Sammendrag
Background: Cognitive behavioural therapy for psychosis (CBTp) is an established evidence-based treatment method. Treatment guidelines include recommendations for using the approach in treatment of psychotic disorders. The later years have however brought along studies reporting more moderate findings regarding the effect of CBTp, leading to a debate regarding the effectiveness of the method. CBTp can be delivered in different formats and contexts, such as an integrated part of vocational rehabilitation programmes. Vocational rehabilitation is a method to support service-users to obtain employment, that has been found effective in improving work-related outcomes. Furthermore, employment is associated with a range of positive effects for individuals with psychotic disorders. Objective: This thesis is an exploratory study of the relevance of therapy context in CBTp. Two CBTp interventions delivered in different contexts were compared on selected outcome measures, investigating whether there are some differences in outcome. One of the CBTp interventions were delivered in a traditional symptom focused therapy context. The other CBTp intervention was delivered as an add-on to a vocational rehabilitation programme. To the best of my knowledge, a comparison between a traditional CBTp intervention and a vocational CBTp intervention has previously never been done. Method: Data in this thesis is based on data from two independent projects; KATOslo and JUMP. The KATOslo study is an RCT comparing CBT with TAU for individuals with early psychosis. The JUMP study is a vocational rehabilitation programme, were one of the intervention groups received vocational rehabilitation augmented with CBT. The present study includes 113 participants with a primary diagnosis of broad schizophrenia-spectrum disorders. The primary outcome measure was functioning, as measured with GAF-F and SFS. Additional outcome measures were general symptom level (measured with GAF-S), level of psychotic symptoms (measured with SCI-PANSS) and self-esteem (measured with RSES). Effects on depression (measured with CDSS) were also investigated. Two series of mixed between-within subjects analysis of variance were conducted, controlling for respectively depression and depression and IQ. Subsequently a series of exploratory analysis were conducted, controlling for number of received therapy sessions. Results: Significant effects were found following both interventions regarding functioning, general symptom level, level of psychotic symptoms and depression. There was a trend of effects in favour of the traditional symptom focused CBTp intervention in KATOslo. No significant effects were found for self-esteem. Conclusion: Although some of the effects were in favour of the traditional symptom focused CBTp intervention, CBTp was associated with improvements in both interventions. This indicates that CBTp can be effective when delivered in different contexts. These findings also provide further support for offering CBTp in treatment of psychotic disorders, and suggest that the availability of CBTp for service-users should be increased. These findings call for research with more stringent studies designed for further investigation of the results in this exploratory study.