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London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis

I: Effects of the treatment phase

Published online by Cambridge University Press:  03 January 2018

Elizabeth Kuipers*
Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF
Philippa Garety
United Medical and Dental School, Department of Psychology, St Thomas' Hospital, London SEI
David Fowler
School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
Graham Dunn
School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester
Paul Bebbington
University College London, Archway Wing 1st Floor, Whittington Hospital, Highgate Hill, London NI9 5NF
Daniel Freeman
Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF
Clare Hadley
Department of Clinical Psychology, Leeds University, 15 Hyde Terrace, Leeds LS2 9LT
Dr E. Kuipers, Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF



A series of small, mainly uncontrolled, studies have suggested that techniques adapted from cognitive–behavioural therapy (CBT) for depression can improve outcome in psychosis, but no large randomised controlled trial of intensive treatment for medication-resistant symptoms of psychosis has previously been published.


Sixty participants who each had at least one positive and distressing symptom of psychosis that was medication-resistant were randomly allocated between a CBT and standard care condition (n=28) and a standard care only control condition (n=32). Therapy was individualised, and lasted for nine months. Multiple assessments of outcome were used.


Over nine months, improvement was significant only in the treatment group, who showed a 25% reduction on the BPRS. No other clinical, symptomatic or functioning measure changed significantly. Participants had a low drop-out rate from therapy (11%), and expressed high levels of satisfaction with treatment (80%). Fifty per cent of the CBT group were treatment responders (one person became worse), compared with 31% of the control group (three people became worse and another committed suicide)


CBT for psychosis can improve overall symptomatology. The findings provide evidence that even a refractory group of clients with a long history of psychosis can engage in talking about psychotic symptoms and their meaning, and this can improve outcome.

Copyright © 1997 The Royal College of Psychiatrists 

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