A new multi-centered study was released about using cognitive therapy for young people who were seen as being at high risk of psychosis.
The article reporting the study is on the British Medical Journal website, available in full – http://www.bmj.com/content/344/bmj.e2233
It’s curious to see how it is being reported in the press. One article, in todayonline, emphasized that the study results indicated that young people seen as having high risk for psychosis should not be given anti-psychotics, because of the high probability they aren’t going to get psychosis anyway, and it emphasized that cognitive therapy can reduce the intensity and frequency of psychotic experiences in those who do go on to become psychotic. But another article, intended for medical people, emphasized the fact that cognitive therapy didn’t seem to alter the frequency of people who went “over the edge” into having some “psychotic” experience.
I think the todayonline article is catching the most important points. What is really key is that we not give damaging drugs to a big group of young people just because a small minority of them might go on to have problems with psychosis in the future. And we should be aware that cognitive therapy seems to provide some kind of benefit if we really want to try something that is relatively safe, even though it doesn’t provide nearly the benefit we would like, at least in its current form as practiced in this experiment.
One further thought: it may be that providing some kind of human contact intervention may dramatically lower the rate of transition into psychosis but this study couldn’t detect such an effect. That’s because for this study, being in the control group involved “monitoring of mental state alone (aimed to provide warm, empathic, and nonjudgmental face to face contact and supportive listening).” Such empathetic listening itself provided by a non-judgmental person may itself be a significant intervention, itself interrupting the social isolation that often leads to psychosis.
My reading of the efficacy of “monitoring of mental state alone” was that it suggests the power of mindful awareness itself. In research on cognitive therapy, it was the recognition of “thoughts as thoughts,” rather than the changing of the thoughts’ contents, that was associated with change. It was that research that lead to the development of Mindfulness Based Cognitive Therapy and Mindfulness Based Relapse Prevention. So, in this study, with or without the cognitive therapy, simple awareness of mental state, presumably in the company of another but independent of “therapy” and perhaps even of empathy (though that’s rarely a bad thing) was sufficient to mediate a lower conversion to psychosis.
Just a thought.
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