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Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial

  • A. P. Morrison (a1) (a2), P. Hutton (a2), M. Wardle (a2), H. Spencer (a3) (a4), S. Barratt (a2), A. Brabban (a5) (a6), P. Callcott (a3), T. Christodoulides (a3), R. Dudley (a3) (a4), P. French (a2), V. Lumley (a5), S. J. Tai (a1) and D. Turkington (a3) (a4)
  • DOI:
  • Published online: 14 September 2011

Although antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.


Twenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.


T tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment; d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.


This study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.

Corresponding author
*Address for correspondence: Professor A. P. Morrison, School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email:
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T Christodoulides , R Dudley , S Brown , D Turkington , AT Beck (2008). Cognitive behaviour therapy in patients with schizophrenia who are not prescribed antipsychotic medication: a case series. Psychology and Psychotherapy: Theory, Research and Practice 81, 199207.

J Cohen (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ.

G Haddock , J McCarron , N Tarrier , EB Faragher (1999). Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptoms Rating Scales (PSYRATS). Psychological Medicine 29, 879889.

RM Hamer , PM Simpson (2009). Last observation carried forward versus mixed models in the analysis of psychiatric clinical trials. American Journal of Psychiatry 166, 639641.

B-C Ho , NC Andreasen , S Ziebell , R Pierson , V Magnotta (2011). Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia. Archives of General Psychiatry 68, 128137.

SR Kay , A Fiszbein , LA Opler (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.

SR Kay , LA Opler , A Fiszbein (1988). Reliability and validity of the Positive and Negative Syndrome Scale for schizophrenics. Psychiatry Research 23, 276286.

JP Lacro , LB Dunn , CR Dolder (2002). Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. Journal of Clinical Psychiatry 63, 892909.

S Leucht , C Corves , D Arbter , RR Engel , C Li , JM Davis (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 373, 3141.

S Leucht , W Kissling , JM Davis (2010). The PANSS should be rescaled. Schizophrenia Bulletin 36, 461462.

JA Lieberman , TS Stroup , JP McEvoy , M Swartz , R Rosenheck , D Perkins , RS Keefe , S Davis , C Davis , B Lebowitz , JB Severe , JK Hsiao (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 12091223.

J Moncrieff , D Cohen , JP Mason (2009). The subjective experience of taking antipsychotic medication: a content analysis of Internet data. Acta Psychiatrica Scandinavica 120, 102111.

PL Morosini , L Magliano , L Brambilla , S Ugolini , R Pioli (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323329.

AP Morrison (2001 a). Cognitive therapy for auditory hallucinations as an alternative to antipsychotic medication: a case series. Clinical Psychology and Psychotherapy 8, 136147.

AP Morrison (2001 b). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29, 257276.

AP Morrison , S Barratt (2010). What are the components of CBT for psychosis? A Delphi study. Schizophrenia Bulletin 36, 136142.

AP Morrison , P French , L Walford , SW Lewis , A Kilcommons , J Green , S Parker , RP Bentall (2004 a). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry 185, 291297.

ST Neil , M Kilbride , L Pitt , M Welford , S Nothard , W Sellwood , AP Morrison (2009). The Questionnaire about the Process of Recovery (QPR): a research instrument developed in collaboration with service users. Psychosis 1, 145155.

GS Owens , G Richardson , AS David , G Szmukler , P Hayward , M Hotopf (2008). Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. British Medical Journal 337, 448.

DO Perkins (2002). Predictors of noncompliance in patients with schizophrenia. Journal of Clinical Psychiatry 63, 11211128.

S Pilling , PE Bebbington , E Kuipers , PA Garety , J Geddes , G Orbach , C Morgan (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine 32, 763782.

WA Ray , CP Chung , KT Murray , K Hall , M Stein (2009). Atypical antipsychotic drugs and the risk of sudden cardiac death. New England Journal of Medicine 360, 225235.

KL Subotnik , KH Nuechterlein , J Ventura , MJ Gitlin , S Marder , J Mintz , GS Hellemann , LA Thornton , IR Singh (2011). Risperidone nonadherence and return of positive symptoms in the early course of schizophrenia. American Journal of Psychiatry 168, 286292.

C Tam , S Law (2007). Best practices: a systematic approach to the management of patients who refuse medications in an assertive community treatment team setting. Psychiatric Services 58, 457459.

R Tandon , RH Belmaker , WF Gattaz , JJ Lopez-Ibor Jr., A Okasha , B Singh , DJ Stein , JP Olie , WW Fleischhacker , HJ Moeller (2008). World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophrenia Research 100, 2038.

K Villeneuve , S Potvin , A Lesage , L Nicole (2010). Meta-analysis of rates of drop-out from psychosocial treatment among persons with schizophrenia spectrum disorder. Schizophrenia Research 121, 266270.

T Wykes , C Steel , B Everitt , N Tarrier (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523537.

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Psychological Medicine
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