BackgroundEvidence for the efficacy of cognitive–behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited.AimsTo test the effectiveness of cognitive–behavioural therapy delivered by clinical nurse specialists in routine practice.MethodOf 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive–behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months.ResultsTreatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%).ConclusionsCognitive–behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis.
Cognitive behaviour therapy (CBT) for generalized anxiety disorder produces variable results. It would be valuable to identify which patients respond well to brief CBT and whether increased intensity of therapy improves outcome for those with a poor prognosis. This clinical effectiveness study was designed to address these issues using a prognostic index developed from earlier research. Suitable patients were given five sessions of CBT if they had a good prognosis and either 9 or 15 sessions of CBT if they had a poor prognosis. There was no evidence that increasing the intensity of therapy for poor prognosis patients improved outcome and 60% remained cases at 6 month follow-up. In contrast, only 12% of good prognosis patients remained cases at follow-up despite receiving only brief therapy. Patient characteristics are a more powerful influence on outcome than the length of therapy. Prognostic indices may have an important place in routine clinical practice.
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