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

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          Abstract

          Background

          A randomised controlled trial of cognitive — behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline.

          Method

          Forty-seven (78% of original n=60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed.

          Results

          Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CB Tappear to have been offset by reductions in service utilisation and associated costs during follow-up.

          Conclusions

          Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.

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          Most cited references9

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          Assessment of insight in psychosis.

          X F Amador, D H Strauss, S A Yale … (1993)
          It is frequently reported that patients with psychotic disorders have poor insight into their illness. Previous research has suggested that poor insight may have considerable power in predicting the long-term course of chronic mental disorders and an impact on patients' compliance with treatment plans. The authors, proposing that insight is best viewed as a multidimensional phenomenon, developed the Scale to Assess Unawareness of Mental Disorder, which samples discrete and global aspects of insight across a variety of manifestations of illness. This article reports on a reliability and validity study of the scale. The study subjects were 43 patients with schizophrenia and schizoaffective disorder. Various aspects of insight into illness were evaluated with the scale. In addition, ratings of psychopathology, course of illness, and compliance with treatment were made. Item variability was high and normally distributed, supporting the authors' contention that insight can be rated on a continuous rather than dichotomous scale. Results of the analyses examining the relations between the various dimensions of insight assessed and the psychopathology, course, and compliance variables were generally as hypothesized. Convergent validity with other global measures of insight was found, and aspects of poor insight were correlated with poorer compliance and course of illness. Examination of the interrelations among the four insight subscales revealed that these subscales sample independent phenomena. The Scale to Assess Unawareness of Mental Disorder has good reliability and validity and has certain advantages over previous measures of insight, suggesting the usefulness of a multidimensional view of this complex concept.
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            Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial

            Ray Cochrane, Max Birchwood, Val Drury … (1996)
            The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms. Of 117 patients with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months. Both groups showed a decline in positive symptoms but this was more marked in the CT group ( P < 0.001). At 9 months 5% of the CT group, v. 56% of the control group, showed moderate or severe residual symptoms. CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.
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              London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis

              Daniel Freeman, Graham Dunn, Elizabeth Kuipers … (1997)
              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.
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                Author and article information

                Journal
                Journal ID (publisher-id): applab
                Title: British Journal of Psychiatry
                Abbreviated Title: Br J Psychiatry
                Publisher: Royal College of Psychiatrists
                ISSN (Print): 0007-1250
                ISSN (Electronic): 1472-1465
                Publication date Created: July 1998
                Publication date (Print): January 2 2018
                Volume: 173
                Issue: 01
                Pages: 61-68
                Article
                DOI: 10.1192/bjp.173.1.61
                SO-VID: 139c952e-bfd9-4d34-952b-e4ddb8bd7379
                Copyright © © 2018
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