Opening the black box of cognitive-behavioural case management in clients with ultra-high risk for psychosis

Background: Cognitive Behavioural Therapy (CBT) is the first-choice treatment in the ultra-high risk (UHR) for psychosis group. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between intensity and content of CBT and severity of symptomatic outcome. Methods: A sample of 268 UHR participants received six months of cognitive behavioural therapy with case management (CBCM) in the context of the multi-centre Neurapro trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for initial severity of APS, the association between (1) number of CBCM sessions received and severity of APS, and (2) specific CBCM components and severity of APS, were investigated. Results: In Month 1, a higher number of sessions and more assessment of symptoms predicted an increase of APS, while in Month 3, a higher number of sessions and more monitoring predicted a decrease in level of APS. More therapeutic focus on APS predicted an increase of APS overall. Conclusions: Our findings indicate that the association between intensity/content of CBCM and severity of APS in a sample of UHR participants depends on time in treatment. CBCM may positively impact severity of APS later in the course of treatment. Therefore, it would seem important to keep UHR young people engaged in treatment beyond this initial period. Regarding the specific content of CBCM, a therapeutic focus on APS may not necessarily be beneficial in reducing the severity of APS, a possibility in need of further investigation