A major concern with all the intervention studies for APS (attenuated psychotic symptoms) is that all subjects are in treatment. We do not know the natural course outside of clinical care. It is easy to imagine that all these specialized treatment settings at least provide stress reduction, help families address issues, help the patient cope with difficult issues, and support reality testing. Cognitive therapy may not add much. This particular APS study is underpowered, but at issue is not whether cognitive therapy can reduce or delay transition, but what would constitute case selection where the benefit is greater than the risk.

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