D-cycloserine augmentation of cognitive behavioral therapy for delusions: a randomized clinical trial
D-cycloserine augmentation of cognitive behavioral therapy for delusions: a randomized clinical trial
Objective: D-cycloserine (DCS) promotes consolidation of extinction learning. This study extends earlier work by examining whether DCS can enhance cognitive behavioral therapy (CBT) for delusions.
Methods: adults reporting moderate or greater delusions were randomly assigned to receive 50 mg of DCS or placebo prior to 10 weekly CBT sessions. The primary outcome was change in severity of delusions measured with the Psychotic Symptom Rating Scale delusion subscale (PSYRATS-D). Secondary outcomes included persistence of response at 3 and 6 month follow-up and the effects of DCS on memory consolidation and cognitive flexibility. Fifty-eight participants were randomized and 44 completed the trial.
Results: the DCS and placebo groups did not differ in change from baseline to end of CBT on PSYRATS-D, nor did DCS improve memory consolidation or cognitive flexibility compared to placebo. However, at the 3 month follow-up visit (week 24), 47% of participants who completed treatment with DCS reported a 20% or greater decrease on PSYRATS-D compared to 15% in the placebo group (p =.04). Change in distress across CBT sessions interacted with treatment group to predict change from baseline to week 24 in PSYRATS-D total score (p =.03) such that response at week 24 was greatest in DCS-treated participants who experienced a decrease in distress during CBT sessions.
Conclusions: DCS augmentation of CBT did not improve delusions compared to placebo during treatment; however, DCS was associated with a higher response rate at 3-month follow-up. DCS may produce a delayed therapeutic effect, associated with successful CBT sessions, but this finding requires replication.
Cognitive behavioral therapy, Cognitive flexibility, Consolidation, D-cycloserine, Delusions, Therapeutic benefit
145-152
Diminich, Erica D.
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Dickerson, Faith
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Bello, Iruma
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Cather, Corinne
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Kingdon, David
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Rakhshan Rouhakhtar, Pamela J.
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Hart, Kamber L.
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Li, Chenxiang
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Troxel, Andrea B.
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Goff, Donald C.
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1 August 2020
Diminich, Erica D.
110cbf67-5a21-4ffe-98d0-67816156f381
Dickerson, Faith
8c4cfa73-6694-42ae-bedb-e7bba76a40fd
Bello, Iruma
4d4807f1-0290-4ebf-a059-2fa3c3e4ce9c
Cather, Corinne
6af89ddc-3abb-4cac-9f5b-5dc1bbe49ced
Kingdon, David
14cdc422-10b4-4b2d-88ec-24fde5f4329b
Rakhshan Rouhakhtar, Pamela J.
5c110acd-b4c9-4bcf-b3e9-3274c6da815b
Hart, Kamber L.
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Li, Chenxiang
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Troxel, Andrea B.
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Goff, Donald C.
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Diminich, Erica D., Dickerson, Faith, Bello, Iruma, Cather, Corinne, Kingdon, David, Rakhshan Rouhakhtar, Pamela J., Hart, Kamber L., Li, Chenxiang, Troxel, Andrea B. and Goff, Donald C.
(2020)
D-cycloserine augmentation of cognitive behavioral therapy for delusions: a randomized clinical trial.
Schizophrenia Research, 222, .
(doi:10.1016/j.schres.2020.06.015).
Abstract
Objective: D-cycloserine (DCS) promotes consolidation of extinction learning. This study extends earlier work by examining whether DCS can enhance cognitive behavioral therapy (CBT) for delusions.
Methods: adults reporting moderate or greater delusions were randomly assigned to receive 50 mg of DCS or placebo prior to 10 weekly CBT sessions. The primary outcome was change in severity of delusions measured with the Psychotic Symptom Rating Scale delusion subscale (PSYRATS-D). Secondary outcomes included persistence of response at 3 and 6 month follow-up and the effects of DCS on memory consolidation and cognitive flexibility. Fifty-eight participants were randomized and 44 completed the trial.
Results: the DCS and placebo groups did not differ in change from baseline to end of CBT on PSYRATS-D, nor did DCS improve memory consolidation or cognitive flexibility compared to placebo. However, at the 3 month follow-up visit (week 24), 47% of participants who completed treatment with DCS reported a 20% or greater decrease on PSYRATS-D compared to 15% in the placebo group (p =.04). Change in distress across CBT sessions interacted with treatment group to predict change from baseline to week 24 in PSYRATS-D total score (p =.03) such that response at week 24 was greatest in DCS-treated participants who experienced a decrease in distress during CBT sessions.
Conclusions: DCS augmentation of CBT did not improve delusions compared to placebo during treatment; however, DCS was associated with a higher response rate at 3-month follow-up. DCS may produce a delayed therapeutic effect, associated with successful CBT sessions, but this finding requires replication.
Text
DCS manuscript 9.26.19
- Accepted Manuscript
Text
DCS Supplement 9.23.19
More information
Accepted/In Press date: 14 June 2020
e-pub ahead of print date: 23 June 2020
Published date: 1 August 2020
Additional Information:
Copyright © 2020 Elsevier B.V. All rights reserved.
Keywords:
Cognitive behavioral therapy, Cognitive flexibility, Consolidation, D-cycloserine, Delusions, Therapeutic benefit
Identifiers
Local EPrints ID: 445339
URI: http://eprints.soton.ac.uk/id/eprint/445339
ISSN: 0920-9964
PURE UUID: 2d88e27b-b253-4181-bd98-97895a26cac1
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Date deposited: 02 Dec 2020 17:33
Last modified: 18 Mar 2024 05:26
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Contributors
Author:
Erica D. Diminich
Author:
Faith Dickerson
Author:
Iruma Bello
Author:
Corinne Cather
Author:
David Kingdon
Author:
Pamela J. Rakhshan Rouhakhtar
Author:
Kamber L. Hart
Author:
Chenxiang Li
Author:
Andrea B. Troxel
Author:
Donald C. Goff
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