BMJ  2006;333:353 (12 August), doi:10.1136/bmj.333.7563.353-a

Letter

What works in schizophrenia

Cognitive behaviour therapy is not effective

EDITOR—Kingdon's statement that more than 20 randomised controlled trials and five meta-analyses have shown cognitive behaviour therapy to be beneficial in schizophrenia gives an oversimplified picture of both the randomised controlled trials and the meta-analyses.¹ Reviewing the randomised controlled trials, Tarrier and Wykes, two supporters of cognitive behaviour therapy in schizophrenia, noted that five included groups who received befriending, supportive counselling, or problem solving to control for the non-specific effects of intervention, in other words as a psychological placebo.² They said that not one study has shown clear and significant overall differences between cognitive behaviour therapy and the non-specific control groups.³

The conclusion of the Cochrane Collaboration's meta-analysis of cognitive behaviour therapy for schizophrenia was currently that trial based data supporting the wide use of such treatment for people with schizophrenia or other psychotic illnesses are far from conclusive.³ Compared with standard care, cognitive behaviour therapy was found not to reduce relapse and readmission; it helped mental state over the medium term but after one year the difference had gone, and it did not show a consistent effect on continuous measures of mental state. Compared with supportive psychotherapy, cognitive behaviour therapy had no effect on relapse or on the outcome "no clinically meaningful improvements in mental state" over the same time periods.

Behind all the recent publicity surrounding cognitive behaviour therapy for schizophrenia, the truth is that it works only in poorly controlled trials and not in well controlled ones.

University of Glasgow, Glasgow G12 0XH peter.mckenna{at}virgin.net

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Competing interests: None declared.

References

1. Kingdon C. Psychological and social interventions for schizophrenia. BMJ 2006;333: 212-3. (29 July.)[Free Full Text]
2. Tarrier N, Wykes T. Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behav Res Ther 2004;42: 1377-401.[CrossRef][ISI][Medline]
3. Jones C, Cormac I, Silveira da Mota Neto JI, Campbell C. Cognitive behaviour therapy for schizophrenia. Cochrane Database of Syst Rev 2004, Issue 4.

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Psychological and social interventions for schizophrenia

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