Effects of Social Recovery Therapy on Functional Outcomes in First-Episode Psychosis
Participants had a wide range of complex comorbidities such as anxiety and depression, and current hopelessness and lack of hope for the future.
The addition of social recovery therapy to early intervention services in patients with non-affective psychosis improved the amount of time spent in structured activity compared with early intervention services alone, according to the results of a phase 2 trial published in The Lancet Psychiatry.
In a single-blind controlled trial, 155 patients aged 16 to 35 years with non-affective psychosis were randomly assigned to continue early intervention services with or without social recovery therapy. Participants had been clients of early intervention services for 12 to 30 months and had severe social disability (<30 h/wk of structured activity). Time spent in structured activity at 9 months was the primary outcome and was assessed by a blinded researcher.
Participants in the social therapy group received a mean (standard deviation) of 16.49 (8.39) sessions. Based on adherence ratings on the social recovery cognitive behavioral therapy checklist, 81% of participants received a sufficient amount of social recovery therapy sessions.
In an intention-to-treat analysis, social recovery therapy was associated with a significant and clinically important increase in structured activity compared with early intervention services alone at 9 months (8.1 hours; 95% CI, 2.5-13.7; P =.005).
No differences were reported for time use, general psychopathology, negative symptoms, hopelessness, and quality of life at 9 and 15 months. The study investigators noted, however, that they had large attrition rates for the majority of secondary outcomes, resulting in fewer participant assessments.
No adverse events attributable to study therapy were reported.
The study researchers concluded that patients receiving "social recovery therapy plus early intervention services had a large, significant, and clinically important improvement… in their level of structured activity compared with those receiving early intervention services alone." The investigators noted that these results were particularly important given that the study enrolled "a subgroup of patients who are known to be hard to treat, tend not to engage, have complex problems, and are the poorest outcome early intervention subgroup for whom no effective treatment currently exists."
Fowler D, Hodgekins J, French P, et al. http:Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial [published online December 11, 2017]. Lancet Psychiatry. doi:10.1016/S2215-0366(17)30476-5