Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial

Abstract

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.

Cognitive Behaviour Therapy for Schizophrenia – A Review of Development, Evidence and Implementation

“…Although there were differences between the CBT and control group over 2-year follow-up, including a lower percentage of relapses, time to relapse and days spent in hospital, these differences were not statistically significant. It is possible that the results reported by Drury et al [40, 41 ]were over-optimistic, resulting from an inflated effect size due to inadequate methodology. In spite of these potential difficulties, the study by Drury et al [40, 41] established that CBT could be carried out even with those who were most severely ill, a fact confirmed by Haddock et al [46].…”

“…It is possible that the results reported by Drury et al [40, 41 ]were over-optimistic, resulting from an inflated effect size due to inadequate methodology. In spite of these potential difficulties, the study by Drury et al [40, 41] established that CBT could be carried out even with those who were most severely ill, a fact confirmed by Haddock et al [46]. This finding stimulated the Study of Cognitive Reality Alignment Therapy in Early Schizophrenia (SoCRATES) [49, 61] which tested whether CBT delivered during admission for an acute episode of early (first or second episode) schizophrenia would speed recovery and confer resistance to subsequent relapse.…”

“…In a 5-year follow-up of their sample, the CBT group reported less residual symptomatology than the activity control group although there was no difference in positive symptoms as a whole [60]. Haddock et al [46] attempted to reproduce the results of Drury et al [40, 41], with a sample size based upon the reported effect size from the study by Drury et al [40, 41]. There were a number of methodological improvements in the study by Haddock et al [46].…”

“…Drury et al [40, 41] reported on a very innovative approach and demonstrated that CBT reduced recovery time by 25–50% and produced significant clinical benefits in terms of reduced symptomatology. In a 5-year follow-up of their sample, the CBT group reported less residual symptomatology than the activity control group although there was no difference in positive symptoms as a whole [60].…”

Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions

“…They found a significant improvement on the PANSS negative symptom scale for both CBT and CR treatments, with no between-group differences, suggesting that both interventions were effective. Drury, Birchwood, Cochrane, and Macmillan (1996) found that people randomly assigned to either group and individual cognitive therapy, or recreation and support therapy (an active control designed to match therapist hours and provide structured activities and informal support) showed comparable improvement in negative symptoms as measured by the Psychiatric Assessment Scale (PAS; Krawiecka, Goldberg, & Vaughan, 1977) after treatment and at the nine month follow-up. Finally, Lewis et al (2002) randomly assigned people in their first or second acute hospital admission for psychosis to five weeks of individual CBT or supportive counseling (a manualized control therapy matched for therapist exposure) and found that those who received CBT had a significant improvement in overall symptoms at post-intervention (negative symptoms results were not reported) compared to those who received TAU (unspecified across participants with the exception that it always included medication and day or inpatient treatment.…”