Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial

Mark van der Gaag, Dorien H. Nieman, Judith Rietdijk, Sara Dragt, Helga K. Ising, Rianne M. C. Klaassen, Maarten Koeter, Pim Cuijpers, Lex Wunderink, Don H. Linszen

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Background: Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive. Objective: A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT] for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help-seeking UHR subjects. Methods: A total of 201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months. Results: In the CBTuhr condition, 10 patients transitioned to psychosis compared with 22 in the TAU condition (chi(2) (1) = 5.575, P = .03). The number needed to treat (NNT) was 9 (95% confidence interval [CI]: 4.7-89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% Cl: 3.7-71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency (chi(2) (1) = 3.338, P = .06). Conclusions: Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis
Original languageEnglish
Pages (from-to)1180-1188
Number of pages9
JournalSchizophrenia Bulletin
Issue number6
Publication statusPublished - 2012

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