Patient predictors of symptom and functional outcome following cognitive behaviour therapy or befriending in first-episode psychosis

Abstract

Background: Cognitive behaviour therapy (CBT) is an effective treatment for many, but not all, individuals with psychosis. An important goal is identifying individuals more likely to benefit from CBT to ensure appropriate delivery. The current study aimed to examine patient-related predictors of symptom and functional outcome following CBT and Befriending in first-episode psychosis (FEP).

Method: Our original randomized controlled trial compared 14 weeks of CBT (n=31) and Befriending (n=31) in FEP (Jackson et al. 2008). A series of regressions were conducted separately for each group to examine demographic, cognitive, symptoms/illness and functioning variables in predicting positive symptoms (BPRS Psychotic), negative symptoms (SANS Total) and functioning (SOFAS) at 1-year follow-up.

Results: In the CBT group, higher baseline functioning (SOFAS) predicted lower levels of positive symptoms (R(2)=0.19; p=0.023), higher educational achievement and lower levels of avolition symptoms (SANS Avolition) predicted lower levels of total negative symptoms (R(2)=0.38; p=0.003), and working/studying at baseline predicted higher functional outcome (R(2)=0.35; p=0.004) at 1 year. In the Befriending group, premorbid adjustment (PAS Average) was the only variable that predicted 1-year positive symptom (R(2)=0.26; p=0.010), negative symptom (R(2)=0.35; p=0.016) and functional (R(2)=0.48; p=0.002) outcome.

Conclusions: FEP individuals with higher baseline functioning may benefit more from CBT than those with poorer functioning. Individuals with functional difficulties may benefit from alternative treatments initially, such as supported education or employment.