Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: An analysis of the EDIE-2 trial
Gumley, Andrew I.
Stewart, Suzanne L. K.
Morrison, Anthony P.
AffiliationUniversity of Manchester ; Greater Manchester West NHS Foundation Trust/Liverpool University ; University of Manchester ; University of Sussex ; University of Glasgow ; University of Warwick ; University of Chester ; Greater Manchester West NHS Foundation Trust/University of Manchester
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AbstractBackground: Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses that the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. Methods: 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 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.
JournalBritish Journal of Psychiatry
DescriptionThis is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.org
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