Impact of the Unified Protocol on Attenuated Psychotic Symptoms, Cognitive Biases and Cognitive Insight in Patients at Ultra High Risk (UHR) for Psychosis: Secondary Results of a Pilot Randomized Controlled Trial.

BACKGROUND AND HYPOTHESIS: Ultra high risk (UHR) for psychosis can have different clinical trajectories but the remission rates are only 51.9% after 3 years of follow-up. Deficits in metacognition are associated with severity of symptoms and poor response to treatment. We hypothesize that the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) will have a positive effect on attenuated psychotic symptoms, cognitive biases and cognitive insight in UHR individuals.

STUDY

DESIGN

This article reports the secondary analyses of a pilot randomized controlled trial with 36 UHR participants assigned to either an online group intervention with UP plus Treatment as Usual (UP + TAU) or TAU alone. Assessments were conducted at baseline, post-intervention and 3-month follow-up and included the severity and distress of attenuated psychotic symptoms (CAARMS), cognitive biases (CBQp) and cognitive insight (BCIS).

STUDY

RESULTS

Significant differences were found in the evolution of the two groups in CAARMS distress scores in favor of the UP condition group. Significant differences in CBQp scores between the two groups were found in the two time assessments in favor of the UP group. No significant differences were found in cognitive insight.

CONCLUSIONS

The UP intervention showed promising effects in reducing distress related to attenuated psychotic symptoms and cognitive biases, but not in improving cognitive insight. Given the small sample size, which fell below the initial target, and the pilot nature of the study, these findings should be interpreted with caution and considered preliminary until replicated in adequately powered trials.