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

Abstract

Background

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.

Method

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.

Results

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)

Conclusions

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.

Type
Papers
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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References

Amador, X. F., Strauss, D. H., Yale, S. A., et al (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873879.Google ScholarPubMed
Amarican Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google ScholarPubMed
Ammons, R. B. & Ammons, C. H. (1962) Quick Test. Missoula. MT: Psychological Test Specialists.Google Scholar
Back, A. T. (1952) Successful outpatient psychotherapy with a schizophrenic with a delusion based on borrowed guilt. Psychiatry. 15, 305312.CrossRefGoogle Scholar
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.CrossRefGoogle ScholarPubMed
Beck, A. T., Waissman, A. W., Lester, D., et al (1974) The assessment of pessimism: the Hopelessness Scale. Journal of Consulting and Clinical Psychology 42, 861865.CrossRefGoogle Scholar
Beck, A. T., Epstein, N., Brown, G., et al (1988) An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897.CrossRefGoogle ScholarPubMed
Bellow, M. (1990) Information Processing Biases and Depression. University of Keele, unpublished PhD thesis.Google Scholar
Birchwood, M. (1996) Early intervention in psychotic relapse: cognitive approaches to detection and management. In Cognitive – behavioural Interventions with Psychotic Disorders (eds Haddock, G. & Slade, P.). pp. 171211. London: Routledge.Google Scholar
Birchwood, M., Smith, J., Cochrane, R., et al (1990) The social functioning scale. British Journal of Psychiatry, 157, 853859.CrossRefGoogle ScholarPubMed
Bouchard, S., Valleves, A., Ray, M., et al (1996) Cognitive restructuring in the treatment of psychotic symptoms in schizophrenia: a critical analysis. Behaviour Therapy, 27, 257277.CrossRefGoogle Scholar
Breier, A., Buchanan, R. W., Kirkpatrick, B., et al (1994) Effects of clozapine on positive and negative symptoms in outpatients with schizophrenia. American Journal of Psychiatry, 151, 2026.Google ScholarPubMed
Brett-Jones, J., Garety, P. A. & Hemsley, D. (1987) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 257265.CrossRefGoogle ScholarPubMed
Buchanan, A., Reed, A., Wsssely, S., et al (1993) Acting on delusions. 2: The phenomenological correlates of acting on delusions. British Journal of Psychiatry, 163, 7781.CrossRefGoogle Scholar
Chadwick, P. D. J. & Lowe, C. F. (1990) Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology. 58, 225232.CrossRefGoogle ScholarPubMed
Drury, V., Birchwood, M., Cochrane, R., et al (1996) Cognitive therapy and recovery from acute psychosis: a controlled trial. I: Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593601.CrossRefGoogle Scholar
Fowler, D. (1992) Cognitive behaviour therapy in the management of patients with schizophrenia: preliminary studies. In Psychotherapy of Schizophrenia: Facilitating and Obstructive Factors (eds Werbart, A. & Cullberg, J.), pp. 145153. Oslo: Scandinavian University Press.Google Scholar
Fowler, D. Morley, S. (1989) The cognitive behavioural treatment of hallucinations and delusions: a preliminary study. Behavioural Psychotherapy, 17, 267282.CrossRefGoogle Scholar
Fowler, D., Garety, P. A. & Kuipers, L. (1995) Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Chichester: Wiley.Google Scholar
Garety, P. A., Hemsley, D. R. & Wessely, S. (1991) Reasoning in deluded schizophrenic and paranoid patients: biases in performance on a probabilistic inference task. Journal of Nervous and Mental Disease, 179, 194201.CrossRefGoogle ScholarPubMed
Garety, P., Kuipers, L., Fowler, D., et al (1994) Cognitive behavioural therapy for drug-resistant psychosis. British Journal of Medical Psychology, 67, 259271.CrossRefGoogle ScholarPubMed
Garety, P., Fowler, I. X., Kuipers, E., et al (1997) The London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis. II: Predictors of outcome in CBT for psychosis. British Journal of Psychiatry, 171, in press.CrossRefGoogle Scholar
Haddock, G., Bentall, R. P. & Slade, P. D. (1996) Psychological treatment of auditory hallucinations: focusing or distraction? In Cognitive–Behavioural Interventions with Psychotic Disorders (eds Haddock, G. & Slade, P.). pp. 4570. London: Routledge.Google Scholar
Hustig, H. H. & Hafner, R. J. (1990) Persistent auditory hallucinations and their relationship to delusions and mood. Journal of Nervous and Mental Disease, 178, 264267.CrossRefGoogle Scholar
Jaspers, K. (1963) General Psychopathology (trans. Hoenig, J. & Hamilton, M.). Manchester: Manchester University Press.Google Scholar
Kane, J. M. (1996) Treatment resistant schizophrenic patients. Journal of Clinical Psychiatry, 57 (suppl. 9). 3540.Google ScholarPubMed
Kane, J. M., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic: a double blind comparison with chtorpromazine. Archives of General Psychiatry, 45, 789796.CrossRefGoogle Scholar
Kingdon, D. G. & Turkington, D. (1991) The use of cognitive behaviour therapy with a normalising rationale in schizophrenia. Journal of Nervous and Mental Disease, 179, 207211.CrossRefGoogle Scholar
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: random controlled trial. British Medical Journal, 312, 345349.CrossRefGoogle Scholar
Matthews, J. N. S., Altman, D. G., Campbell, M. J., et al (1990) Analysis of serial measurements in medical research. British Medical Journal, 300, 230235.CrossRefGoogle ScholarPubMed
Miller, E. (1984) verbal fluency as a function of a measure of verbal intelligence and in relation to different types of cerebral pathology. British Journal of Clinical Psychology 23, 5357.CrossRefGoogle ScholarPubMed
Nelson, H. E. (1982) The National Adult Reading Test. Windsor. Berkshire: NFER–Nelson.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports. 10, 799812.CrossRefGoogle Scholar
Pocock, S. (1983) Clinical Trials. Chichester: Wiley.Google ScholarPubMed
Robson, P. (1989) Development of a new self-report questionnaire to measure self esteem. Psychological Medicine, 19, 513518.CrossRefGoogle ScholarPubMed
Shallice, T. & Evans, M. (1978) The involvement of the frontal lobes in cognitive estimation. Cortex, 14, 292303.CrossRefGoogle ScholarPubMed
Shapiro, D. A. (1996) Outcome research. In Behavioural and Mental Health Research (2nd edn) (eds Parry, G. & Watts, F.). Hove: Lawrence Erlbaum.Google Scholar
Tarrier, N., Beckett, R., Harwood, S., et al (1993) A trial of two cognitive–behavioural methods of treating drug-resistant psychotic symptoms in schizophrenic patients. I: Outcome. British Journal of Psychiatry 162, 524532.CrossRefGoogle ScholarPubMed
Watts, F. N., Powell, G. E. & Austin, S. V. (1973) The modification of abnormal beliefs. British Journal of Medical Psychology. 46, 359363.CrossRefGoogle ScholarPubMed
Williams, J. M. G. (1992) The Psychological Treatment of Depression. A Guide to Theory and Practice of Cognitive Behaviour Therapy London: Routledge.Google Scholar
Williams, J. M. G. Dritschel, B. H. (1988) Emotional disturbance and the specificity of autobiographical memory. Cognition and Emotion, 2, 221234.CrossRefGoogle Scholar
World Health Organization (1992) SCAN Schedules for Clinical Assessment in Neuropsychiatry Geneva: WHO.Google ScholarPubMed
Young, J. (1990) Cognitive Therapy for Personality Disorder. Sarasota. FL: Professional Resource Exchange Inc.Google Scholar
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