June 2018
By Cynthia Z. Burton, Unger Research Fellow, University of Michigan
In recent years, there has been a growing effort among mental health researchers and clinicians to recognize and even provide treatment for adolescents and young adults considered “at risk” for developing psychosis. But how are these youth identified? And what treatments are they offered? And most importantly, do they work?
A team of scientists in Canada recently released a paper addressing these questions. Published in the journal “Early Intervention in Psychiatry,” the authors conducted a “systematic review and meta-analysis,” meaning they reviewed and combined data from many different research studies into one larger, more powerful analysis. They were interested in comparing treatments for individuals with attenuated psychosis symptoms, or APS. APS is not a formal mental health diagnosis, but rather a designation for people who are distressed by unusual beliefs or experiences, are suspicious or have trouble organizing their thoughts and behavior. Although these symptoms do not meet the threshold for diagnosis of psychosis, they can be very upsetting and lead to developing more serious symptoms (known as conversion).
To conduct their study, the research team searched multiple journal databases (which resulted in over 3,000 records!) and narrowed down the list to 41 studies meeting their criteria for review and 17 to be included in the meta-analysis. Overall, their data included 3,146 participants with an average age of 19, about half of whom were male. They examined various treatments provided to these high-risk participants, including different types of therapy like cognitive behavioral therapy or family therapy, as well as different types of medications or supplements such as antipsychotic medications, NMDAR modulators, and omega-3. They compared these treatments to control conditions at various time points for up to 2 years.
In a nutshell, the results indicated that cognitive behavioral therapy, or CBT, was associated with a significant reduction in symptoms at 18- and 24-month follow-up. CBT focuses on how thoughts, feelings, and behaviors are connected; in other words, the way we think affects our behavior, and our behavior affects the way we think. CBT helps people recognize and challenge inaccurate or unhelpful thinking patterns and engage in more effective behavior to reduce symptoms and improve day-to-day functioning. Study results showed that other treatments were not significantly better than controls.
In another analysis examining each of the treatments compared to one another (rather than to a control group), there were no superior treatments identified statistically. There was a hint, though, that CBT and family therapy were favorable as compared with the other interventions.
Overall, this paper is the largest and most comprehensive investigation to date of APS treatments for people at risk for psychosis. There were some limitations worth considering, including the general lack of high-quality studies in this area, the differences among the various instruments used to assess symptoms, and the relatively small number of studies included in the treatment-to-treatment analysis. Nevertheless, this study demonstrated that CBT was effective at reducing APS for up to 2 years, and that family therapy may be a promising avenue for future treatment studies. For people seeking help at the first signs of these distressing experiences, these two treatments might be a good place to start.
To read the full review and meta-analysis, go to https://doi.org/10.1111/eip.12677.