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Cognitive behavioral therapy in adolescents with early-onset psychosis: a randomized controlled pilot study

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Abstract

Cognitive behavioral therapy for psychosis (CBT) is an effective treatment in adult patients with schizophrenia. However, no randomized controlled and blinded trial in adolescents with early-onset psychosis (EOP) has been conducted. Therefore, the present pilot study explores the acceptance, tolerability, feasibility, and safety of a modified CBT in adolescents with EOP. Twenty-five adolescents with EOP were randomized to either 9 months (20 sessions) of CBT + treatment as usual (TAU) or TAU alone. The primary endpoint was the PANSS-positive subscale (P1-7). Secondary endpoints included psychopathology, global functioning, and quality of life (QoL). Acceptance, tolerability, feasibility, and safety were assessed. Blinded assessments took place by the end of the treatment (9 months) and at 24-month follow-up. Despite improvements in both groups and lack of statistical significance between CBT + TAU and TAU regarding the primary endpoint, we observed between-group effect sizes of at least d = 0.39 in favor of CBT + TAU at post-treatment for delusions, negative symptoms, functioning and QoL after the intervention and effect sizes of at least d = 0.35 after 24 months. CBT in EOP was highly acceptable (73.5% agreed to randomization), well-tolerated (83.1% attendance rate, no drop-outs), and safe (one serious adverse event (SAE) in CBT + TAU in comparison with six SAEs in TAU). These findings suggest that CBT adapted to the needs of adolescents with EOP is a promising approach regarding negative symptoms, functioning, and QoL. CBT is a safe and tolerable treatment. However, due to the small sample size and the pilot character of the study, these conclusions are limited, and should be tested in a larger, adequately powered randomized controlled trial.

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Acknowledgements

The mCBT-trial was supported by the German Federal Ministry of Education and Research (BMBF). Grant number: 01GV0619.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany

    Hendrik Müller, Mareike Kommescher, Jörn Güttgemanns, Helen Wessels & Andreas Bechdolf

  2. Department of Childhood and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany

    Petra Walger & Gerd Lehmkuhl

  3. Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany

    Kathrin Kuhr, Stefanie Hamacher & Walter Lehmacher

  4. Kinder- und Jugendwohnheim Leppermühle, Leppermühle 1, 35418, Buseck, Germany

    Kerstin Müller

  5. Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Jutta Herrlich

  6. Department of Psychiatry and Psychotherapy, Klinikum Fulda, Pacelliallee 4, 36043, Fulda, Germany

    Georg Wiedemann

  7. Department of Childhood and Adolescent Psychiatry and Psychotherapy, University of Tübingen, Geissweg 3, 72076, Tübingen, Germany

    Dieter Stösser

  8. Department of Psychiatry and Psychotherapy, University of Tübingen, Geissweg 3, 72076, Tübingen, Germany

    Stefan Klingberg

  9. Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban, Dieffenbachstraße 1, 10967, Berlin, Germany

    Andreas Bechdolf

  10. Vivantes Klinikum im Friedrichshain, Berlin, Germany

    Andreas Bechdolf

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  1. Hendrik Müller
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  2. Mareike Kommescher
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  15. Andreas Bechdolf
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Correspondence to Andreas Bechdolf.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The protocol was approved by the respective institutional ethics committees at the Universities of Cologne, Frankfurt (Main) and Tübingen, Germany and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

All participants and parents/legal guardians of minor patients provided written informed consent before any research activity.

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Müller, H., Kommescher, M., Güttgemanns, J. et al. Cognitive behavioral therapy in adolescents with early-onset psychosis: a randomized controlled pilot study. Eur Child Adolesc Psychiatry 29, 1011–1022 (2020). https://doi.org/10.1007/s00787-019-01415-4

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  • DOI: https://doi.org/10.1007/s00787-019-01415-4

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