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Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project

Published online by Cambridge University Press:  16 November 2007

H. J. Jackson ,
P. D. McGorry ,
E. Killackey ,
S. Bendall ,
K. Allott ,
P. Dudgeon ,
J. Gleeson ,
T. Johnson  and
S. Harrigan
H. J. Jackson*
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
P. D. McGorry
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
E. Killackey
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
S. Bendall
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
K. Allott
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
P. Dudgeon
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
J. Gleeson
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
T. Johnson
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
S. Harrigan
Affiliation:
Departments of Psychology and Psychiatry, University of Melbourne and ORYGEN Research Centre, Parkville, Australia
*
*Address for correspondence: Dr H. J. Jackson, Department of Psychology, 12th Floor, Redmond Barry Building, University of Melbourne, Parkville, 3052, VIC, Australia. (Email: henryjj@unimelb.edu.au)
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Abstract

Background

The ACE project involved 62 participants with a first episode of psychosis randomly assigned to either a cognitive behaviour therapy (CBT) intervention known as Active Cognitive Therapy for Early Psychosis (ACE) or a control condition known as Befriending. The study hypotheses were that: (1) treating participants with ACE in the acute phase would lead to faster reductions in positive and negative symptoms and more rapid improvement in functioning than Befriending; (2) these improvements in symptoms and functioning would be sustained at a 1-year follow-up; and (3) ACE would lead to fewer hospitalizations than Befriending as assessed at the 1-year follow-up.

Method

Two therapists treated the participants across both conditions. Participants could not receive any more than 20 sessions within 14 weeks. Participants were assessed by independent raters on four primary outcome measures of symptoms and functioning: at pretreatment, the middle of treatment, the end of treatment and at 1-year follow-up. An independent pair of raters assessed treatment integrity.

Results

Both groups improved significantly over time. ACE significantly outperformed Befriending by improving functioning at mid-treatment, but it did not improve positive or negative symptoms. Past the mid-treatment assessment, Befriending caught up with the ACE group and there were no significant differences in any outcome measure and in hospital admissions at follow-up.

Conclusions

There is some preliminary evidence that ACE promotes better early recovery in functioning and this finding needs to be replicated in other independent research centres with larger samples.

Keywords

ACEacute treatment phaseBefriendingCBTfirst-episode psychosisrandomized controlled treatmentsrecoveryschizophrenia

Information

Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 5 , May 2008 , pp. 725 - 735
Copyright
Copyright © Cambridge University Press 2007

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References

Andreasen, NC (1984). Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Bendall, S, Jackson, HJ, Killackey, E, Allott, K, Johnson, T, Harrigan, S, Gleeson, J, McGorry, PD (2006). The credibility and acceptability of befriending as a control therapy in a randomised controlled trial of cognitive behaviour therapy for acute first episode psychosis. Behavioural and Cognitive Psychotherapy 34, 277–291.CrossRefGoogle Scholar
Bendall, S, Killackey, E, Jackson, H, Gleeson, J (2003). Befriending Manual. ORYGEN Research Centre and Department of Psychology, University of Melbourne: Melbourne.Google Scholar
Bendall, S, Killackey, E, Marois, MJ, Jackson, H (2005). ACE Manual (Active Cognitive Therapy for Early Psychosis). ORYGEN Research Centre and Department of Psychology, University of Melbourne: Melbourne.Google Scholar
Bird, KD (2004). Analysis of Variance via Confidence Intervals. Sage Publications: London.CrossRefGoogle Scholar
Bird, KD, Hadzi-Pavlovic, D, Isaac, AP (2000). PSY Statistical Program. School of Psychology, University of New South Wales: Sydney, Australia (www.psy.unsw.edu.au/research/PSY.htm).Google Scholar
Chadwick, PJ, Birchwood, M, Trower, P (1996). Cognitive Therapy for Delusions, Voices and Paranoia. Wiley: Chichester, UK.Google Scholar
Drury, V, Birchwood, M, Cochrane, R (2000). Cognitive therapy and recovery from acute psychosis: a controlled trial. 3. Five-year follow-up. British Journal of Psychiatry 177, 8–14.CrossRefGoogle ScholarPubMed
Drury, V, Birchwood, M, Cochrane, R, Macmillan, F (1996). Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on positive symptoms. British Journal of Psychiatry 169, 593–607.CrossRefGoogle Scholar
Edwards, J, McGorry, PD (2002). Implementing Early Intervention in Psychosis: A Guide to Establishing Early Psychosis Services. Martin Dunitz: London.CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2001). Structured Clinical Interview for DSM-IV-TR Axis 1 Disorders – Research Version, Patient Edition (SCID-I/P). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Fowler, D, Garety, P, Kuipers, E (1997). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Wiley: Chichester, UK.Google Scholar
Harrigan, SM, McGorry, PD, Krstev, H (2003). Does treatment delay in first-episode psychosis really matter? Psychological Medicine 33, 97–110.CrossRefGoogle ScholarPubMed
Henry, L, Edwards, J, Jackson, H, Hulbert, C, McGorry, P (2002). Cognitively Oriented Psychotherapy for Early Psychosis (COPE): A Practitioner's Manual. EPPIC: Melbourne.Google Scholar
Hermann-Doig, T, Maude, D, Edwards, J (2003). Systematic Treatment of Persistent Psychosis. Martin Dunitz: London.Google Scholar
Jackson, H, McGorry, P, Edwards, J, Hulbert, C, Henry, L, Harrigan, S, Dudgeon, P, Francey, S, Maude, D, Cocks, J, Killackey, E, Power, P (2005). A controlled trial of cognitively oriented psychotherapy for early psychosis (COPE) with four-year readmission data. Psychological Medicine 35, 1295–1306.CrossRefGoogle ScholarPubMed
Jackson, H, McGorry, P, Henry, L, Edwards, J, Hulbert, C, Harrigan, S, Dudgeon, P, Francey, S, Maude, D, Cocks, J, Power, P (2001). Cognitively-oriented psychotherapy for early psychosis: a 1-year follow-up. British Journal of Clinical Psychology 40, 57–70.CrossRefGoogle ScholarPubMed
Jackson, HJ, McGorry, PD, Edwards, J, Hulbert, C, Henry, L, Francey, S, Maude, D, Cocks, J, Power, P, Harrigan, S, Dudgeon, P (1998). Cognitively-oriented psychotherapy for early psychosis (COPE): preliminary results. British Journal of Psychiatry 172 (Suppl.), 93–100.CrossRefGoogle ScholarPubMed
Jolley, S, Garety, P, Craig, T, Dunn, G, White, J, Aitken, M (2003). Cognitive therapy in early psychosis: a pilot randomised trial. Behavioural and Cognitive Psychotherapy 31, 473–478.CrossRefGoogle Scholar
Kingdon, D, Turkington, D (1994). Cognitive-Behavioral Therapy of Schizophrenia. Guilford Press: New York.Google ScholarPubMed
Kuipers, L, Garety, P, Fowler, D, Dunn, G, Bebbington, P, Freeman, D, Hadley, C (1997). London-East Anglia randomised controlled trial of cognitive-behavioural therapy in psychosis. I: Effects of the treatment phase. British Journal of Psychiatry 171, 319–327.CrossRefGoogle ScholarPubMed
Lewis, S, Tarrier, N, Haddock, G, Bentall, R, Kinderman, P, Kingdon, D, Siddle, R, Drake, R, Everitt, J, Leadley, K, Benn, A, Grazebrook, K, Haley, C, Akhtar, S, Davies, L, Palmer, S, Faragher, B, Dunn, G (2002). Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. British Journal of Psychiatry 181 (Suppl. 43), s91–s97.CrossRefGoogle Scholar
McGorry, P, Killackey, E, Elkins, K, Lambert, M, Lambert, T (2003). Summary Australian and New Zealand clinical practice guidelines for the treatment of schizophrenia. Australasian Psychiatry 11, 137–147.CrossRefGoogle Scholar
McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305–326.CrossRefGoogle ScholarPubMed
McGraw, KE, Wong, SP (1996). Forming inferences about some intraclass correlation coefficients. Psychological Methods 1, 30–46.CrossRefGoogle Scholar
Moher, D, Schulz, KF, Altman, D, for the CONSORT Group (2001). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Journal of the American Medical Association 285, 1987–1991.CrossRefGoogle Scholar
Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Orbach, G, Morgan, C (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine 32, 763–782.CrossRefGoogle ScholarPubMed
R Development Core Team (2007). R: A Language and Environment for Statistical Computing (version 2.6.0). R Foundation for Statistical Computing: Vienna, Austria (http://www.R-project.org).Google Scholar
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley: New York.CrossRefGoogle Scholar
Schafer, JL (2001). Multiple imputation with PAN. In New Methods for the Analysis of Change (ed. Collins, L. M. and Sayer, A. G.), pp. 355–377. American Psychological Association: Washington, DC.Google Scholar
Schafer, JL, Graham, JW (2002). Missing data: our view of the state of the art. Psychological Methods 7, 147–177.CrossRefGoogle ScholarPubMed
Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, O'Carroll, M, Barnes, TRE (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry 57, 165–172.CrossRefGoogle ScholarPubMed
StataCorp (2005). Stata Statistical Software: Release 9. StataCorp LP: College Station, TX.Google Scholar
Tarrier, N, Lewis, S, Haddock, G, Bentall, R, Drake, R, Kinderman, P, Kingdon, D, Siddle, R, Everitt, J, Leadley, K, Benn, A, Grazebrook, K, Haley, C, Akhtar, S, Davies, L, Palmer, S, Dunn, G (2004). Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry 184, 231–239.CrossRefGoogle ScholarPubMed
Ventura, J, Lukoff, D, Nuechterlein, KH, Liberman, RP, Green, MF, Shaner, A (1993). Brief Psychiatric Rating Scale (BPRS) Expanded Version (4.0). Scales, Anchor Points, and Administration Manual. UCLA Department of Psychiatry and Behavioral Sciences: West Los Angeles.Google Scholar
Young, JE, Beck, AT (1988). Cognitive Therapy Rating Scale. Unpublished manuscript. University of Pennsylvania: Philadelphia, PA.Google Scholar
Zimmerman, G, Favrod, J, Trieu, VH, Pomini, V (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research 77, 1–9.CrossRefGoogle Scholar