O9.8. USING APPROPRIATE OUTCOMES WHEN EVALUATING COGNITIVE BEHAVIOR THERAPY FOR PSYCHOSIS (CBTP) FOR PATIENTS WITH SCHIZOPHRENIA IN AN INPATIENT SETTING: TRENDS OBSERVED IN CLINICAL PRACTICE

Cognitive behavior therapy for psychosis (CBTp) has been used with patients with schizophrenia for well over fifty years. Previous evaluations of CBTp have emphasized change in global scores of psychosis as the primary (if not the only) outcome, neglecting evaluation of change in patient distress and functioning. This method of practice is inconsistent with the theory and aims of the interventions used in CBTp, particularly from a recovery perspective. Fifty-three patients with schizophrenia spectrum illnesses in an inpatient hospital were offered weekly, 60-minute group sessions of illness education using a CBTp framework. A retrospective review was completed, which examined participant attendance and average level of engagement across sessions. Primary outcomes were analyzed for subsets of patients and included change in distress secondary to symptoms (clinician derived rating scale and Clinical Global Impressions scale [CGI]), symptoms of depression (Calgary Depression Rating Scale [CDS]), global assessment of functioning (GAF), and severity of psychosis (Brief Psychiatric Rating Scale [BPRS]) from initiation of CBTp to discharge (or at time of data collection). Fourteen patients rated subjective distress and interference in functioning secondary to symptoms, satisfaction with CBTp group and utility of skills learned. On average, participants attended 32.0 (27.2) groups, or 70.6% of groups offered. Moderate to high engagement across sessions was observed in 84% of the sample. Analyses of change from initiation of CBTp to endpoint yielded significant reduction in distress secondary to symptoms on both clinician ratings (W=666, p<0.001) and the CGI (W=120, p<0.001), as well as significant improvement on the GAF scale (W=-666, p<0.001), with an average increase of over 25 points. Total BPRS scores decreased significantly (W= 255, p<0.001), with significant reductions also seen in the negative symptom subscale (p= 0.016), anxiety/depression (p= 0.002), hostility (p= 0.003) and thought disturbance (p= 0.002). Trends were noted for attendance and engagement relating to greater distress reductions, improvements in CDS, total BPRS scores, and GAF scores. On average patients indicated that they were satisfied to very satisfied with the group overall and reported that they agree to mostly agree that skills learned in group help them to feel better and function better. From a recovery perspective, psychosocial treatments should emphasize distress reduction and improvement in adaptive functioning. Outcome measure selection should be consistent with the aims of the interventions. These findings indicate that individuals who participate in group CBTp demonstrate significant reductions in objective and subjective distress secondary to symptoms and in improvement in overall functioning. Moreover, participants report satisfaction with the group and report that the skills learned in group help them to cope with distress secondary to symptoms of the illness. Though change in total BPRS scores should be of interest (and reductions were indeed observed), this outcome should not be the primary, and certainly not the only focus when discussing efficacy of CBTp. It is suggested that future research evaluate CBTp in a manner consistent with the goals of the interventions.

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