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The future of cognitive-behavioural therapy for psychosis: not a quasi-neuroleptic

  • Max Birchwood (a1) and Peter Trower (a2)
Summary

Some 20 trials of cognitive-behavioural therapy (CBT) for psychosis have re-established psychotherapy as a credible treatment for psychosis. However, it is not without its detractors and problems, including uncertainty about the nature of its active ingredients. We believe that the way forward is to abandon the neuroleptic metaphor of CBT for psychosis and to develop targeted interventions that are informed by the growing understanding of the interface between emotion and psychosis.

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Copyright
Corresponding author
Professor Max J. Birchwood, Director, Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Trust, Harry Watton House, 97 Church Lane, Aston, Birmingham B6 5UG, UK. E-mail: m.j.birchwood.20@bham.ac.uk
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Declaration of Interest

None.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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The future of cognitive-behavioural therapy for psychosis: not a quasi-neuroleptic

  • Max Birchwood (a1) and Peter Trower (a2)
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eLetters

Participation in CBT for Psychosis Treatments

Keith J Gaynor, Psychology
10 February 2006

Keith Gaynor School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland

Barbara DooleySchool of Psychology, University College Dublin Belfield, Dublin 4, Ireland

Eadbhard O’Callaghan(i) DELTA/DETECT, Psychosis Early Intervention Service, Dun Laoghaire, Co.Dublin, Ireland. (ii) School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland. (iii) St John of God Hospital, Stillorgan, Co. Dublin

Elizabeth LawlorDELTA/DETECT, Psychosis Early Intervention Service, Dun Laoghaire, Co. Dublin, Ireland

Declaration of Interest: Keith Gaynor is funded by the Irish ResearchCouncil for the Humanities and Social Sciences as a Government of Ireland Scholar.

Birchwood & Trower (2006) called on researchers to try to identify the active agents in CBT for psychosis and to look at ways of increasing its effectiveness. They list a number of interesting and usefulareas for further study. A key area which was not included in the list, iswhy so many potential therapy candidates do not participate in therapy at all. We believe that this, the engagement process, merits consideration.

Our own experience in conducting a RCT is that it is very difficult to recruit people with first episode psychosis to participate in psychological treatments. Yet, once people do engage they seem to embrace it whole-heartedly and others report similar findings as evidenced by the low drop out rates. Although disappointing, the level of refusal for psychological interventions should be seen in the light of other treatments for psychosis. For example, Lieberman et al’s (2005) RCT of atypical anti-psychotics had a 74% dropout rate over 18 months.

While the debate regarding the effect size of psychological treatments is undoubtedly important; given the low level of engagement, perhaps we need to evaluate the methods we use to engage patients with psychosis in psychological therapy. Other disciplines have investigated recruitment and engagement techniques. For example, in gynaecology, Wiemann et al, (2005) proposed 8 techniques for increasing recruitment among a high-drop out subgroup. Reviews such as Bryant and Powell (2005) that looks at recruitment incentives for staff or Edwards et al, (2002) that looks at response rates to postal questionnaires are early models of a potentially new area of research.

There is a need to engage, motivate and interest psychosis patients in their own care. Perhaps, we need studies of the reasons why people choose to participate or not in psychological therapies. The role of the public understanding of psychiatric illness in the engagement process might be a good place to start.

ReferencesBirchwood, M. & Trower, P. (2006) The future of cognitive behavioural therapy forpsychosis: not a quasi-neuroleptic. British Journal of Psychiatry, 188, 107-108

Bryant, J. & Powell, J. (2005) Payment to healthcare professionals for patient recruitment to trials: a systematic review. British Medical Journal,10,331(7529), 1377-1378.

Edwards, P., Roberts, I., Clarke, M., DiGuiseppi, C., Pratap, S., Wentz, R. & Kwan, I.(2002) Increasing response rates to postal questionnaires: systematic review.British Medical Journal, 18, 324(7347), 1183.

Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A.,Perkins, D. O., Keefe, R. S. E., Davis, S. M., Davis, C.E., Lebowitz, B. D.,Severe, J., Hsiao, J. K. (2005) Effectiveness of Antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353,1209-1223.

Wiemann, C. M., Chacko, M. R., Tucker, J. C., Velasquez, M. M., Smith, P. B.,Diclemente R. J. & von Sternberg, K. (2005) Enhancing recruitment and retention of minority young women in community-based clinical research. Journal of Paediatric Adolescent Gynaecology, 18 (6), 403-407.
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