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

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• 作者：Tania M. Lincoln^a ; ^{tania.lincoln@uni-hamburg.de" class="auth_mail} ; Winfried Rief^b ; Stefan Westermann^c ; Michael Ziegler^d ; Marie-Luise Kesting^e ; Eva Heibach^a ; Stephanie Mehl^f
• 关键词：Predictors ; Schizophrenia ; Psychosis ; CBT ; Dropout ; Adherence
• 刊名：Psychiatry Research
• 出版年：15 May, 2014
• 年：2014
• 卷：216
• 期：2
• 页码：198-205
• 全文大小：383 K

文摘

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 (). 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脳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.