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

Flach, C., French, P., Dunn, G., Fowler, D., Gumley, A.I. , Birchwood, M., Stewart, S.L.K. and Morrison, A.P. (2015) Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: analysis of the EDIE-2 trial. British Journal of Psychiatry, 207(2), pp. 123-129. (doi:10.1192/bjp.bp.114.153320) (PMID:25999337)

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Abstract

Background: 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. Method: 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. Results: 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). Conclusions: 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Gumley, Professor Andrew
Authors: Flach, C., French, P., Dunn, G., Fowler, D., Gumley, A.I., Birchwood, M., Stewart, S.L.K., and Morrison, A.P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:British Journal of Psychiatry
Publisher:Royal College of Psychiatrists
ISSN:0007-1250
ISSN (Online):1472-1465

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
423761Early detection and psychological intervention for individuals at high risk of psychosisAndrew GumleyMedical Research Council (MRC)G0500264/73571IHW - MENTAL HEALTH & WELLBEING