Efficay and mechanisms of change of an emotion-oriented version of Cognitive-behavioral Therapy for Psychosis (CBTd-E) in reducing delusions. A randomized-controlled treatment study.

大量的荟萃分析发现，精神病的认知行为疗法(CBTp)是有效的。除了抗精神病药物治疗外，对阳性症状所取得的效果大小从小到中等不等。然而，错觉改变的效果要稍低一些。因此，事实可能证明，更准确地针对与妄想相关的过程量身定做CBTp干预措施是有益的。根据经验得出的错觉形成和维持模型假定认知偏差、情绪因素和自尊具有重要作用。更多的研究已经证明睡眠受损与妄想症的相关性。然而，旨在改变妄想的CBTp干预往往主要集中在推理偏差上。几项主要关注改善妄想症患者的情绪因素、睡眠质量和自尊的非受控先导研究的结果表明，这些因素的变化有可能减少妄想症。然而，在这些研究中，单一的干预措施很短，并且没有实施到更广泛的治疗理性中。因此，可以假设，在一个更广泛的治疗理性中，CBT干预的组合可能会对妄想症产生更大的影响。目前的单盲随机对照治疗研究的目的是评估一种新形式的认知行为疗法(CBTd-E)治疗妄想症的疗效，该疗法将在25个单独的疗程中应用，重点是情绪调节、自尊和睡眠质量的改善。此外，本研究的目的是检验CBTd-E的有效性是否通过假设的过程来调节。主要假设是：1.基线差异：与健康对照组相比，精神分裂症患者在情绪调节方面表现出更明显的问题，睡眠质量下降，自尊更低和更不稳定。2.CBTd-E的疗效：接受CBTd-E治疗的急性妄想症患者表现出更明显的妄想减少(主要结果)，阳性症状、抑郁和一般精神病理学的减少也更明显。3.调解：CBTd-E对妄想症改变的影响是通过a)改善情绪稳定性和情绪调节能力，b)改善睡眠质量，c)改善和更稳定的自尊。除了问卷和访谈外，还将使用行为范式、心理生理学评估和电子日记来检验假设。如果我们能够证明CBTd-E可以减少妄想症，这将为我们提供一种更可接受和可行的治疗妄想症的方法。

Numerous meta-analyses have found Cognitive Behaviour Therapy for psychosis (CBTp) to be effective. The effect sizes that are achieved for positive symptoms in addition to antipsychotic treatment vary between small to medium. However, the effect sizes for changes in delusions are somewhat lower. Thus, it could prove beneficial to tailor CBTp interventions more precisely to the processes that are relevant to delusions. Empirically derived models of the formation and maintenance of delusions postulate an important role of cognitive biases, emotional factors and self-esteem. Additional studies have demonstrated the relevance of impaired sleep to delusions. Nevertheless, CBTp interventions that aim to change delusions tend to focus mainly on reasoning bias. The results of several uncontrolled pilot studies that focused primarily at improving emotional factors, quality of sleep and self-esteem in patients with delusions indicate that changes in these factors have the potential to reduce delusions. However, in these studies the singular interventions were short and were not implemented into a broader therapy rational. It can thus be assumed that a combination of CBT-interventions within a broader therapy rational might have an even greater impact on delusions. The aim of the present single-blind randomized-controlled therapy study is to assess the efficacy of a new form of Cognitive Behavioral Therapy for delusions with a focus on emotion regulation, improvement of self-esteem and sleep quality (CBTd-E) that will be applied in 25 individual sessions. Moreover, the study aims to test whether the efficacy of CBTd-E is mediated by the postulated processes. The main hypotheses are: 1. Baseline differences: in comparison to healthy controls, patients with schizophrenia show more pronounced problems in emotion regulation, a reduced sleep quality and a lower and less stable self-esteem. 2. Efficacy of CBTd-E: patients with acute delusions who receive CBTd-E show a more pronounced reduction of delusions (primary outcome), as well as a more pronounced reduction of positive symptoms, depression and general psychopathology, a stronger improvement in general and social functioning and will receive lower doses of antipsychotic medication (secondary outcomes) at post-treatment. 3. Mediation: the effect of CBTd-E on change in delusions is mediated by a) improved emotional stability and emotion regulation ability, b) improved sleep quality, c) improved and more stable self-esteem.In addition to questionnaires and interviews, behavioral paradigms, psychophysiological assessments and electronic diaries will be used to test the hypotheses. If we can demonstrate that CBTd-E reduces delusions, this would provide us with a more acceptable and feasible therapy for treating delusions.