Do psychotic experiences act as effect modifiers in youths with common mental health problems allocated to transdiagnostic cognitive behavioural therapy versus management as usual? Secondary analyses of the Mind‐My‐Mind randomized trial

Abstract

AbstractBackgroundPsychotic experiences (PEs) are common in help‐seeking youths with non‐psychotic mental health problems, yet the clinical importance of PEs as potential effect modifiers of psychotherapy interventions has been scarcely examined. We examined if PEs were associated with a differential response to transdiagnostic cognitive behavioural therapy (CBT) aimed at common emotional and behavioural problems.MethodsWe present secondary analyses from the Mind My Mind (MMM) trial that randomized 396, 6‐16‐year‐old youths to either 9–13 sessions of transdiagnostic modular community‐based CBT (MMM) or community‐based management as usual (MAU). MMM was superior to MAU in reducing parent‐reported impact of mental health problems according to the Strengths and Difficulties Questionnaire (SDQ). PEs were assessed by semi‐structured screening interviews at baseline. The contrast between subgroups (presence/absence of PEs) was calculated to test if PEs are potential effect modifiers regarding the change in parent‐reported SDQ‐impact (primary outcome, rated 0[low]‐10[high]) and other SDQ‐related outcomes.ResultsBaseline PEs were present in 74 (19%) of youths. The superior effect of MMM on changes in SDQ‐impact from baseline to week 18 was not effect modified by the presence of PEs (PEs[yes] −0.89 [95%CI −1.77;‐0.01] vs. PEs[no] −1.10 [95%CI −1.52;‐0.68], p‐value for interaction .68). For secondary outcomes similar patterns were observed.Limitations Statistical power was limited to show if PEs modified treatment response. Replication and meta‐analytic evidence are needed.ConclusionsThe beneficial effects of MMM transdiagnostic CBT did not differ by PE‐status, indicating that youths with emotional and behavioural problems could be offered such psychotherapy irrespective of co‐occurring PEs.