Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis

Jessica A. Hartmann; Patrick D. McGorry; Stefanie J. Schmidt; G. Paul Amminger; Hok Pan Yuen; Connie Markulev; Gregor E. Berger; Eric Y.H. Chen; Lieuwe De Haan; Ian B. Hickie; Suzie Lavoie; Meredith J. McHugh; Nilufar Mossaheb; Dorien H. Nieman; Merete Nordentoft; Anita Riecher-Rössler; Miriam R. Schäfer; Monika Schlögelhofer; Stefan Smesny; Andrew Thompson; Swapna Kamal Verma; Alison R. Yung; Barnaby Nelson

doi:10.1159/000477551

Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis

Jessica A. Hartmann, Patrick D. McGorry, Stefanie J. Schmidt, G. Paul Amminger, Hok Pan Yuen, Connie Markulev, Gregor E. Berger, Eric Y.H. Chen, Lieuwe De Haan, Ian B. Hickie, Suzie Lavoie, Meredith J. McHugh, Nilufar Mossaheb, Dorien H. Nieman, Merete Nordentoft, Anita Riecher-Rössler, Miriam R. Schäfer, Monika Schlögelhofer, Stefan Smesny, Andrew ThompsonSwapna Kamal Verma, Alison R. Yung, Barnaby Nelson

Department of Clinical Medicine

11 Citations (Scopus)

Abstract

Background: Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. Methods: A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. Results: In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. Conclusions: Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.

Original language	English
Journal	Psychotherapy and Psychosomatics
Volume	86
Issue number	5
Pages (from-to)	292-299
Number of pages	8
ISSN	0033-3190
DOIs	https://doi.org/10.1159/000477551
Publication status	Published - Oct 2017

Keywords

At-risk mental state
Case management
Cognitive-behavioural therapy
Early intervention
Ultra-high risk for psychosis

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10.1159/000477551

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Hartmann, J. A., McGorry, P. D., Schmidt, S. J., Amminger, G. P., Yuen, H. P., Markulev, C., Berger, G. E., Chen, E. Y. H., De Haan, L., Hickie, I. B., Lavoie, S., McHugh, M. J., Mossaheb, N., Nieman, D. H., Nordentoft, M., Riecher-Rössler, A., Schäfer, M. R., Schlögelhofer, M., Smesny, S., ... Nelson, B. (2017). Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis. Psychotherapy and Psychosomatics, 86(5), 292-299. https://doi.org/10.1159/000477551

Hartmann, JA, McGorry, PD, Schmidt, SJ, Amminger, GP, Yuen, HP, Markulev, C, Berger, GE, Chen, EYH, De Haan, L, Hickie, IB, Lavoie, S, McHugh, MJ, Mossaheb, N, Nieman, DH, Nordentoft, M, Riecher-Rössler, A, Schäfer, MR, Schlögelhofer, M, Smesny, S, Thompson, A, Verma, SK, Yung, AR & Nelson, B 2017, 'Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis', Psychotherapy and Psychosomatics, vol. 86, no. 5, pp. 292-299. https://doi.org/10.1159/000477551

@article{012a8c8681cb49b5b9185d6b68e08ac8,

title = "Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis",

abstract = "Background: Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. Methods: A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. Results: In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. Conclusions: Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.",

keywords = "At-risk mental state, Case management, Cognitive-behavioural therapy, Early intervention, Ultra-high risk for psychosis",

author = "Hartmann, {Jessica A.} and McGorry, {Patrick D.} and Schmidt, {Stefanie J.} and Amminger, {G. Paul} and Yuen, {Hok Pan} and Connie Markulev and Berger, {Gregor E.} and Chen, {Eric Y.H.} and {De Haan}, Lieuwe and Hickie, {Ian B.} and Suzie Lavoie and McHugh, {Meredith J.} and Nilufar Mossaheb and Nieman, {Dorien H.} and Merete Nordentoft and Anita Riecher-R{\"o}ssler and Sch{\"a}fer, {Miriam R.} and Monika Schl{\"o}gelhofer and Stefan Smesny and Andrew Thompson and Verma, {Swapna Kamal} and Yung, {Alison R.} and Barnaby Nelson",

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month = oct,

doi = "10.1159/000477551",

language = "English",

volume = "86",

pages = "292--299",

journal = "Psychotherapy and Psychosomatics",

issn = "0033-3190",

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TY - JOUR

T1 - Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis

AU - Hartmann, Jessica A.

AU - McGorry, Patrick D.

AU - Schmidt, Stefanie J.

AU - Amminger, G. Paul

AU - Yuen, Hok Pan

AU - Markulev, Connie

AU - Berger, Gregor E.

AU - Chen, Eric Y.H.

AU - De Haan, Lieuwe

AU - Hickie, Ian B.

AU - Lavoie, Suzie

AU - McHugh, Meredith J.

AU - Mossaheb, Nilufar

AU - Nieman, Dorien H.

AU - Nordentoft, Merete

AU - Riecher-Rössler, Anita

AU - Schäfer, Miriam R.

AU - Schlögelhofer, Monika

AU - Smesny, Stefan

AU - Thompson, Andrew

AU - Verma, Swapna Kamal

AU - Yung, Alison R.

AU - Nelson, Barnaby

PY - 2017/10

Y1 - 2017/10

N2 - Background: Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. Methods: A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. Results: In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. Conclusions: Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.

AB - Background: Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. Methods: A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. Results: In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More therapeutic focus on APS predicted an overall increase in APS. Conclusions: Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on the length of time in treatment. CBCM may positively impact the severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation.

KW - At-risk mental state

KW - Case management

KW - Cognitive-behavioural therapy

KW - Early intervention

KW - Ultra-high risk for psychosis

U2 - 10.1159/000477551

DO - 10.1159/000477551

M3 - Journal article

C2 - 28903120

AN - SCOPUS:85029460631

SN - 0033-3190

VL - 86

SP - 292

EP - 299

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

IS - 5

ER -

Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis

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Keywords

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