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London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis

I: Effects of the treatment phase

Published online by Cambridge University Press:  03 January 2018

Elizabeth Kuipers ,
Philippa Garety ,
David Fowler ,
Graham Dunn ,
Paul Bebbington ,
Daniel Freeman  and
Clare Hadley
Elizabeth Kuipers*
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF
Philippa Garety
Affiliation:
United Medical and Dental School, Department of Psychology, St Thomas' Hospital, London SEI
David Fowler
Affiliation:
School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
Graham Dunn
Affiliation:
School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester
Paul Bebbington
Affiliation:
University College London, Archway Wing 1st Floor, Whittington Hospital, Highgate Hill, London NI9 5NF
Daniel Freeman
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF
Clare Hadley
Affiliation:
Department of Clinical Psychology, Leeds University, 15 Hyde Terrace, Leeds LS2 9LT
*
Dr E. Kuipers, Department of Clinical Psychology, Institute of Psychiatry, London SE5 8AF
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Abstract

Background

A series of small, mainly uncontrolled, studies have suggested that techniques adapted from cognitive–behavioural therapy (CBT) for depression can improve outcome in psychosis, but no large randomised controlled trial of intensive treatment for medication-resistant symptoms of psychosis has previously been published.

Method

Sixty participants who each had at least one positive and distressing symptom of psychosis that was medication-resistant were randomly allocated between a CBT and standard care condition (n=28) and a standard care only control condition (n=32). Therapy was individualised, and lasted for nine months. Multiple assessments of outcome were used.

Results

Over nine months, improvement was significant only in the treatment group, who showed a 25% reduction on the BPRS. No other clinical, symptomatic or functioning measure changed significantly. Participants had a low drop-out rate from therapy (11%), and expressed high levels of satisfaction with treatment (80%). Fifty per cent of the CBT group were treatment responders (one person became worse), compared with 31% of the control group (three people became worse and another committed suicide)

Conclusions

CBT for psychosis can improve overall symptomatology. The findings provide evidence that even a refractory group of clients with a long history of psychosis can engage in talking about psychotic symptoms and their meaning, and this can improve outcome.

Type
Papers
Information
The British Journal of Psychiatry , Volume 171 , Issue 4 , October 1997 , pp. 319 - 327
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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