There is a growing body of evidence that cognitive-behaviour therapy is an effective treatment in chronic psychosis for reducing the severity and distress associated with hallucinations and delusions. However, no work has been published that has applied cognitive-behaviour therapy (CBT) with inpatients within secure environments who may have co-existing problems with psychosis and aggression. This paper describes how CBT for psychosis has been integrated with a CBT approach for treating anger for this group of patients. Three case studies of inpatients on a low secure, high dependency facility are described with whom this approach was used. The paper highlights the unique problems of interventions with these types of clients, and describes how CBT can be applied within these environments.