no. 01GV0618). Declaration of Interests: All authors declare that there is no conflict of interest.

Ethics Approval Statement: The study protocol was reviewed without objections by the ethics committee of the coordinating study center and the local ethics committees of all participating centers. Patients were included in the study after written informed consent was obtained, which was assured by external monitoring.

Keywords: Schizophrenia, Psychosis, Positive Symptoms, CBTp, Cognitive Behavioral Therapy, Psychological Intervention, Randomized Clinical Trial, RCT

Suggested Citation

Klingberg, Stefan and Wittorf, Andreas and Meisner, Christoph and Wiedemann, Georg and Bechdolf, Andreas and Mueller, Bernhard and Wagner, Michael and Mehl, Stephanie and Conradt, Birgit and Herrlich, Jutta and Sartory, Gudrun and Hesse, Klaus and Buchkremer, Gerhard and Wölwer, Wolfgang, Cognitive Behavioral Therapy for Psychosis (CBTp): Multicenter Randomized Clinical Trial on Specific Efficacy (July 27, 2018). Available at SSRN: https://ssrn.com/abstract=3223118

Stefan Klingberg (Contact Author)

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Andreas Wittorf

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Christoph Meisner

University of Tuebingen, Faculty of Medicine, Institute for Clinical Epidemiology and Applied Biometry ( email )

Germany

Georg Wiedemann

Klinikum-Fulda gAG - Department of Psychiatry and Psychotherapy ( email )

Germany

Andreas Bechdolf

Vivantes Klinikum am Urban ( email )

Germany

University of Cologne, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Bernhard Mueller

University of Duisburg-Essen, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Michael Wagner

University of Bonn, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Stephanie Mehl

University of Marburg, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Birgit Conradt

University of Duesseldorf, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Jutta Herrlich

Goethe University Frankfurt - Department of Psychiatry and Psychotherapy ( email )

Germany

Gudrun Sartory

University of Wuppertal ( email )

Gaußstraße 20
42097 Wuppertal
Germany

Klaus Hesse

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Gerhard Buchkremer

University of Tuebingen, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

Wolfgang Wölwer

University of Duesseldorf, Faculty of Medicine, Department of Psychiatry and Psychotherapy ( email )

Germany

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