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

Clare Flach; Paul French; Graham Dunn; David Fowler; Andrew I Gumley; Max Birchwood; Suzanne L K Stewart; Anthony P Morrison

doi:10.1192/bjp.bp.114.153320

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

Clare Flach, Paul French, Graham Dunn, David Fowler, Andrew I Gumley, Max Birchwood, Suzanne L K Stewart, Anthony P Morrison

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

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.

Original language	English
Pages (from-to)	123-9
Number of pages	7
Journal	The British journal of psychiatry : the journal of mental science
Volume	207
Issue number	2
DOIs	https://doi.org/10.1192/bjp.bp.114.153320
Publication status	Published - Aug 2015

Keywords

Adolescent
Adult
Cognitive Therapy
Female
Humans
Male
Problem Solving
Psychomotor Performance
Psychotic Disorders
Risk Factors
Treatment Outcome
Young Adult

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Flach, C., French, P., Dunn, G., Fowler, D., Gumley, A. I., Birchwood, M., Stewart, S. L. K., & 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. The British journal of psychiatry : the journal of mental science, 207(2), 123-9. https://doi.org/10.1192/bjp.bp.114.153320

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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.",

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author = "Clare Flach and Paul French and Graham Dunn and David Fowler and Gumley, {Andrew I} and Max Birchwood and Stewart, {Suzanne L K} and Morrison, {Anthony P}",

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AU - Gumley, Andrew I

AU - Birchwood, Max

AU - Stewart, Suzanne L K

AU - Morrison, Anthony P

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AB - 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.

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

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Keywords

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