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...

This article meta-analytically reviews the research on the association between therapist positive regard (PR) and treatment outcome. The history of the construct of unconditional PR in client-centered theory and the efforts to clearly operationalize and measure this construct are reviewed. Several clinical examples are presented. The updated meta-analysis, which features expanded inclusion criteria and a larger number of studies (k ϭ 64) than previous analyses, yielded a small positive association between PR and treatment outcome, g ϭ .28. To control for the repeated use of data sets and study samples within the database, a multilevel meta-analysis was adopted that indicated a stronger relation between PR and clinical outcome (g ϭ 0.36). These analyses support PR's standing as a significant component of the therapy relationship that leads to improved clinical outcomes. The article concludes with limitations of the research, patient contributions, diversity considerations, and recommendations for using PR in practice. Clinical Impact StatementQuestion: This article addresses the following question: Aggregated over multiple studies over several decades, what association emerges between the therapist's provision of positive regard and therapeutic outcome? Findings: The findings of the meta-analysis conducted indicate that there is a small but positive relation between these variables and that no demographic or therapy-related variable significantly affects this association. Meaning: These findings suggest the importance of providing positive regard to one's patients; affirming patients may serve many valuable functions and, at a minimum, "sets the stage" for other mutative interventions. Next Steps: Research is needed to determine what specific forms of positive regard, including verbal and nonverbal expressions, have which kinds of effects for which kinds of patients at which points in therapy.

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Introduction The COVID-19 crisis and subsequent stay-at-home orders have produced unprecedented challenges to the dissemination of recovery oriented behavioral health services (RS) that support the treatment of those with complex psychosis (CP).This population has typically been managed with in-person pharmacotherapy and/or RS, with the goals of relieving symptoms, improving life satisfaction and increasing community engagement. COVID-19 related social distancing measures have required rapid shifts in care management, while easing of telehealth regulations has allowed for flexibility to approach RS differently. It is essential to learn from the RS telemedicine implementation experience, so that RSs can maintain care for this vulnerable and needy population. Method This paper describes the successful telehealth conversion of a NYC-based, university affiliated RS that serves adults with severe mental illnesses (SMI; n = 64). Results focus on the telehealth acceptance rates of the subset of participants with CP ( n = 23). Results The RS continued providing services including intake, care coordination, group psychotherapies, skills training groups, individual skills coaching, and vocational/educational supports. The telehealth conversion rates of the CP subsample indicated that 90% of CP patients accepted telehealth sessions and maintained their specific treatment plans in the virtual format. Mean comparisons between session attendance and cancellations/no-shows during the six-week period before and after telehealth conversion showed no significant differences in service utilization. Discussion RSs play an essential role in the treatment of CP and telehealth may prove to be a viable format of care delivery even after the COVID-19 crisis subsides. The multiple factors in the inner and outer treatment setting that contributed to successful conversion to telehealth will be considered along with the challenges that clinicians and patients encountered.

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