These findings demonstrate the effectiveness of a program of routine care integrated with motivational interviewing, cognitive behavior therapy, and family intervention over routine psychiatric care alone for patients with comorbid schizophrenia and alcohol or drug abuse or dependence.

Objectives: To investigate whether intensive cognitive behaviour therapy results in significant improvement in positive psychotic symptoms in patients with chronic schizophrenia. Design: Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms and sex, to intensive cognitive behaviour therapy and routine care, supportive counselling and routine care, and routine care alone. Setting: Adjunct treatments were carried out in outpatient clinics or in the patient's home. Subjects: 87 patients with persistent positive symptoms who complied with medication; 72 completed treatment. Outcome measures: Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Number of patients who showed a 50% or more improvement in symptoms. Exacerbation of symptoms and rates of readmission to hospital. Results: Significant improvements were found in the severity (F = 5.42, df = 2,86; P = 0.006) and number (F = 4.99, df = 2,86; P = 0.009) of positive symptoms in those treated with cognitive behaviour therapy. The supportive counselling group showed a non-significant improvement. Significantly more patients treated with cognitive behaviour therapy showed an improvement of 50% or more in their symptoms ( 2 = 5.18, df = 1; P = 0.02). Logistic regression indicated that receipt of cognitive behaviour therapy results in almost eight times greater odds (odds ratio 7.88) of showing this improvement. The group receiving routine care alone also experienced more exacerbations and days spent in hospital. Conclusions: Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients with chronic schizophrenia.

In this paper, an account of auditory hallucinations is outlined, incorporating the phenomena of intrusive thoughts; this is done with reference to the prevailing cognitive models of auditory hallucinations. The account proposes that metacognitive beliefs inconsistent with intrusive thoughts lead to their external attribution as auditory hallucinations, and that such a misattribution is maintained by reducing cognitive dissonance. It is also suggested that the appraisal of the resulting hallucinatory experience elicits behavioural, emotional and physiological responses that may be involved in the maintenance process. The possibility of extending such an account to certain other positive symptoms is discussed, and the theoretical and clinical implications of such an account are considered, and illustrated with a case example. Finally, a number of testable predictions are made. IntroductionThere has been a long tradition within clinical psychology of using theories of normal psychological processes to inform our understanding of clinical phenomena. This paper will attempt to outline a potentially useful, but speculative, account of certain positive symptoms of schizophrenia incorporating the phenomena of intrusive mental experiences. This will be done with reference to existing cognitive models of positive symptoms, and will initially focus on explaining auditory hallucinations, although other symptoms (thought insertion, visual hallucinations and delusions of control) will be considered briefly. The symptoms of schizophreniaSchizophrenia has received much attention from researchers over the last century, but the aetiology of this syndrome is still unknown. Recent Acknowledgements: The authors are grateful to Dr Adrian Wells for his helpful comments on an earlier version of this paper.Reprint requests to Tony Morrison,

The treatment programme was superior to routine care on outcomes relating to illness and service use, and the cost was comparable to the control treatment.