Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia

BMJ 1998;317:303-307 ( 1 August )

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Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia

Nicholas Tarrier, professor of clinical psychology, ^a Lawrence Yusupoff, senior fellow in clinical psychology, ^a Caroline Kinney, research psychologist, ^a Eilis McCarthy, research psychologist, ^a Ann Gledhill, lecturer in clinical psychology, ^a Gillian Haddock, senior lecturer in clinical psychology, ^a Julie Morris, medical statistician. ^b

^a Department of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, Manchester M20 8LR, ^b Department of Medical Statistics, University of Manchester

Correspondence to: Professor Tarrier ntarrier{at}fs1.with.man.ac.uk

Objectives: To investigate whether intensive cognitive behaviour therapy results in significant improvement in positivepsychotic symptoms in patients with chronicschizophrenia.
Design: Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms andsex, to intensive cognitive behaviour therapy and routine care,supportive counselling and routine care, and routine carealone.
Setting: Adjunct treatments were carried out in outpatient clinics or in the patient'shome.
Subjects: 87 patients with persistent positive symptoms who complied with medication; 72 completedtreatment.
Outcome measures: Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Numberof patients who showed a 50% or more improvement in symptoms.Exacerbation of symptoms and rates of readmission tohospital.
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 cognitivebehaviour therapy. The supportive counselling group showed a non-significantimprovement. Significantly more patients treated with cognitivebehaviour therapy showed an improvement of 50% or more in theirsymptoms ( $chi$ ²=5.18, df=1; P=0.02). Logistic regression indicated that receiptof cognitive behaviour therapy results in almost eight times greaterodds (odds ratio 7.88) of showing this improvement. The groupreceiving routine care alone also experienced more exacerbationsand days spent inhospital.
Conclusions: Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients withchronicschizophrenia.

Key messages

Persistent psychotic symptoms are common in patients with chronic schizophrenia
Cognitive behaviour therapy is a method of changing patients' thought processes, behaviour, and emotions
Giving cognitive behaviour therapy in addition to routine care reduced positive psychotic symptoms more than giving routine care alone
Supportive counselling was also effective but to a lesser extent

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Rapid Responses:

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Early case study of cognitive behavior therapy with a paranoid schizophrenic: Gerald C Davison
bmj.com, 3 Aug 1998 [Full text]
Incomplete statistical analysis: Peter McKenna
bmj.com, 26 Aug 1998 [Full text]
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bmj.com, 25 Aug 1998 [Full text]