Pharmacological and psychological intervention combined are proved to be more effective for treating psychosis than pharmacological treatment alone. Cognitive Behavioural Therapy has been empirically supported as conjoint treatment providing significant improvement in positive and negatives symptoms, and functional outcomes for psychosis. However, rates of patient’s discontinuation in CBTp and ocasional lack of improvement in symptom shows it is important to refine the identification of the individual characteristics related to better response to CBTp.
Twenty studies (15 randomized controlled trials, 5 uncontrolled trials) were considered to determine which characteristics are relevant for a distinctive response to CBTp in people with schizophrenia and other psychotic disorders.
Studies have shown divergences in methodology, focus on different domains and time-points of disease outcome and great heterogeneity in results. While one study pointed out impairment in verbal memory as related to shortage of improvement in symptoms and a greater likelihood to abandon of treatment before completion, the majority of studies did not find neurocognitive functioning to be a predictor of outcome in CBTp. More consistent agreements are related to cognitive flexibility, insight, and clinical awareness. There is strong evidence that great positive symptom severity and less pronounced negative symptoms at baseline, shorter duration of illness, a greater number of hospitalization in the previous five years and pre-therapy coping style can predict better outcome in CBTp, although their significance has varied between studies.
Further study is needed to determine the extent and validity of these predictors in different populations within the scope of psychosis. Nevertheless, professionals can benefit from the gathered knowledge, using these findings to better target CBTp and to focus early stages of intervention on developing patient’s abilities such as cognitive flexibility, working memory, coping skills and clinical awareness in order to improve their receptiveness to treatment.
Key words: CBT; predictors; outcomes; psychosis; schizophrenia.
Individual cognitive behavioural therapies and related approaches , Influencing research
