Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-25T19:02:54.130Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation

Published online by Cambridge University Press:  16 July 2019

Andrea Pozza ,
Sandro Domenichetti  and
Davide Dèttore
Andrea Pozza*
Affiliation:
Department of Health Sciences, University of Florence, Florence, Italy
Sandro Domenichetti
Affiliation:
Adult Mental Health Unit, Azienda USL Toscana Centro, Borgo San Lorenzo, Florence, Italy
Davide Dèttore
Affiliation:
Department of Health Sciences, University of Florence, Florence, Italy
*
*Corresponding author. Email: andrea.pozza@unifi.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk.

Key learning aims

  1. (1) To understand CBT evidence and procedures for young individuals with ARMS.

  2. (2) To reflect on the current limitations in the literature on CBT for ARMS.

  3. (3) To understand the importance and clinical implications of assessing worry in ARMS.

  4. (4) To focus on changes in worry as an outcome after CBT for ARMS.

  5. (5) To reflect on future research directions on the role of worry in CBT for ARMS.

Keywords

cognitive behavioural therapyearly interventionpsychosisschizophreniaworryyoung people
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e36
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Fresán, A, León-Ortiz, P, Robles-García, R, Azcárraga, M, Guizar, D, Reyes-Madrigal, F … & de la Fuente-Sandoval, C (2015). Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R). Journal of Psychiatric Research 61, 168–173.CrossRefGoogle Scholar
van der Gaag, M, Nieman, D, & Van den Berg, D (2013). CBT for Those at Risk of a First Episode Psychosis: Evidence-based Psychotherapy for People with an ‘At Risk Mental State’. New York, NY, USA: Routledge.CrossRefGoogle Scholar
van der Gaag, M, Smit, F, Bechdolf, A, French, P, Linszen, DH, Yung, AR, … & Cuijpers, P (2013b). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophrenia Research 149, 56–62.CrossRefGoogle ScholarPubMed
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, … & Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 39, 964–971.CrossRefGoogle ScholarPubMed

References

Addington, J, Epstein, I, Liu, L, French, P, Boydell, KM, & Zipursky, RB (2011). A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophrenia Research 125, 54–61.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn). Washington, DC, USA: American Psychiatric Association Publishing.Google Scholar
Bechdolf, A, Wagner, M, Ruhrmann, S, Harrigan, S, Putzfeld, V, Pukrop, R, … & Bottlender, R (2012). Preventing progression to first-episode psychosis in early initial prodromal states. The British Journal of Psychiatry 200, 22–29.CrossRefGoogle ScholarPubMed
Borkovec, TD, & Inz, J (1990). The nature of worry in generalized anxiety disorder: a predominance of thought activity. Behaviour Research and Therapy 28, 153–158.CrossRefGoogle ScholarPubMed
Borkovec, TD, Robinson, E, Pruzinsky, T, & DePree, JA (1983). Preliminary exploration of worry: some characteristics and processes. Behaviour Research and Therapy 21, 9–16.CrossRefGoogle ScholarPubMed
Brandizzi, M, Valmaggia, L, Byrne, M, Jones, C, Iwegbu, N, Badger, S, … & Fusar-Poli, P (2015). Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up. Journal of Psychiatric Research 65, 115–123.CrossRefGoogle ScholarPubMed
Cohen, J (1968). Weighted kappa: nominal scale agreement provision for scaled disagreement or partial credit. Psychological Bulletin 70, 213–220.CrossRefGoogle ScholarPubMed
Coluccia, A, Ferretti, F, Fagiolini, A, & Pozza, A (2015). Incidenza e fattori di rischio per disturbi psicotici nelle popolazioni migranti in Europa: una meta-analisi di studi trasversali. Italian Journal of Criminology 9, 29–39.Google Scholar
Cotter, J, Yung, AR, Carney, R, & Drake, RJ (2017). Metacognitive beliefs in the at-risk mental state: a systematic review and meta-analysis. Behaviour Research and Therapy 90, 25–31.CrossRefGoogle ScholarPubMed
First, M, Spitzer, R, Gibbon, M, & Williams, J (1997a). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Firenze: Giunti OS.Google Scholar
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, & Benjamin, LS (1997b). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC, USA: American Psychiatric Press.Google Scholar
Freeman, D, Dunn, G, Startup, H, Pugh, K, Cordwell, J, Mander, H, … & Kingdon, D (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The Lancet Psychiatry 2, 305–313.CrossRefGoogle ScholarPubMed
Freeman, D, Stahl, D, McManus, S, Meltzer, H, Brugha, T, Wiles, N, & Bebbington, P (2012). Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social Psychiatry and Psychiatric Epidemiology 47, 1195–1203.CrossRefGoogle ScholarPubMed
Fresán, A, León-Ortiz, P, Robles-García, R, Azcárraga, M, Guizar, D, Reyes-Madrigal, F … & de la Fuente-Sandoval, C (2015). Personality features in ultra-high risk for psychosis: a comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R). Journal of Psychiatric Research 61, 168–173.CrossRefGoogle Scholar
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, … McGuire, P (2012a). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220–229.CrossRefGoogle ScholarPubMed
Fusar-Poli, P, Nelson, B, Valmaggia, L, Yung, AR, & McGuire, PK (2012b). Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin 40, 120–131.CrossRefGoogle ScholarPubMed
Häfner, H, Maurer, K, & an der Heiden, W (2013). ABC Schizophrenia study: an overview of results since 1996. Social Psychiatry and Psychiatric Epidemiology 48, 1021–1031.CrossRefGoogle ScholarPubMed
Hartley, S, Haddock, G, Vasconcelos, E, Sa, D, Emsley, R, & Barrowclough, C (2014). An experience sampling study of worry and rumination in psychosis. Psychological Medicine 44, 1605–1614.CrossRefGoogle ScholarPubMed
Ising, HK, Kraan, TC, Rietdijk, J, Dragt, S, Klaassen, RM, Boonstra, N, … & Wunderink, L (2016). Four-year follow-up of cognitive behavioral therapy in persons at ultra-high risk for developing psychosis: the Dutch early detection intervention evaluation (EDIE-NL) trial. Schizophrenia Bulletin 42, 1243–1252.CrossRefGoogle ScholarPubMed
Kay, SR, Opler, LA, & Lindenmayer, JP (1989). The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. British Journal of Psychiatry 155, 59–65.CrossRefGoogle Scholar
Lin, A, Wood, SJ, Nelson, B, Beavan, A, McGorry, P, & Yung, AR (2015). Outcomes of nontransitioned cases in a sample at ultra-high risk for psychosis. American Journal of Psychiatry 172, 249–258.CrossRefGoogle Scholar
Maffei, C, Fossati, A, Agostoni, I, Barraco, A, Bagnato, M, Donati, D, Namia, C, Novella, L, & Petrachi, M (1997). Interrater reliability and internal consistency of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), version 2.0. Journal of Personality Disorders 11, 279–284.CrossRefGoogle ScholarPubMed
Mazzi, F, Morosini, P, De Girolamo, G, Lussetti, M, & Guaraldi, GP (2000). SCID-I– Structured Clinical Interview for DSM-IV Axis I Disorders (Italian edition). Firenze: Giunti OS.Google Scholar
McGorry, PD, Nelson, B, Phillips, LJ, Yuen, HP, Francey, SM, Thampi, A, … & Thompson, AD (2013). Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome. Journal of Clinical Psychiatry 74, 349–356.CrossRefGoogle ScholarPubMed
McHugh, MJ, McGorry, PD, Yuen, HP, Hickie, IB, Thompson, A, de Haan, L, … & Schloegelhofer, M (2018). The ultra-high-risk for psychosis groups: evidence to maintain the status quo. Schizophrenia Research 195, 543–548.CrossRefGoogle ScholarPubMed
Meneghelli, A, Meliante, M, Amato, L, Pozza, A, & Dèttore, D (2016). ‘I fear going crazy’ … could cognitive concerns be early warning signs of psychosis? Evidence from the Anxiety Sensitivity in the first stages of Psychosis study (ASP study). Early Intervention in Psychiatry 10, 229–229.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL, & Borkovec, TD (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487–495.CrossRefGoogle ScholarPubMed
Morani, S, Pricci, D, & Sanavio, E (1999). Penn State Worry Questionnaire e Worry Domains Questionnaire. Presentazione delle versioni italiane ed analisi della fedeltà. Psicoterapia Cognitiva e Comportamentale 5, 13–34.Google Scholar
Okuzawa, N, Kline, E, Fuertes, J, Negi, S, Reeves, G, Himelhoch, S, & Schiffman, J (2014). Psychotherapy for adolescents and young adults at high risk for psychosis: a systematic review. Early Intervention in Psychiatry 8, 307–322.CrossRefGoogle Scholar
Pozza, A, Coradeschi, D, & Dèttore, D (2013). Do dysfunctional beliefs moderate the negative influence of comorbid severe depression on outcome of residential treatment for refractory OCD? A pilot study. Clinical Neuropsychiatry 10, 72–83.Google Scholar
Pozza, A, & Dèttore, D (2017). The CBQ-p: a confirmatory study on factor structure and convergent validity with psychotic-like experiences and cognitions in adolescents and young adults. BPA-Applied Psychology Bulletin (Bollettino di Psicologia Applicata) 65, 58–69.Google Scholar
Rietdijk, J, Dragt, S, Klaassen, R, Ising, H, Nieman, D, Wunderink, L, … & van der Gaag, M (2010). A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an At Risk Mental State for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Trials 11, 1–9.CrossRefGoogle Scholar
Ruscio, AM (2002). Delimiting the boundaries of generalized anxiety disorder: differentiating high worriers with and without GAD. Journal of Anxiety Disorders 16, 377–400.CrossRefGoogle ScholarPubMed
Schmidt, SJ, Schultze-Lutter, F, Schimmelmann, BG, Maric, NP, Salokangas, RKR, Riecher-Rössler, A, … & Morrison, A (2015). EPA guidance on the early intervention in clinical high risk states of psychoses. European Psychiatry 30, 388–404.CrossRefGoogle ScholarPubMed
Schultze-Lutter, F, Michel, C, Schmidt, SJ, Schimmelmann, BG, Maric, NP, Salokangas, RKR, … & Meneghelli, A (2015). EPA guidance on the early detection of clinical high risk states of psychoses. European Psychiatry 30, 405–416.CrossRefGoogle ScholarPubMed
Stain, HJ, Bucci, S, Baker, AL, Carr, V, Emsley, R, Halpin, S, … & Startup, M (2016). A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis: the detection and evaluation of psychological therapy (DEPTh) trial. Schizophrenia Research 176, 212–219.CrossRefGoogle ScholarPubMed
Startup, H, Pugh, K, Dunn, G, Cordwell, J, Mander, H, Černis, E, … & Freeman, D (2016). Worry processes in patients with persecutory delusions. British Journal of Clinical Psychology 55, 387–400.CrossRefGoogle ScholarPubMed
Thompson, E, Millman, ZB, Okuzawa, N, Mittal, V, DeVylder, J, Skadberg, T, … & Schiffman, J (2015). Evidence-based early interventions for individuals at clinical high risk for psychosis: a review of treatment components. Journal of Nervous and Mental Disease 203, 342–351.CrossRefGoogle ScholarPubMed
van der Gaag, M, Nieman, DH, Rietdijk, J, Dragt, S, Ising, HK, Klaassen, RM, … & Linszen, DH (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin 38, 1180–1188.CrossRefGoogle ScholarPubMed
van der Gaag, M, Nieman, D, & Van den Berg, D (2013a). CBT for Those at Risk of a First Episode Psychosis: Evidence-based Psychotherapy for People with an ‘At Risk Mental State’. New York, NY, USA: Routledge.CrossRefGoogle Scholar
van der Gaag, M, Smit, F, Bechdolf, A, French, P, Linszen, DH, Yung, AR, … & Cuijpers, P (2013b). Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophrenia Research 149, 56–62.CrossRefGoogle ScholarPubMed
von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, & Vandenbroucke, JP (2007). STROBE Initiative (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370, 1453–1457.CrossRefGoogle ScholarPubMed
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, … & Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 39, 964–971.CrossRefGoogle ScholarPubMed
Wells, A (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy 23, 301–320.CrossRefGoogle Scholar
Wells, A (2011). Metacognitive Therapy for Anxiety and Depression. New York, NY, USA: Guilford Press.Google Scholar
Submit a response

Comments

No Comments have been published for this article.