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Randomized Controlled Trial
. 2015 Sep:48:82-9.
doi: 10.1016/j.jbtep.2015.02.007. Epub 2015 Feb 24.

Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs

Helen Waller  1 , Richard Emsley  2 , Daniel Freeman  3 , Paul Bebbington  4 , Graham Dunn  2 , David Fowler  5 , Amy Hardy  6 , Elizabeth Kuipers  6 , Philippa Garety  6
Affiliations
Randomized Controlled Trial

Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs

Helen Waller et al. J Behav Ther Exp Psychiatry. 2015 Sep.

Abstract

Background and objectives: Delusional beliefs with persecutory content are common in psychosis, but difficult to treat. Interventions targeting hypothesised causal and maintaining factors have been proposed as a way of improving therapy. The current study is a feasibility randomised controlled trial of the 'Thinking Well (TW)' intervention: This novel approach combines the recently developed Maudsley Review Training Programme (MRTP), with additional, focussed cognitive-behavioural therapy sessions.

Methods: 31 participants with distressing persecutory delusions and schizophrenia spectrum disorders were randomised to TW or to treatment as usual in a 2:1 ratio. Participants completed outcome assessments at 0 (baseline), 1 (post-MRTP), 6 (post-TW) and 8 (follow-up) weeks. Key outcomes included belief flexibility, paranoia, and delusional conviction and distress. Participants allocated to TW completed the MRTP package and four CBT sessions with a clinical psychologist.

Results: Recruitment proved feasible. Participants reported the intervention was relevant and had resulted in positive changes in thinking and mood, which they could use in everyday life. Treatment effects were moderate-large for key outcomes including belief flexibility, paranoia conviction and distress. The additional TW sessions appeared to confer benefits over MRTP alone.

Limitations: Assessments were not carried out blind to treatment condition. Recruitment was opportunistic, from an identified pool of research participants. Finally, a few participants had already completed the MRTP as part of a previous study.

Conclusions: The TW intervention appears to be feasible and acceptable to participants, and the effects of treatment are promising. A fully powered randomised controlled trial of the intervention is warranted.

Keywords: Belief flexibility; CBT; Psychosis; Reasoning.

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References

    1. Andreasen N.C. University of Iowa; Iowa City; IA: 1984. Scale for the Assessment of Positive Symptoms (SAPS)
    1. Coid J., Ullrich S., Kallis C., Keers R., Barker D., Cowden F. The relationship between delusions and violence. JAMA Psychiatry. 2013;70:465–471. - PubMed
    1. Evans J.S. Dual processing accounts of reasoning, judgment and social cognition. Annual Review of Clinical Psychology. 2008;59:255–278. - PubMed
    1. Freeman D. Improving cognitive treatments for delusions. Schizophrenia Research. 2011;132(2–3):135–139. - PubMed
    1. Freeman D., Dunn G., Fowler D., Bebbington P., Kuipers E., Emsley R. Current paranoid thinking in patients with delusions: the presence of cognitive affective biases. Schizophrenia Bulletin. 2013;39:1281–1287. - PMC - PubMed

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