Cognitive Behaviour Therapy for Psychotic Symptoms: A Randomized Controlled Effectiveness Trial

Abstract

Background: Cognitive behavioural therapy for psychosis (CBTp) is currently a recommended form of psychosocial treatment for persons suffering from persistent psychotic symptoms. It has been argued that effect sizes from efficacy studies cannot be generalized to real clinical settings. Aims: Our aim was to evaluate whether the positive results from randomized controlled trials conducted by experts could be replicated in clinical setting with a heterogeneous sample of patients with psychotic disorder. Method: Patients referred to the study were either randomized to CBTp + TAU (the treatment group) or to a waiting-list group, only receiving TAU. The patients were assessed on different outcome measures such as the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), and the Psychotic Symptom Rating Scales (PSYRATS), at pretreatment, at posttreatment (6 months), and at 12 months follow-up. In total, 45 patients participated in the study. Results: The results showed that 20 sessions of CBTp performed significantly better than the waiting list controls with respect to the global score on the BPRS, the delusional scale on the PSYRATS, and the GAF symptom score at posttreatment. At 12 months follow-up only the GAF symptom score remained significantly changed for the total sample. Conclusions: The study revealed that CBTp delivered by non-experts in routine clinical settings can produce improvements in positive psychotic symptoms, and also that some of these improvements can be maintained at one year follow-up.

Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

“…Network meta‐analysis results show that, for the primary outcome, CBT was associated with a higher decrease in positive symptoms than inactive control (SMD=−0.29; 95% CI: –0.55 to −0.03, seven RCTs contributing direct evidence to the network meta‐analysis, low confidence in the estimates), treatment as usual (SMD=−0.30; 95% CI: –0.45 to −0.14, 18 RCTs contributing direct evidence, moderate confidence in the estimates) and supportive therapy (SMD=−0.47; 95% CI: –0.91 to −0.03, two RCTs contributing direct evidence, low confidence in the estimates). The difference was not significant for the comparison with waitlist (SMD=−0.24; 95% CI: –0.65 to 0.16), but only two small trials (with 30 and 45 participants respectively) contributed direct evidence to this comparison (Figure ).…”

“…These trials provided comparisons of the following psychological treatments: CBT (N=40), metacognitive training (N=6), mindfulness (N=2), acceptance and commitment therapy (N=2), experience focused counselling (N=1), hallucination focused integrative treatment (N=1), and AVATAR therapy (N=1).…”

A Chinese version of the Psychotic Symptom Rating Scales: psychometric properties in recent-onset and chronic psychosis

“…Very few structured assessment tools measure single or multiple domains/dimensions of psychotic symptoms, for example, Oulis Auditory Hallucinations Rating Scale4 and Delusions Inventory5 for single symptoms, or Positive and Negative Syndrome Scale (PANSS)6 and Revised Behavior and Symptom Identification Scale7 for overall symptoms. Among those measures of psychotic symptoms, the Psychotic Symptom Rating Scales (PSYRATS)8 (Figure S1) consists of the multidimensional features of two main psychotic symptoms (ie, auditory hallucinations and delusions) in one measurement tool, and the PSYRATS has been translated into different languages, validated, and increasingly used for outcome evaluation of interventions for patients with acute and chronic psychotic disorders 9,10…”

Cognitive Behavioral Therapy Compared with Non-specialized Therapy for Alleviating the Effect of Auditory Hallucinations in People with Reoccurring Schizophrenia: A Systematic Review and Meta-analysis

“…Unlike CBT, these interventions contain skills and resources that can be reproduced by the general community mental health teams (Buckley et al 2007;Krakvik et al 2013). …”

“…However, currently there is limited research and data to explore the potential role and effectiveness of such interventions for community patients with schizophrenia and persistent auditory hallucinations (Buckley et al 2007). Krakvik et al (2013) noted that current research into CBT interventions does not reflect the capabilities of a general mental health team as it employs well-trained and highly motivated CBT therapists. Reproducing this into current clinical practice has proven to be difficult.…”