Modified Illness Perceptions Questionnaire Predicts Response to CBT for Psychosis

OBJECTIVE: Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp.

METHODS: Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later.

RESULTS: The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects.

LIMITATIONS: We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample.

CONCLUSIONS: The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.

Marcus, E., Garety, P., Weinman, J., Emsley, R., Dunn, G., Bebbington, P., Freeman, D., … Jolley, S. (December 01, 2014). A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis. Journal of Behavior Therapy and Experimental Psychiatry, 45, 4, 459-466.

CBT for Medication-Resistant Psychosis: A Meta-analytic Review

Support for cognitive-behavioral therapy (CBT) for psychosis has accumulated, with several reviews and meta-analyses indicating its effectiveness for various intended outcomes in a broad variety of clinical settings. Most of these studies, however, have evaluated CBT provided to the subset of people with schizophrenia who continue to experience positive symptoms despite adequate treatment with antipsychotics. Despite several reviews and meta-analyses, a specific estimate of the effects of CBT for patients with medication-resistant positive symptoms, for whom CBT is frequently used in outpatient clinical settings, is lacking. This meta-analysis examined CBT’s effectiveness among outpatients with medication-resistant psychosis, both on completion of treatment and at follow-up.

Systematic searches (until May 2012) of the Cochrane Collaborative Register of Trials, MEDLINE, PsycINFO, and PubMed were conducted. Sixteen published articles describing 12 randomized controlled trials were used as source data for the meta-analysis. Effect sizes were estimated using the standardized mean difference corrected for bias, Hedges’ g, for positive and general symptoms.

The trials included a total of 639 individuals, 552 of whom completed the posttreatment assessment (dropout rate of 14%). Overall beneficial effects of CBT were found at posttreatment for positive symptoms (Hedges’ g=.47) and for general symptoms (Hedges’ g=.52). These effects were maintained at follow-up for both positive and general symptoms (Hedges’ g=.41 and .40, respectively).

For patients who continue to exhibit symptoms of psychosis despite adequate trials of medication, CBT for psychosis can confer beneficial effects above and beyond the effects of medication.

Burns, A., Erickson, D., & Brenner, C. (2014). Cognitive-behavioral therapy for medication-resistant Psychosis: a meta-analytic review. Psychiatric Services. doi: 10.1176/

Cognitive Therapy Improves Symptoms in Schizophrenia Spectrum Disorder Patients not Taking Antipsychotic Drugs

According to a new study published in The Lancet, Cognitive Therapy (CT) has been shown to reduce the severity of psychiatric symptoms among schizophrenia spectrum disorder patients not taking antipsychotic drugs. In this first study of its kind, researchers performed a single-blind randomized control trial at two UK Centers between 2010 and 2013. Participants included 74 schizophrenia spectrum disorders patients, aged 16-65 years, who had chosen not to take antipsychotic medication. They were randomly assigned to receive either CT plus treatment as usual (n=37) or the control, treatment as usual (n=37). In the CT group, participants received 26 weekly sessions for a maximum of 9 months, plus up to four boosters in the subsequent 9 months that followed. Therapy focused on normalization and evaluation of patients’ own appraisals, behavioral experiments to test appraisals, and helping patients to identify and modify unhelpful cognitive and behavioral responses. The Positive and Negative Syndrome Scale (PANSS), the primary outcome measure, was utilized to evaluate treatment at baseline, and at 3, 6, 9, 12, 15, and 18 months. Results showed that PANSS total scores were significantly and consistently less in the cognitive therapy group than in the control group. On secondary outcomes, CT was also shown to improve personal and social functioning, and some dimensions of delusional beliefs and voice hearing. These findings offer hope for individuals who decline pharmacological treatment, and while further research is necessary, evidence based treatment should be available to this population.

Morrison, A. P., Turkington, D., Pyle, M., Spencer, H., Brabban, A., Dunn, G., Christodoulides, T., … Hutton, P. (February 01, 2014). Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet.

A Monthly Summary of Beck Institute Updates [May 2013]

In its efforts to encourage the growth and dissemination of CBT throughout the world, Beck Institute has expanded its online presence across social media and other platforms. To keep you (our readers) informed of our most recent updates, we’ve decided to implement a monthly summary including: blogs, CBT articles, CBT trainings, and other updates for our readers. We’re very excited about some of the new developments at Beck Institute, including our new Core Curriculum. Please use the following links to go back and read what you may have missed from May 2013:

Click here for a complete schedule of Beck Institute workshops

See what you missed in April 2013

CBT for Chronic Schizophrenia

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck describes his early work with treating chronic schizophrenia as quite “memorable.” Dr. Beck’s early work, which he documented in a paper published 1952, helped pave the way for treating schizophrenia with evidence-based CBT. CBT for schizophrenia is commonly practiced in the United Kingdom and gaining momentum in the United States.

Beck Institute’s next CBT for Schizophrenia Workshop will take place May 6-8, 2013. For more information, visit our website.

Insight is a Predictive Variable in Cognitive Behavior Therapy for Psychosis

According to a recent study published in Cognitive Behaviour Therapy, insight (illness awareness) may be a predictive variable in cognitive behavior therapy for psychosis (CBTp). In the current study, researchers assessed forty-four psychotic patients before and following a CBTp intervention. They discovered that insight correlated to improvements in psychotic symptoms among patients with auditory and visual hallucinations and ideas of reference.  Insight did not correlate to other symptom types (e.g., paranoid delusions, mind reading, and thought insertion), however. These findings suggest that symptom type moderates the relationship between insight and outcome in CBTp and that CBTp may be particularly effective with certain patients with specific symptomatology.

Kuller, A.M., Libben, M.R., Rosmarin, D.H., & Björgvinsson T. (2012). Does symptom type moderate the relationship between insight and outcome in cognitive behavioral therapy for psychosis? A preliminary investigation. Cognitive Behaviour Therapy, 1-12. Doi: 10.1080/16506073.2012.676670

Cognitive Therapy Reduces the Severity of Psychosis

According to a recent study published in the British Medical Journal, cognitive therapy (CT) may reduce the severity of psychotic symptoms among individuals who develop psychosis. Participants (n = 288) identified as high-risk for developing a psychotic disorder were randomly assigned to receive either six months of CT plus mental state monitoring or mental state monitoring only. While CT did not significantly reduce the transition to psychosis, it did reduce the severity of psychotic symptoms in high-risk individuals. Further, the overall prevalence of transition to psychosis (8%) was lower than expected, and most participants in both groups improved over time. These findings impart an optimistic message to patients at risk for psychosis: Patients can improve with intervention, and CT may help with recovery.

Morrison, A. P., Stewart, S. L. K., French, P., Parker, S., Byrne, R., Birchwood, M., Brunet, K., … Dunn, G. (2012). Early detection and intervention evaluation for people at risk of psychosis: Multisite randomised controlled trial. British Medical Journal (online), 344, 7852.

CBT for Schizophrenia

CBT Training at Beck InstituteDr. Judith Beck greeting participants at Beck Institute’s first ever CBT for Schizophrenia Workshop.

CBT for Psychosis

In this video Dr. Aaron T. Beck answers a question about CBT treatment for at-risk adolescents with psychosis. Dr. Beck explains past research and significant findings that have led to efficacious cognitive therapy treatment protocol for treating adolescents with psychosis. To find out how you can learn more about CBT for Children and Adolescents visit and for treating psychosis using cognitive therapy for patients with schizophrenia visit

The Relationship between Interpersonal Self-Concept and Paranoia in Patients with Schizophrenia

newstudy-graphic-66x60.jpgA recent study published in Behavior Therapy examined the relationship between interpersonal self-concept and global self-worth, and psychotic and depressive symptoms in patients with psychosis. The participants consisted of 83 patients, all of whom had diagnoses on the schizophrenia spectrum, and 33 healthy individuals. The researchers measured each participant’s global self-worth, interpersonal self-concept, dysfunctional beliefs, positive and negative symptoms, delusions, paranoia, and depressive symptoms.

Results showed that (1) Global self-worth is related more to depression than it is to paranoia, (2) the perception of not being accepted by others is more related to psychotic symptoms, (3) individuals who believe that others evaluate them positively have lower levels of paranoia, regardless of their dysfunctional beliefs levels, and (4) negative self-concept (i.e., not being respected , trusted, loved, and accepted by others) is most closely related to positive symptoms, paranoia, and psychosis.

The significant correlation between dysfunctional interpersonal self-concept, dysfunctional attitudes, and paranoia reinforces the formulation-based cognitive approach to delusions and the importance of eliminating dysfunctional self-concepts. The results of this study suggest that cognitive therapy may be successful in treating persecutory delusions and paranoia by focusing on interpersonal and threat-related self-concepts.

Lincoln, T.M., Mehl, S., Ziegler, M. Kesting, M.L., Exner, C., & Rief, W. (2010). Is fear of others linked to an uncertain sense of self? The relevance of self-worth, interpersonal self-concepts, and dysfunctional beliefs to paranoia. Behavior Therapy, 41, 187-197.