Skip to main content

Psychological treatments for schizophrenia spectrum disorder: What is around the corner?

  • Douglas Turkington and Latoyah Lebert

The evidence base for cognitive-behavioural therapy (CBT), family therapy, psychoeducation and cognitive remediation as adjuncts to antipsychotic medication in the treatment of schizophrenia is well established. It is, however, clear that the moderate effect size of the best researched of these treatments (CBT) compared with treatment as usual reduces to small when compared with an active psychological treatment. It would seem that many different psychosocial interventions de liver benefit in schizophrenia. We are now at a stage in their development when new treatments are being energetically piloted and combination treatments tested. This article outlines the most promising of these new interventions and attempts to answer the crucial question as to their differential effects on different psychotic presentations.

Learning Objectives

• Be aware of the most promising new psychosocial treatments for schizophrenia

• Learn the key elements of each intervention

• Understand which of these approaches might be best suited to particular presentations of schizophrenia spectrum disorder

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Psychological treatments for schizophrenia spectrum disorder: What is around the corner?
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Psychological treatments for schizophrenia spectrum disorder: What is around the corner?
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Psychological treatments for schizophrenia spectrum disorder: What is around the corner?
      Available formats
Corresponding author
Correspondence Professor Douglas Turkington, Academic Psychiatry, Wolfson Unit, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE46BE, UK. Email:
Hide All

For a commentary on this article see pp. 24-26, this issue.

Declaration of Interest

D.T. delivers lectures and training courses on the subject of CBT for psychosis

Hide All
Allott, KA, Killackey, E, Sun, P, et al (2016) Feasibility and acceptability of cognitive adaptation training for first-episode psychosis. Early Intervention in Psychiatry, 10: 476–84.
Bach, P, Hayes, SC (2002) The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 70: 1129–39.
Beck, AT (1952) Successful outpatient psychotherapy of a chronic schizophrenia with a delusion based on borrowed guilt. Psychiatry, 15: 305–12.
Carey, T (2006) The Method of Levels: How to Do Psychotherapy without Getting in the Way. Living Control Systems.
Carey, TA, Mansell, W, Tai, SJ, et al (2014) Conflicted control systems: the neural architecture of trauma. Lancet Psychiatry, 1: 316–8.
Chadwick, P (2014) Mindfulness for psychosis. British Journal of Psychiatry, 204: 333–4.
de Bont, PA, van den Berg, DPG, van der Vleugel, BM, et al (2013a) A multi-site single blind clinical study to compare the effects of prolonged exposure, eye movement desensitization and reprocessing and waiting list on patients with a current diagnosis of psychosis and co morbid post traumatic stress disorder: study protocol for the randomized controlled trial Treating Trauma in Psychosis. Trials, 14: 151.
de Bont, PA, van Minnen, A, de Jongh, A (2013b) Treating PTSD in patients with psychosis: a within-group controlled feasibility study examining the efficacy and safety of evidence-based PE and EMDR Protocols. Behavior Therapy, 44: 717–30.
Fowler, D, Garety, P, Kuipers, E (1995) Cognitive Behaviour Therapy for Psychosis: Theory and Practice. John Wiley.
Freeman, D, Dunn, G, Startup, H, et al (2015) Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. Lancet Psychiatry, 2: 305–13.
Freud, S (1911) Psychoanalytic notes on an autobiographical account of a case of paranoia (dementia paranoides). Reprinted (1953-1974) in The Standard Edition of the Complete Psychological Works of Sigmund Freud (trans & ed Strachey, J), vol 12: 382. Hogarth Press.
Garety, PA, Kuipers, E, Fowler, D, et al (2001) A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31: 189–95.
Gilbert, P (2009) Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 5: 199208.
Harrison, G, Hopper, K, Craig, T, et al (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study. British Journal of Psychiatry, 178: 506–17.
Hayes, SC, Luoma, J, Bond, F, et al (2006) Acceptance and commitment therapy: model, processes, and outcomes. Behaviour Research and Therapy, 44: 125.
Heriot-Maitland, C, Vidal, JB, Ball, S, et al (2014) A compassionate-focused therapy group approach for acute inpatients: feasibility, initial pilot outcome data, and recommendations. British Journal of Clinical Psychology, 53: 7894.
Jauhar, S, McKenna, PJ, Radua, J, et al (2014) Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and metaanalysis with examination of potential bias. British Journal of Psychiatry, 204: 20–9.
Jung, CG (1911/1912) Symbols of Transformation Vol II: An Analysis of the Prelude to a Case of Schizophrenia. Reprinted (1962), trans Hull, RFC. Harper Torchbook.
Kingdon, DG, Turkington, D (1991) The use of cognitive behavioural therapy with a normalizing rationale in schizophrenia: preliminary report. Journal of Nervous and Mental Disease, 179: 207–11.
Kingdon, DG, Turkington, D (2005) Cognitive Therapy of Schizophrenia. Guilford Press.
Mayhew, SL, Gilbert, P (2008) Compassionate mind training with people who hear malevolent voices: a case series report. Clinical Psychology and Psychotherapy, 15: 113–38.
Meyer, PS (2014) Adapting a positive psychology intervention for people with schizophrenia. In The Wiley Blackwell Handbook of Positive Psychological Intervention (eds Parks, AC, Schuelller, SM): 344–57. John Wiley & Sons.
Moritz, S, Andreou, C, Schneider, BC, et al (2014) Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia. Clinical Psychology Review, 34: 358–66.
Morrison, AP (1998) A cognitive analysis of the maintenance of auditory hallucinations: are voices to schizophrenia what bodily sensations are to panic. Behavioural and Cognitive Psychotherapy, 26: 289302.
Morrison, AP (2004) The use of imagery in cognitive therapy for psychosis: a case example. Memory, 12: 517–24.
Morrison, AP, Pyle, M, Chapman, N, et al (2014) Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: a feasibility study. Journal of Behavior Therapy and Experimental Psychiatry, 45: 280–4.
Morrison, AP, Turkington, D, Pyle, M, et al (2015) Cognitive therapy for people with schizophrenia spectrum disorders not taking anti-psychotic drugs: a single-blind randomised controlled trial. Lancet, 383: 1395–405.
National Collaborating Centre for Mental Health (2014) Psychosis and Schizophrenia in Adults: the NICE Guideline on Treatment and Management - Updated Edition 2014. NCCMH.
National Institute for Health and Care Excellence (2014) Psychosis and Schizophrenia in Adults: Prevention and Management (Clinical Guideline CG178). NICE.
Powers, WT (1973) Behavior: The Control of Perception. Living Control Systems.
Read, J, van Os, J, Morrison, AP, et al (2005) Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112: 330–50.
Samarasekara, N, Kingdon, D, Skiddle, R, et al (2007) Befriending patients with medication-resistant schizophrenia: can psychotic symptoms predict treatment response. Psychology and Psychotherapy, 80: 97106.
Schrank, B, Bird, V, Tylee, A, et al (2013) Conceptualising and measuring the well-being of people with psychosis: systematic review and narrative synthesis. Social Science and Medicine, 92: 921.
Seikkula, J, Alkare, B, Aaltonen, J (2001) Open Dialogue in Psychosis II: a comparison of good and poor outcome cases. Journal of Constructivist Psychology, 14: 267–84.
Seikkula, J, Alakare, B, Aaltonen, J, et al (2003) Open Dialogue approach: treatment principles and preliminary results of a two-year follow-up on first episode schizophrenia. Ethical Human Sciences and Services, 5: 163–82.
Seikkula, J, Aaltonen, J, Alkare, B, et al (2006) Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16: 214–28.
Shapiro, F (2001) Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd edn). Guilford Press.
Tai, S (2009) Using perceptual control and method of levels to work with people who experience psychosis. Cognitive Behaviour Therapist, 2: 227–42.
van den Berg, DP, van der Gaag, M (2012) Treating trauma in psychosis with EMDR: a pilot study. Journal of Behavior Therapy & Experimental Psychiatry, 43: 664–71.
van den Berg, DP, de Bont, PA, van der Vleugel, BM, et al (2015) Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry, 72: 259–67.
van Os, J, Linscott, RJ, Myin-Germeys, I, et al (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine, 39: 179–95.
Velligan, DI, Tai, S, Roberts, DL, et al (2015) A randomised controlled trial comparing cognitive behavioural therapy, cognitive adaptation training, their combination and treatment as usual in chronic schizophrenia. Schizophrenia Bulletin, 41: 597603.
Wells, AM (2009) Metacognitive Therapy for Anxiety and Depression. Guilford Press.
White, R, Gumley, A, McTaggart, J, et al (2011) A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49: 901–7.
Wright, NP, Turkington, D, Kelly, OP, et al (2014) Treating Psychosis: A Clinician's Guide to Integrating Acceptance & Commitment Therapy, Compassion-Focused Therapy & Mindfulness Approaches within the Cognitive Behavioral Therapy tradition. New Harbinger Publications.
Wykes, T, Huddy, V, Cellard, C, et al (2011) A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry, 168: 472–85.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 85 *
Loading metrics...

Abstract views

Total abstract views: 284 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 20th May 2018. This data will be updated every 24 hours.

Psychological treatments for schizophrenia spectrum disorder: What is around the corner?

  • Douglas Turkington and Latoyah Lebert
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *