Clinical and psychosocial factors related to change and therapy attendance during cognitive-behavioral therapy for young people at ultra high-risk of psychosis.

BACKGROUND: Cognitive-behavioral therapy (CBT) is the well-established standard treatment for young people with an ultra high-risk (UHR) state for psychosis. While CBT has been shown to reduce the risk of transition to psychosis, early treatment discontinuation is highly prevalent. This study examines the impact of attenuated psychotic symptoms on change mechanisms and therapy attendance. METHODS: 65 young people at UHR (confirmed with the Structured Interview for Psychosis-Risk Syndromes, SIPS) received a specialized, 12-session CBT intervention at an Early Recognition and Intervention Centre (FETZ Bern) between 2018 and 2023. They provided demographic information, pre and post therapy measures of psychopathology (including psychotic, depressive, and anxiety symptoms), functioning, and quality of life. The Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) was rated regularly by patients and therapists. RESULTS: Of 65 participants (71% female, mean age 18 years), 43 (66%) completed the intervention and experienced improvements in psychotic, depressive and anxiety symptoms, functioning, and quality of life. Psychotic symptoms were negatively associated with patient-rated resource activation and problem actuation early in therapy. Mastery and resource activation improved significantly over the course of therapy. Neither psychotic symptoms nor SACiP scores predicted attendance. CONCLUSION: CBT for UHR is associated with improved clinical symptoms and functioning. Nevertheless, even in specialized early intervention services like FETZ Bern, a substantial proportion of young people discontinue treatment early. The interplay between psychotic symptoms and change mechanisms can help to understand the subjective experience of psychotherapy in UHR cohorts and should be studied further.