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

Garety, Philippa; Fowler, David; Kuipers, Elizabeth; Freeman, Daniel; Dunn, Graham; Bebbington, P; Hadley, Clare; Jones, Steven

doi:10.1192/bjp.171.5.420

Cited by 268 publications

(141 citation statements)

References 17 publications

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“…We would also highlight two other factors that have received less experimental attention. First, we have obtained evidence that a lack of belief flexibility (the willingness to consider alternatives to delusional beliefs) is associated with poorer outcome, independent of the severity of the delusion (Garety et al 1997). Secondly, the normal belief confirmation bias is likely to maintain psychotic beliefs (Maher, 1974).…”

Section: A Cognitive Model Of Psychosismentioning

confidence: 98%

“…Standard assessments of insight are only modestly correlated with outcome (David, 1998). However, insight is correlated with the ' belief maintenance ' subscale of the Maudsley Assessment of Delusions, and improved outcome for delusions in response to CBT is associated with and predicted by changes in the MADS subscale (Garety et al 1997). Also important are appraisals of the experience of chronic mental illness as stigmatizing and humiliating, appraisals which may influence the development of depression (Birchwood & Iqbal, 1998).…”

Section: Dysfunctional Schemas and Adverse Social Environmentsmentioning

confidence: 99%

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A cognitive model of the positive symptoms of psychosis

et al. 2001

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In the last 10 years a consensus has developed that the symptoms of psychosis may be better understood by linking the steps between the phenomenological experiences and social, psychological and neurobiological levels of explanation. Cognitive models of psychosis are an important link in this chain. They provide a psychological description of the phenomena from which hypotheses concerning causal processes can be derived and tested; social, individual, and neurobiological factors can then be integrated via their impact on these cognitive processes. In this paper, we set out the cognitive processes that we think lead to the formation and maintenance of the positive symptoms of psychosis and we attempt to integrate into our model research in social factors. If this model proves useful, a fuller integration with the findings of biological research will be required (Frith, 1992).

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Section: A Cognitive Model Of Psychosismentioning

confidence: 98%

Section: Dysfunctional Schemas and Adverse Social Environmentsmentioning

confidence: 99%

A cognitive model of the positive symptoms of psychosis

et al. 2001

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“…The present study, as well as one other study of CBT for psychosis (Leclerc et al 2000), found that neuropsychological impairment did not significantly moderate outcome in CBT relative to standard care. Further, more severe neuropsychological impairment was associated with better symptom outcome in another study of CBT for psychosis (Garety et al 1997). Published research, therefore, has provided no support for the assumption that people with neuropsychological impairment should be excluded from CBT for psychosis.…”

Section: Discussionmentioning

confidence: 96%

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…One study of CBT for psychosis (Leclerc et al 2000) found that attention and learning and memory did not moderate outcome in CBT relative to standard care. Another study of CBT for psychosis (Garety et al 1997), found that only one of four neuropsychological tests was a significant moderator of symptom outcome, but the finding was counter-intuitive: More severe neuropsychological impairment was associated with better symptom outcome.We developed a group therapy intervention for functional impairment in schizophrenia that combined CBT and SST called, Cognitive Behavioral Social Skills Training (CBSST) McQuaid et al 2000). By adding CBT to SST, thoughts that interfere with skill performance in the real world (e.g., low self-efficacy, expectancy and ability beliefs) can be addressed in therapy.…”

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confidence: 99%

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Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Granholm

McQuaid

Link

et al. 2008

Schizophrenia Research

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Cognitive Behavioral Social Skills Training (CBSST) is a 24-session weekly group therapy intervention to improve functioning in people with schizophrenia. In our prior randomized clinical trial comparing treatment as usual (TAU) with TAU plus group CBSST (Granholm et al. 2005), participants with schizophrenia in CBSST showed significantly better functional outcome than participants in TAU. The present study was a secondary analysis of neuropsychological predictors of functional outcome in our prior CBSST trial. We examined (1) whether neuropsychological impairment at baseline moderated functional outcome in CBSST relative to TAU, and (2) whether improvement in neuropsychological abilities mediated improvement in functional outcome in CBSST. Attention, verbal learning/memory, speed of processing, and executive functions were assessed at baseline, end of treatment, and 12-month follow-up. Greater severity of neuropsychological impairment at baseline predicted poorer functional outcome for both treatment groups (nonspecific predictor), but the interaction between severity of neuropsychological impairment and treatment group was not significant (no moderation). Effect sizes for the difference between treatment groups on functional outcome measures at 12-month follow-up were similar for participants with relatively mild (d=.44-.64) and severe (d=.29-.60) neuropsychological impairment. Results also did not support the hypothesis that improvement in neuropsychological abilities mediated improvement in functioning in CBSST. Adding CBSST to standard pharmacologic care, therefore, improved functioning relative to standard care alone, even for participants with severe neuropsychological impairment, and this improvement in functioning was not related to improvement in neuropsychological abilities in CBSST. KeywordsSchizophrenia; cognitive behavior therapy; social skills training; neuropsychological impairment; functioning Please address all correspondence to: Eric Granholm, Ph.D., VA San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA 92161, Phone: (858) 552-8585 x 7768, FAX: (858) 642-6416, Email: egranholm@ucsd.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThere is considerable evidence that neuropsychological impairment is associated with poor functioning in people with schizophrenia (Bowen et al. 1994;Green et al. 2000;Kern et al. 1992;Lysaker et al. 1995;McKee et al. 1997;Penn et al. 1995). Neuropsychological impairment is also a strong predictor ...

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Towards an integrated psychotherapeutic approach in psychosis: three case studies

Rothwell¹,

Duffy

1999

Clin. Psychol. Psychother.

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Whilst there are now controlled studies supporting the effectiveness of cognitive behaviour therapy in psychosis, the effective components of the therapy are unclear. It is possible that certain core factors may have a central role in effectiveness. Integrative models of therapy typically consist of such factors in the form of a list of clinical strategies. A similar format is used here to develop an empirically derived, integrative approach to therapy with clients who have been diagnosed as psychotic. The approach is illustrated by three case studies of individuals with a long history of schizophrenia and poor response to psychotropic medication. These also provide a preliminary evaluation. Using the SCL-90-R as the outcome measure, the clients each reported a symptom reduction of around 50% after 50±80 sessions of therapy, which was maintained at 10 month follow-up. Factor scores of the SCL-90-R are used to examine differences in the change processes of the three people. The generalizability and limitations of this study are discussed.

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

Abstract: Good outcome is strongly predicted in patients with persistent delusions by a cognitive measure, while this was not the case in controls. Thus we argue that positive outcome in CBT is due in part to specific effects on delusional thinking.

Cited by 268 publications

References 17 publications

A cognitive model of the positive symptoms of psychosis

A cognitive model of the positive symptoms of psychosis

Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Towards an integrated psychotherapeutic approach in psychosis: three case studies

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