Durability of the effects of cognitive–behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up

Tarrier, Nicholas; Wittkowski, Anja; Kinney, Caroline; McCarthy, Eilis; Morris, Julie; Humphreys, Lloyd G.

doi:10.1192/bjp.174.6.500

Cited by 161 publications

(92 citation statements)

References 7 publications

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“…However, delayed or enduring effects have not been observed in other studies (Tarrier et al 1999, and the most recent meta-analysis (NICE, 2008) found effect sizes for CBT against ' active controls ' (mainly non-specific control interventions, but in one case cognitive remediation therapy) of only x0.18 (95 % CI x0.39 to +0.03, five studies) at 12-month follow-up and x0.08 (95 % CI x0.40 to +0.24, three studies) at 24 months.…”

Section: Study (1st-named Author)mentioning

confidence: 73%

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

2009

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Background. Although cognitive behavioural therapy (CBT) is claimed to be effective in schizophrenia, major depression and bipolar disorder, there have been negative findings in well-conducted studies and meta-analyses have not fully considered the potential influence of blindness or the use of control interventions.Method. We pooled data from published trials of CBT in schizophrenia, major depression and bipolar disorder that used controls for non-specific effects of intervention. Trials of effectiveness against relapse were also pooled, including those that compared CBT to treatment as usual (TAU). Blinding was examined as a moderating factor.Results. CBT was not effective in reducing symptoms in schizophrenia or in preventing relapse. CBT was effective in reducing symptoms in major depression, although the effect size was small, and in reducing relapse. CBT was ineffective in reducing relapse in bipolar disorder.Conclusions. CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates. It is effective in major depression but the size of the effect is small in treatment studies. On present evidence CBT is not an effective treatment strategy for prevention of relapse in bipolar disorder. Key words : Bipolar disorder, cognitive therapy, depression, schizophrenia. IntroductionCognitive behavioural therapy (CBT) has been widely adopted by psychiatry in recent years, but its increase in use in the severe disorders of schizophrenia, major depression and bipolar disorder is particularly noteworthy. This is because it challenges what has, until recently, been a dominance of biological approaches to these disorders. Thus, although contemporary accounts of schizophrenia (e.g. Picchioni & Murray, 2007) emphasize biological factors in its aetiology and consider neuroleptic drugs to be the mainstay of treatment, official UK treatment guidelines from the National Institute for Clinical Excellence (NICE) also state that psychological interventions are indispensable and that CBT should be offered to all patients (NICE, 2003(NICE, , 2009. Psychological factors may loom larger in the aetiology of major affective disorder, but when it comes to treatment, the emphasis in the literature, particularly in bipolar disorder, has once again been firmly on pharmacotherapy. Attitudes may be changing here too, however. References to the effectiveness of CBT are pervasive in the UK depression treatment guideline (NICE, 2004) ; a government initiative is under way in the UK to provide CBT for depression and anxiety in 250 dedicated therapy centres (Layard, 2006) ; and CBT is being advocated for relapse prevention in bipolar disorder (e.g. Scott & Colom, 2005 ;Basco & Rush, 2007).Nevertheless, a cursory look at the literature reveals well-conducted trials where CBT has had negative findings in all three disorders. For example, large-scale trials of CBT in schizophrenia have failed to find significant advantages over befriending (Sensky et al. 2000) or supportive counselling (L...

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Section: Study (1st-named Author)mentioning

confidence: 73%

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

2009

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“…Four studies 61,[70][71][72] delivered cognitive therapy during the acute/recovery phase. Three studies 65,73,74 focused on those with drug-resistant symptoms. One study 75 studied group cognitive therapy.…”

Section: Schizophreniamentioning

confidence: 99%

“…The BPRS was employed in the studies by Buchkremer and colleagues, 76 Garety and colleagues, 73 Haddock and colleagues, 70 Startup and colleagues 72 and Tarrier and colleagues. 74 The CPRS was used in the study by Sensky and colleagues. 65 The PANSS was used in the studies by Barrowclough and colleagues 68 and Lewis and colleagues.…”

Section: Schizophreniamentioning

confidence: 99%

Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland

Durham

Chambers²,

Power³

et al. 2005

Health Technol Assess

110

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“…Sensky et al (2000) found that the CBT group continued to improve on measures of positive symptoms, depression and negative symptoms. Tarrier et al (1999) reported 12-month follow-up results for CBT compared to supportive counselling (SC) or routine care (RC). Participants in CBT continued to show significant treatment effects for both positive and negative symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Four trials provide post-treatment follow-up (Kuipers et al 1998 ;Drury et al 2000 ;Sensky et al 2000;Tarrier et al 1999Tarrier et al , 2000. Kuipers et al (1998) and Sensky et al (2000) do not report relapse rates for their participants.…”

Section: Introductionmentioning

confidence: 99%

Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy

et al. 2003

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Durability of the effects of cognitive–behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up

Abstract: At 12-month follow-up the significant advantage of cognitive-behavioural therapy compared to routine care alone remained.

Cited by 161 publications

References 7 publications

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland

Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy

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