Background:Research evidence supports the efficacy of cognitive-behavioral therapy in the treatment of drugrefractory positive symptoms of schizophrenia. Although the cumulative evidence is strong, early controlled trials showed methodological limitations.

The Thorn Initiative is a prominent education and training programme for psychosocial interventions. The course originated in two centres in the UK in 1992, 10 years on the programme had expanded to 13 centres across England and Wales. A survey of course content and structure was sent out to all 13 sites by email of which eight responded by post. The survey results showed that since 1999 there has been a rapid growth in the number of Thorn sites. There remains a high degree of fidelity to the original courses in mode of delivery, service user and carer participation, and core content. All of the sites were progressing towards providing degree courses, usually in a modular format and with an expanded curriculum. In conclusion, the Thorn Steering Group has been successful in Thorn site expansion and curriculum development. Such success has taken activity away from audit and research in psychosocial interventions, education, training, implementation and fidelity to taught skills. Implementation remains a cause for concern and it is recommended that a focus for Thorn sites should be on creating and evaluating novel solutions to this pervasive problem.

Baseline psychotic symptoms strongly predicted outcome in this sample. The finding that hallucinations predicted a poor outcome is consistent with previous research. These results may help to determine which patients would benefit from supportive interventions.

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