Parker Sophie Kate, Mulligan Lee D, Milner Philip, Bowe Samantha, Palmier-Claus Jasper E
Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
Front Psychol. 2020 Jan 17;10:2741. doi: 10.3389/fpsyg.2019.02741. eCollection 2019.
Developing effective interventions for preventing first episode psychosis have been an important research focus in the last decade. Cognitive behavioral therapy is a currently indicated treatment for people at ultra-high risk of psychosis, however, access and resource issues limit its delivery within the NHS. Treatments which partial out potential active ingredients and are aimed at a range of psychological difficulties seen within this population have the potential to be more efficacious and efficient. We conducted a single-arm exploratory pilot trial, designed to investigate the feasibility and acceptability of Metacognitive therapy for individuals at ultra-high risk (UHR) of developing psychosis. Trial uptake was good, with 11 out of 12 referred individuals meeting for an eligibility assessment (one individual was excluded prior to the assessment). Of these, 10 individuals were eligible and included in the trial. Retention to treatment was high with 80% treatment adherence gained and an overall average of 8 sessions completed. All participants were offered follow-up assessments immediately post-treatment and at 6 months, which comprised measures of psychotic like experiences, anxiety and depression, and metacognitive processes implicated in the model. Retention to the post-treatment (12-week) follow-up was good, with 80% completion; however retention to the 6-month follow-up was lower at 60%. Clinically significant results were observed in psychotic like experiences, anxiety, depression and functioning with medium to large effect sizes. Measures related to beliefs and processes targeted within MCT showed clinically significant change with medium to large effect sizes. Our results suggest that MCT based upon a specific metacognitive model for individuals meeting ARMS criteria may be an important treatment target and warrants further attention. Limitations and possible focuses for future research are discussed. ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465.
在过去十年中，开发预防首次发作精神病的有效干预措施一直是重要的研究重点。认知行为疗法是目前针对精神病超高风险人群的指定治疗方法，然而，获取途径和资源问题限制了其在英国国家医疗服务体系（NHS）中的应用。分离出潜在有效成分并针对该人群中出现的一系列心理问题的治疗方法，有可能更有效且高效。我们进行了一项单臂探索性试点试验，旨在研究元认知疗法对处于精神病超高风险（UHR）个体的可行性和可接受性。试验招募情况良好，12名被转诊的个体中有11名参加了资格评估（1名个体在评估前被排除）。其中，10名个体符合条件并被纳入试验。治疗保留率很高，治疗依从性达到80%，平均共完成8次治疗。所有参与者在治疗后立即以及6个月时均接受了随访评估，评估内容包括精神病性体验、焦虑和抑郁的测量，以及该模型中涉及的元认知过程。治疗后（12周）随访的保留率良好，完成率为80%；然而，6个月随访的保留率较低，为60%。在精神病性体验、焦虑、抑郁和功能方面观察到具有中等到大效应量的临床显著结果。与元认知疗法（MCT）中所针对的信念和过程相关的测量显示出具有中等到大效应量的临床显著变化。我们的结果表明，基于特定元认知模型的元认知疗法对于符合ARMS标准的个体可能是一个重要的治疗靶点，值得进一步关注。文中讨论了局限性以及未来研究可能的重点。ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465。
