Early cognitive behavioural therapy reduces risk of psychosis

Young people seeking help who are at high risk of developing psychosis could significantly reduce their chances of going on to develop a full-blown psychotic illness by getting early access to cognitive behavioural therapy (CBT), new research shows.

Researchers from The University of Manchester found the risk of developing psychosis was more than halved for those receiving CBT at six, 12 and 18-24 months after treatment started.

The team from the University’s School of Psychological Science and the Psychosis Research Unit at Greater Manchester West Mental Health NHS Foundation Trust adds weight to earlier studies in this area.

CBT is a person-centred approach which involves helping people understand how the way they make sense of their experiences, and how they respond to them, can often determine how distressing or disabling they are. Through CBT, patients learn a range of strategies they can use to reduce their distress, allowing them to work towards a recovery which is meaningful to them. CBT for psychosis prevention places a heavy emphasis on ‘normalising’ and de-stigmatising experiences such as hearing voices or having paranoid thoughts.

The research team analysed previous studies which covered 800 people at high risk of developing psychosis. Patients were randomly allocated to receive either CBT or a control treatment, which was either treatment as usual or supportive counselling.

Dr Paul Hutton, who led the study which has been published in Psychological Medicine, said: “We found that the risk of developing a full-blown psychotic illness was more than halved for those receiving CBT at six, 12 and 18-24 months after treatment started.

“Our research suggests that young people seeking help who are at risk of developing psychosis should now be offered a package of care which includes at least six months of CBT.

“There was no evidence that CBT had adverse effects, although we argue future clinical trials should measure this more thoroughly. Our analysis also suggests that existing CBT approaches may need to be adapted to focus more on improving social and occupational functioning.”

The Manchester findings back conclusions from a similar analysis conducted by researchers from the National Institute of Clinical Excellence and University of Manchester researcher Professor Tony Morrison which was reported in the British Medical Journal in January.

The University of Manchester has played an important role in the development of CBT, with Professor Morrison, who also works part-time at Greater Manchester West Mental Health NHS Foundation Trust, and colleagues pioneering its use for psychosis prevention and conducting the first clinical trials in this area in 1999. Manchester Professor Alison Yung, formerly of University of Melbourne, was one of the first researchers to develop reliable tools for identifying those at incipient risk of psychosis.