Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: Analysis of the EDIE-2 trial

Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. P...

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Bibliographic Details
Published in:British journal of psychiatry 2015-08, Vol.207 (2), p.123-129
Main Authors: Flach, Clare, French, Paul, Dunn, Graham, Fowler, David, Gumley, Andrew I., Birchwood, Max, Stewart, Suzanne L. K., Morrison, Anthony P.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Behavior modification
Case formulation
Clinical trials
Cognition & reasoning
Cognitive ability
Cognitive Behavioral Therapy - methods
Cognitive models
Cognitive therapy
Fear & phobias
Female
Fidelity
Homework
Humans
Intervention
Male
Problem Solving
Psychiatry
Psychomotor Performance
Psychosis
Psychotherapy
Psychotic Disorders - prevention & control
Risk Factors
Schizophrenia
Treatment Outcome
Variables
Young Adult
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Summary:Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis. A significant decrease in the symptom score for case formulation (coefficient = -23, 95% CI -44 to -1.7, P = 0.036) and homework (coefficient = -0.26, 95% CI -0.51 to -0.001, P = 0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient = -0.23, 95% CI -0.47 to 0.005, P = 0.056). There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
ISSN:0007-1250
1472-1465
DOI:10.1192/bjp.bp.114.153320