- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05703698
EEG Outcomes From Cognitive Behavioural Therapy for Psychosis (EPIC)
Study Overview
Status
Intervention / Treatment
Detailed Description
Despite decades of refining traditional treatments for schizophrenia-spectrum disorders, recovery rates remain unchanged at only 13.5%, and there is an urgent need for innovative new interventions. Cognitive behavioural therapy has more recently been applied to treating psychosis and initial evidence has suggested that cognitive behavioural therapy for psychosis (CBTp) is the most effective psychosocial intervention available for psychosis. However, the efficacy of CBTp has been limited to moderate effect sizes. Little is currently understood about the mechanisms of CBTp, and a greater understanding of mechanisms is necessary in order to improve treatment efficacy. Despite overwhelming evidence for neurocognitive and neurophysiological factors involved in the etiology of psychosis, these factors have never been examined as mechanisms of improvement from CBTp. Cognitive behavioural therapy for psychosis (CBTp) has demonstrated efficacy for reducing positive symptoms, negative symptoms, and improving community functioning6 for individuals diagnosed with psychotic disorders. Despite meta-analytic evidence for the efficacy of CBTp, little is known about the neurophysiological processes through which symptomatic and functional change occurs. Electroencephalography (EEG) provides temporally precise measurement of neurophysiological activity. Positive symptoms have been associated with reduced integration of discrepant information as indexed by the N400 event-related potential, reduced resting state power in the EEG alpha frequency band, and reduced cognitive control as indexed by EEG alpha and theta power during cognitive flanker tasks. Additionally, neurocognitive abilities such as attention, memory, and problem solving are the best predictors of community functioning among individuals diagnosed with psychotic disorders. Although CBTp improves community functioning,[6] neurophysiological and neurocognitive outcomes have never been examined as therapeutic mechanisms from CBTp, despite the fact that therapeutic processes would be expected to improve cognitive functions.
Aim 1: Examine neurophysiological outcomes from CBTp using EEG.
Aim 2: Examine neurocognitive outcomes from CBTp
Hypothesis 1: After CBTp it is expected that participants will have a) increased N400 amplitude; b) increased resting state EEG alpha power; and c) reduced alpha and increased theta power during a flanker task
Hypothesis 2: After CBTp participants will have increased global neurocognitive abilities as indexed by a neurocognitive composite score.
Although CBTp has demonstrated efficacy to improve symptoms for individuals experiencing psychosis, little is known about the neurophysiological process through which this improvement occurs, and neither EEG nor neurocognitive outcomes from CBTp have ever been examined. The current results will provide preliminary evidence for neurophysiological mechanisms of change from CBTp that will increase understanding of the disorder and provide critical insights for refining psychotherapeutic interventions. Additionally, psychotherapy trials typically only examine psychological outcomes, however, if CBTp is effective it would be expected that this could be detected at both the neurophysiological level and neurocognitive level as well. My incorporation of multiple levels of assessment in clinical trials was recently praised as a goldstandard approach to trial methodology. This line of research is critical to improving the efficacy of CBTp.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Michael W Best, Ph.D.
- Phone Number: 1 6476896098
- Email: m.best@utoronto.ca
Study Locations
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Ontario
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Scarborough, Ontario, Canada, M1C 1A4
- Recruiting
- University of Toronto Scarborough
-
Contact:
- Michael W Best, PhD
- Phone Number: 1 6476896098
- Email: m.best@utoronto.ca
-
Principal Investigator:
- Michael W Best, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- The inclusion criteria is anyone who meets the criteria of schizophrenia, schizoaffective disorder or any other psychotic disorder, are also 18-65 years of age, are not abusing drugs or alcohol and can read and speak English. Participants must be experiencing active symptoms of psychosis as indicated on the PANSS.
Exclusion Criteria:
- Exclusion criteria include anyone with a neurological disease or neurological damage, medical illnesses that can change neurocognitive function, a medical history of head injury with loss of consciousness and those with physical handicaps that would prevent them from engaging in assessment procedures
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Cognitive Behavioural Therapy for psychosis
CBTp will be delivered according to an established manual that the PI has previously used successfully for in-person treatment.
Treatment will consist of individual sessions with a psychologist employed by the University of Toronto for 1-hour per week for 6-months, or by one of the listed clinical graduate students under his supervision.
All treatment will be delivered in-person.
This treatment will be delivered in addition to usual care and no changes to usual care will be required.
|
CBT will be delivered according to an established manual that the PI has previously used successfully for in-person treatment.
Treatment will consist of individual sessions with a psychologist employed by the University of Toronto for 1-hour per week for 6-months, or by one of the listed clinical graduate students under his supervision.
All treatment will be delivered in-person.
This treatment will be delivered in addition to usual care and no changes to usual care will be required.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Positive and Negative Syndrome Scale (PANSS) Total Score
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The PANSS is a semi-structured interview that will be delivered through Zoom by one of the listed graduate students under the supervision of a registered clinical psychologist.
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Change from Baseline to Follow-up (6 months post treatment)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Personal and Social Performance Scale (PSP)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The PSP assesses community functioning through a brief interview with the participant about their daily activities.
|
Change from Baseline to Follow-up (6 months post treatment)
|
The Psychotic Symptom Rating Scales (PSYRATS)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The PSYRATS assesses frequency and distress associated with the experiences of hallucinations and delusions based on the PANSS interview.
|
Change from Baseline to Follow-up (6 months post treatment)
|
Calgary Depression Scale for Schizophrenia (CDSS)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The CDSS is an interview-based measure of depression symptoms specifically designed for use with people experiencing schizophrenia.
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Change from Baseline to Follow-up (6 months post treatment)
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The Questionnaire About the Process of Recovery (QPR)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The QPR is a self-report measure of recovery for people with psychosis.
|
Change from Baseline to Follow-up (6 months post treatment)
|
Beliefs About Paranoia Scale (BAPS)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The BAPS assesses metacognitive beliefs about paranoia.
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Change from Baseline to Follow-up (6 months post treatment)
|
Beliefs About Voices Questionnaire (BAVQ)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
BAVQ assesses metacognitive beliefs about voices.
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Change from Baseline to Follow-up (6 months post treatment)
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Experiences Questionnaire (EQ)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
The EQ assesses decentering which is the process of distancing one's self from their thoughts and is associated with mindfulness.
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Change from Baseline to Follow-up (6 months post treatment)
|
Dysfunctional Attitude Scale (DAS)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
DAS assesses dysfunctional beliefs.
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Change from Baseline to Follow-up (6 months post treatment)
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Davos Assessment of Cognitive Biases Scale (DACOBS)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
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DACOBS assesses cognitive processing biases associated with psychosis.
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Change from Baseline to Follow-up (6 months post treatment)
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Childhood Trauma Questionnaire (CTQ)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
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The CTQ assesses experiences of trauma during childhood.
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Change from Baseline to Follow-up (6 months post treatment)
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Working Alliance Inventory (WAI)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
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The WAI is a measure completed by both the therapist and the client about the quality of the therapeutic relationship.
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Change from Baseline to Follow-up (6 months post treatment)
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Psychological Distance Scaling Task (PDST)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
A commonly used experimental task associated with cognitive processing biases in psychosis.
The PDST gives measure of both how positive and negative a person views themselves, and how tightly held these beliefs are based on the clustering of the ratings.
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Change from Baseline to Follow-up (6 months post treatment)
|
Brief Core Schema Scale (BCSS)
Time Frame: Change from Baseline to Follow-up (6 months post treatment)
|
he BCSS assesses core beliefs that individuals hold about themselves and others.
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Change from Baseline to Follow-up (6 months post treatment)
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Michael W Best, Ph.D., University of Toronto
Publications and helpful links
General Publications
- Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261-76. doi: 10.1093/schbul/13.2.261.
- Nuechterlein KH, Green MF, Kern RS, Baade LE, Barch DM, Cohen JD, Essock S, Fenton WS, Frese FJ 3rd, Gold JM, Goldberg T, Heaton RK, Keefe RS, Kraemer H, Mesholam-Gately R, Seidman LJ, Stover E, Weinberger DR, Young AS, Zalcman S, Marder SR. The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. Am J Psychiatry. 2008 Feb;165(2):203-13. doi: 10.1176/appi.ajp.2007.07010042. Epub 2008 Jan 2.
- van der Gaag M, Valmaggia LR, Smit F. The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophr Res. 2014 Jun;156(1):30-7. doi: 10.1016/j.schres.2014.03.016. Epub 2014 Apr 14.
- Grant PM, Huh GA, Perivoliotis D, Stolar NM, Beck AT. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry. 2012 Feb;69(2):121-7. doi: 10.1001/archgenpsychiatry.2011.129. Epub 2011 Oct 3.
- Morrison AP, Law H, Carter L, Sellers R, Emsley R, Pyle M, French P, Shiers D, Yung AR, Murphy EK, Holden N, Steele A, Bowe SE, Palmier-Claus J, Brooks V, Byrne R, Davies L, Haddad PM. Antipsychotic drugs versus cognitive behavioural therapy versus a combination of both in people with psychosis: a randomised controlled pilot and feasibility study. Lancet Psychiatry. 2018 May;5(5):411-423. doi: 10.1016/S2215-0366(18)30096-8. Epub 2018 Apr 5. Erratum In: Lancet Psychiatry. 2019 Jul;6(7):e16.
- Jaaskelainen E, Juola P, Hirvonen N, McGrath JJ, Saha S, Isohanni M, Veijola J, Miettunen J. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull. 2013 Nov;39(6):1296-306. doi: 10.1093/schbul/sbs130. Epub 2012 Nov 20.
- Alvarez-Jimenez M, Parker AG, Hetrick SE, McGorry PD, Gleeson JF. Preventing the second episode: a systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis. Schizophr Bull. 2011 May;37(3):619-30. doi: 10.1093/schbul/sbp129. Epub 2009 Nov 9.
- Morrison AP, Turkington D, Pyle M, Spencer H, Brabban A, Dunn G, Christodoulides T, Dudley R, Chapman N, Callcott P, Grace T, Lumley V, Drage L, Tully S, Irving K, Cummings A, Byrne R, Davies LM, Hutton P. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. Lancet. 2014 Apr 19;383(9926):1395-403. doi: 10.1016/S0140-6736(13)62246-1. Epub 2014 Feb 6.
- Jackson F, Foti D, Kotov R, Perlman G, Mathalon DH, Proudfit GH. An incongruent reality: the N400 in relation to psychosis and recovery. Schizophr Res. 2014 Dec;160(1-3):208-15. doi: 10.1016/j.schres.2014.09.039. Epub 2014 Oct 22.
- Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD. Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry. 2006 Mar;163(3):418-25. doi: 10.1176/appi.ajp.163.3.418.
- Vinogradov S. Has the Time Come for Cognitive Remediation in Schizophrenia...Again? Am J Psychiatry. 2019 Apr 1;176(4):262-264. doi: 10.1176/appi.ajp.2019.19020160. No abstract available.
- Kim M, Lee TY, Lee S, Kim SN, Kwon JS. Auditory P300 as a predictor of short-term prognosis in subjects at clinical high risk for psychosis. Schizophr Res. 2015 Jul;165(2-3):138-44. doi: 10.1016/j.schres.2015.04.033. Epub 2015 May 5.
- Scherbaum S, Fischer R, Dshemuchadse M, Goschke T. The dynamics of cognitive control: evidence for within-trial conflict adaptation from frequency-tagged EEG. Psychophysiology. 2011 May;48(5):591-600. doi: 10.1111/j.1469-8986.2010.01137.x. Epub 2010 Nov 2.
- Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, Parker S, Bentall RP. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry. 2004 Oct;185:291-7. doi: 10.1192/bjp.185.4.291.
- Blackburn, I., James, I., Milne, D., Baker, C., Standart, S., Garland, A., & Reichelt, F. The revised cognitive therapy scale (CTS-R): Psychometric properties. Behavioural and Cognitive Psychotherapy. 2001; 29(4): 431-446.
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 38831 (Other Identifier: Organon)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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