To review the nature of cognitive-behavioural interventions for psychosis and to evaluate evidence of their effectiveness.
Method:
Electronic (Medline and Psychinfo) and bibliography-based searches were carried out to locate descriptions and evaluations of cognitive-behavioural interventions for psychosis.
Results:
Various cognitive-behavioural interventions have been used for reducing psychosis. These have usually been applied to auditory hallucinations and/or delusions in otherwise treatment-resistant patients. Most evaluations comprise case studies or simple pre-post designs. Controlled trial evaluations are few, and although the results are promising, methodological problems limit the conclusions that can be drawn concerning the clinical utility of such approaches.
Conclusions:
More and better controlled trial evaluations of cognitive-behavioural interventions are needed in this area. If further research supports the efficacy of these techniques, issues related to clinical effectiveness, mediators of treatment effects, risks, and cost-effectiveness will also need to be addressed.
MosherLRKeithSJ. Psychosocial treatment: Individual, group, family and community support approaches. Schizophr Bull1980;6:127–58.
2.
StantonAHGundersonJG, Knapp PH, and others. Effects of psychotherapy in schizophrenia: I. Design and implementation of a controlled study. Schizophr Bull1984;10:520–62.
3.
MeuserKTBerenbaumH. Psychodynamic treatment of schizophrenia: Is there a future?Psychol Med1990;20:253–62.
4.
GundersonJGFrankAF, Katz HM, and others. Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment. Schizophr Bull1984;10:564–98.
5.
SedereDrake. The adverse effects of intensive treatment of chronic schizophrenia. Compr Psychiatry1996;27:313–26.
6.
CourseyRD. Psychotherapy with personal suffering from schizophrenia: The need for a new agenda. Schizophr Bull1989;15:349–53.
7.
KingdonDGTurkingtonD. Cognitive-behavioural therapy of schizophrenia. New York: Guilford Press; 1994.
8.
McNallyRJ. Innovations in cognitive-behavioural approaches to schizophrenia. Behavior Therapy1994;25:1–4.
9.
PerrisC. Cognitive therapy with schizophrenic patients. New York: Guilford Press; 1989.
10.
ChadwickPBirchwoodMTrowerP. Cognitive therapy for delusions, voices and paranoia. Chichester: John Wiley; 1996.
11.
FowlerDGaretyPKuipersE. Cognitive-behaviour therapy for psychosis: Theory and practice. Chichester: John Wiley; 1995.
12.
BarlowDHLehmanCL. Advances in the psychosocial treatment of anxiety disorders. Arch Gen Psychiatry1996;53:727–35.
13.
BlackburnIMMooreRG. Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression. Br J Psychiatry1997;171:328–34.
14.
EvansMDHollonSDDeRubeisRJPlaseckiJMGrooveWM, Garvey MJ, and others. Differential relapse following cognitive therapy and pharmacotherapy for depression. Arch Gen Psychiatry1992;49:802–8.
15.
MarksIM. Advances in behavioral-cognitive therapy of social phobia. J Clin Psychiatry1995;56:25–31.
16.
CarrV. Patients techniques for coping with schizophrenia: An exploratory study. BMJ1988;61:339–52.
17.
FalloonIRHTalbotRE. Persistent auditory hallucinations: Coping mechanisms and implications for management. Psychol Med1981;11:329–39.
18.
ThunnIHaefherH. Perceived vulnerability, relapse risk and coping in schizophrenia: An exploratory study. European Archives of Psychiatry and Neurological Science1987;237:46–53.
19.
WeidlKHSchottnerB. Coping with symptoms related to schizophrenia. Schizophr Bull1991;17:525–38.
20.
TakaiAVernatsuMKaiyaHInoveMVekiH. Coping styles to basic disorders among schizophrenics. Acta Psychiatr Scand1990;82:289–94.
21.
DittmannJSchuttlerR. Disease consciousness and coping strategies of patients with schizophrenia psychosis. Acta Psychiatr Scand1990;82:318–22.
22.
FowlesDC. Schizophrenia: Diathesis-stress revised. Annu Rev Psychol1992;43:303–36.
23.
NicholsonIRNeufeldRWJ. A dynamic vulnerability perspective on stress and schizophrenia. Am J Orthopsychiatry1992;62:117–30.
24.
NormanRMGMallaAK. Stressful life events and schizophrenia I: A review of the research. Br J Psychiatry1993;162:161–6.
25.
NormanRMGMallaAK. A prospective study of daily stressors and symptomatology in schizophrenia. Soc Psychiatry Psychiatr Epidemiol1994;29:1–6.
26.
KaneJMMarderSR. Psychopharmacologic treatment of schizophrenia. Schizophr Bull1993;19:287–302.
27.
PantelisCBarnesTR. Drug strategies and treatment resistant schizophrenia. Aust N Z J Psychiatry1996;30:20–37.
28.
HogartyGEAndersonCMReissDJKornblithSJGreenwaldDP, Ulrich RF, and others. Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. Two year effects of a controlled study on relapse and adjustment. Environmental-Personal Indicators in the Course of Schizophrenia (EPICS) Research Group. Arch Gen Psychiatry1991;48:340–8.
29.
KaneJMMcGlashanTH. Treatment of schizophrenia. Lancet1995;346:820–5.
30.
PatienceDA. Cognitive-behavioural therapy for schizophrenia. Br J Psychiatry1994;165:266–7.
31.
TeasdaleJD. Emotion and two kinds of meaning: Cognitive therapy and applied cognitive science. Behav Res Ther1993;31:339–54.
32.
BenedictRHBHarrisAEMarkowTMcCormickJANuechterleinKHAsarnowRF. Effects of attention training on information processing in schizophrenia. Schizophr Bull1994;20:537–46.
33.
GreenMF. Cognitive remediation in schizophrenia: Is it time yet?Am J Psychiatry1993;150:178–87.
34.
ChamberlainRRappCA. A decade of case management: A methodological review of outcome research. Community Ment Health J1991;27:171–88.
35.
SmithTEBellackASLibermanRP. Social skills training for schizophrenia: Review and future directions. Clin Psychol Rev1996;16:599–618.
36.
BarlowDH. Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford Press; 1988.
37.
BeckATRushAJShawBFEmeryG. Cognitive therapy of depression. New York: Guilford Press; 1979.
38.
BumsDD. Feeling good: The new mood therapy. New York: Avon Books; 1992.
39.
HersenMBellackAS, editors. Handbook of clinical behavior therapy with adults. New York: Plenum Press; 1985.
40.
AllenTEAgusB. Hyperventilation leading to hallucinations. Am J Psychiatry1968;125:632–7.
41.
AlumbaughRV. Use of behavior modification technique toward reduction of hallucinatory behaviour: A case study. Psychological Record1971;21:415–7.
42.
BentallRPHaddockGSladePD. Cognitive behavior therapy for persistent auditory hallucinations: From theory to therapy. Behavior Therapy1994;25:51–66.
43.
AlfordGSFleeceLRothblumE. Hallucinatory-delusional verbalizations: Modification in a chronic schizophrenic by self-control and cognitive restructuring. Behav Modif1982;3:421–35.
44.
FederR. Auditory hallucinations treated by radio headphones. Am J Psychiatry1982;139:1188–90.
45.
FowlerDMorleyS. The cognitive-behavioral treatment of hallucinations and delusions: A preliminary study. Behavioural Psychotherapy1989;17:267–82.
46.
PersaudRMarksI. A pilot study of exposure control of chronic auditory hallucinations in schizophrenia. Br J Psychiatry1995;167:45–50.
47.
SamaanN. Thought stopping and flooding in a case of hallucinations, obsessions and homicidal-suicidal behaviour. J Behav Ther Exp Psychiatry1975;6:64–7.
48.
SladePD. The effects of systematic desensitization on auditory hallucinations. J Behav Ther Exp Psychiatry1972;10:85–91.
49.
AlfordBA. Behavioral treatment of schizophrenic delusions: A single case experimental analysis. Behavior Therapy1986;17:637–44.
50.
NydeggerRV. The elimination of hallucinatory and delusional behavior by verbal conditioning and assertive training: A case study. J Behav Ther Exp Psychiatry1972;3:225–7.
51.
WattsRNPowellGEAustinSV. Modification of delusional beliefs. Br J Med Psychol1973;46:359–63.
52.
WeidmerF. In vivo desensitization of a paranoid schizophrenic. J Behav Ther Exp Psychiatry1970;1:79–81.
53.
BuchkremerGKlingbergSHolleRSchulzeMHHomungWP. Psychoeducation psychotherapy for schizophrenic patients and their key relatives or caregivers: Results of a 2 year follow-up. Acta Psychiatr Scand1997;96:483–91.
54.
KingdonDGTurkingtonD. The use of cognitive behavior therapy with a normalizing rationale in schizophrenia: Preliminary report. J Nerv Ment Dis1991;179:207–11.
55.
KingdonDGTurkingtonD. Cognitive behaviour therapy of schizophrenia. In: WykesTTarrierNLewisS, editors. Outcome and innovation in psychological treatment of schizophrenia. Chichester: Wiley; 1998. p 59–79.
56.
HogartyGEKomblithSJGreenwaldDDiBarryALCooleyS, Ulrich RF, and others. Three year trials of personal therapy among schizophrenic patients living with or independent of family. I: Description of study and effects on relapse rates. Am J Psychiatry1997;154:1504–13.
57.
HogartyGEGreenwaldDUlrichRFKornblithSJDiBarryAL, Cooley S, and others. Three year trials of personal therapy among schizophrenic patients living with or independent of family. II: Effects on adjustment of patients. Am J Psychiatry1997;154:1514–24.
58.
HogartyGEKornblithSJGreenwaldDDiBarryALCooleyS, Flesher S, and others. Personal therapy: A disorder-relevant psychotherapy for schizophrenia. Schizophr Bull1995;21:379–93.
59.
KuipersEGaretyPFowlerDDunnGBebbingtonP, Freeman D, and others. London-East Anglia randomized controlled trial of cognitive-behavioural therapy for psychosis. I: Effects of the treatment phase. Br J Psychiatry1997;171:319–27.
60.
GaretyPFowlerDKuipersEFreemanDDunnG, Bebbington P, and others. London-East Anglia randomized controlled trial of cognitive-behavioural therapy for psychosis. II: Predictors of outcome. Br J Psychiatry1997;171:420–6.
61.
TarrierNBeckettRHarwoodSBakerAYusupoffLUgarteburuI. A trial of two cognitive-behavioural methods of treating drug resistant residual psychotic symptoms in schizophrenia patients: I. Outcome. Br J Psychiatry1993;162:524–32.
62.
TarrierNSharpeLBeckettRHarwoodSBakerAYusopoffL. A trial of two cognitive-behavioural methods of treating drug resistant residual psychotic symptoms in schizophrenic patients. II. Treatment-specific in coping and problem-solving. Soc Psychiatry Psychiatr Epidemiol1993;28:5–10.
63.
TarrierNYusupoffLKinneyCMcCarthyEGledhillA, Haddock G, and others. Randomized controlled trial of intensive cognitive behavior therapy for patients with chronic schizophrenia. BMJ1998;317:303–7.
64.
TarrierNHarwoodSYusupoffLBeckettRBakerA. Coping strategy enhancement (CSE): A method of treatment residual schizophrenic symptoms. Behavioral Psychotherapy1990; 18:283–93.
65.
DruryVBirchwoodMCochraneRMacMillanF. Cognitive therapy and recovery from acute psychosis: A controlled trial. Br J Psychiatry1996;169:593–601.
66.
DruryVBirchwoodMCochraneRMacMillanF. Cognitive therapy and recovery from acute psychosis: A controlled trial. II. Impact on recovery time. Br J Psychiatry1996;169:602–7.
67.
JohnsonDAW. Peer review of ‘Cognitive therapy and recovery from acute psychosis.’Br J Psychiatry1996;169:608–9.
68.
LacompteD. Drug compliance and cognitive-behavioral therapy in schizophrenia. Acta Psychiatrica Belgica1995;95:91–100.
69.
WyattRJ. Early intervention for schizophrenia: Can the course of the illness be altered?Biol Psychiatry1995;38:1–3.
