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London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis: I: Effects of the treatment phase

  • Elizabeth Kuipers (a1), Philippa Garety (a2), David Fowler (a3), Graham Dunn (a4), Paul Bebbington (a5), Daniel Freeman (a1) and Clare Hadley (a6)...

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.

Copyright

Corresponding author

Dr E. Kuipers, Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF

References

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Amador, X. F., Strauss, D. H., Yale, S. A., et al (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873879.
Amarican Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Ammons, R. B. & Ammons, C. H. (1962) Quick Test. Missoula. MT: Psychological Test Specialists.
Back, A. T. (1952) Successful outpatient psychotherapy with a schizophrenic with a delusion based on borrowed guilt. Psychiatry. 15, 305312.
Beck, A. T., Rush, A. J., Shaw, B. F., et al (1979) Cognitive Therapy of Depression. New York: Guilford Press.
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.
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.
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.
Bellow, M. (1990) Information Processing Biases and Depression. University of Keele, unpublished PhD thesis.
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.
Birchwood, M., Smith, J., Cochrane, R., et al (1990) The social functioning scale. British Journal of Psychiatry, 157, 853859.
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.
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.
Brett-Jones, J., Garety, P. A. & Hemsley, D. (1987) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 257265.
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.
Chadwick, P. D. J. & Lowe, C. F. (1990) Measurement and modification of delusional beliefs. Journal of Consulting and Clinical Psychology. 58, 225232.
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.
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.
Fowler, D. Morley, S. (1989) The cognitive behavioural treatment of hallucinations and delusions: a preliminary study. Behavioural Psychotherapy, 17, 267282.
Fowler, D., Garety, P. A. & Kuipers, L. (1995) Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Chichester: Wiley.
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.
Garety, P., Kuipers, L., Fowler, D., et al (1994) Cognitive behavioural therapy for drug-resistant psychosis. British Journal of Medical Psychology, 67, 259271.
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.
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.
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.
Jaspers, K. (1963) General Psychopathology (trans. Hoenig, J. & Hamilton, M.). Manchester: Manchester University Press.
Kane, J. M. (1996) Treatment resistant schizophrenic patients. Journal of Clinical Psychiatry, 57 (suppl. 9). 3540.
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.
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.
Kemp, R., Hayward, P., Applewhaite, G., et al (1996) Compliance therapy in psychotic patients: random controlled trial. British Medical Journal, 312, 345349.
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.
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.
Nelson, H. E. (1982) The National Adult Reading Test. Windsor. Berkshire: NFER–Nelson.
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports. 10, 799812.
Pocock, S. (1983) Clinical Trials. Chichester: Wiley.
Robson, P. (1989) Development of a new self-report questionnaire to measure self esteem. Psychological Medicine, 19, 513518.
Shallice, T. & Evans, M. (1978) The involvement of the frontal lobes in cognitive estimation. Cortex, 14, 292303.
Shapiro, D. A. (1996) Outcome research. In Behavioural and Mental Health Research (2nd edn) (eds Parry, G. & Watts, F.). Hove: Lawrence Erlbaum.
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.
Watts, F. N., Powell, G. E. & Austin, S. V. (1973) The modification of abnormal beliefs. British Journal of Medical Psychology. 46, 359363.
Williams, J. M. G. (1992) The Psychological Treatment of Depression. A Guide to Theory and Practice of Cognitive Behaviour Therapy London: Routledge.
Williams, J. M. G. Dritschel, B. H. (1988) Emotional disturbance and the specificity of autobiographical memory. Cognition and Emotion, 2, 221234.
World Health Organization (1992) SCAN Schedules for Clinical Assessment in Neuropsychiatry Geneva: WHO.
Young, J. (1990) Cognitive Therapy for Personality Disorder. Sarasota. FL: Professional Resource Exchange Inc.

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London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis: I: Effects of the treatment phase

  • Elizabeth Kuipers (a1), Philippa Garety (a2), David Fowler (a3), Graham Dunn (a4), Paul Bebbington (a5), Daniel Freeman (a1) and Clare Hadley (a6)...
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