Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: Acute-phase outcomes

Abstract

BackgroundCognitive–behavioural therapy (CBT) improves persistent psychotic symptoms.AimsTo test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia.MethodA 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM–IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded.ResultsLinear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBTv. routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v. supportive counselling for auditory hallucinations score.ConclusionsCBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.

Early intervention in psychosis: concepts, evidence and future directions

“…Psychosocial treatments in early psychosis have been extensively studied, and there are positive findings pointing to the value of cognitive therapies in accelerating and maximizing symptomatic and functional recovery (81,82). Increasingly there has been attention to the fact that medications, while assisting in symptomatic recovery, do not, by themselves, contribute to a return to functioning.…”

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

“…The majority of the studies also concentrate on outpatients with chronic disorders, with the most notable exception being Drury et al (1996), which looked at a population of in-patients with a relatively recent onset of the disorder. The current Socrates trial (Lewis et al 2002), which focuses on treatment of recent onset patients, may well provide further information on the value of CBT for such patients.…”

Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment

“…For comparison, in the band 1 arm, 275 would be needed in each arm for 90% power. Estimating that there would be a 15% dropout rate at 12 months (based on the outcome of the SoCRATES trial 181 ), it was concluded that the band 1 arm would need to recruit 564 patients in total.…”