Cognitive Therapy for Patients with Schizophrenia

New Study (1)Abstract

Background Antipsychotic drugs are usually the first line of treatment for schizophrenia; however, many patients refuse or discontinue their pharmacological treatment. We aimed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs.

Methods We did a single-blind randomised controlled trial at two UK centres between Feb 15, 2010, and May 30, 2013. Participants aged 16–65 years with schizophrenia spectrum disorders, who had chosen not to take antipsychotic drugs for psychosis, were randomly assigned (1:1), by a computerised system with permuted block sizes of four or six, to receive cognitive therapy plus treatment as usual, or treatment as usual alone. Randomisation was stratified by study site. Outcome assessors were masked to group allocation. Our primary outcome was total score on the positive and negative syndrome scale (PANSS), which we assessed at baseline, and at months 3, 6, 9, 12, 15, and 18. Analysis was by intention to treat, with an ANCOVA model adjusted for site, age, sex, and baseline symptoms. This study is registered as an International Standard Randomised Controlled Trial, number 29607432.

Findings 74 individuals were randomly assigned to receive either cognitive therapy plus treatment as usual (n=37), or treatment as usual alone (n=37). Mean PANSS total scores were consistently lower in the cognitive therapy group than in the treatment as usual group, with an estimated between-group effect size of ?6·52 (95% CI ?10·79 to ?2·25; p=0·003). We recorded eight serious adverse events: two in patients in the cognitive therapy group (one attempted overdose and one patient presenting risk to others, both after therapy), and six in those in the treatment as usual group (two deaths, both of which were deemed unrelated to trial participation or mental health; three compulsory admissions to hospital for treatment under the mental health act; and one attempted overdose).

Interpretation Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs. Evidence-based treatments should be available to these individuals. A larger, definitive trial is needed.

Bera, S.C., & Sarkar, Siddharth (2014). Cognitive therapy for patients with schizophrenia. The Lancet. 384 (9941), 401. DOI:

CBT and Medication for Severe Mental Illness

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck and Dr. Judith Beck discuss the effects of combining CBT and medication in the treatment of depression and schizophrenia. They also compare research findings on CBT treatment alone, medication alone, and a combination of CBT and medication among clients with severe depression and schizophrenia.

For CBT resources, visit our website.

Cognitive Restructuring in Schizophrenia

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck describes how to modify and utilize cognitive restructuring with a schizophrenic client. Using an example, Dr. Beck explains that he will initially focus on the client’s interests to build engagement and self-efficacy. As self-efficacy increases, the client’s problematic and unhelpful behaviors begin to decrease. Dr. Beck emphasizes the use of cognitive conceptualization to target the variables that drive the client’s behavior, which can be used to structure treatment.

For CBT resources, visit our website.

CBT Treatment Goals for Schizophrenia

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck describes the shift in treatment aims for clients with Schizophrenia. He explains that previously “getting better” meant a decrease in symptoms of delusions and hallucinations. Today, Cognitive Behavior Therapy (CBT) aims to help clients function in their communities, whether or not they still experience symptoms. Dr. Beck goes on to say that when clients reintegrate into society, overall adaptive functioning typically improves.

For CBT resources, visit our website.

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.

Neurocognitive Change in Schizophrenia

In this video from a recent CBT workshop at the Beck Institute, Dr. Aaron Beck discusses neurocognitive change among schizophrenic patients who receive CBT treatment. Dr. Beck references a study in which a sample of highly regressed patients with schizophrenia received between six and eighteen months of Cognitive Therapy. Dr. Beck first explains that at the end of the study patients improved on both psychological tests (e.g., quality of life measures) and neurocognitive tests. He then provides a hypothesis for this outcome.

For more information on Beck Institute’s workshops, visit our website.

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.

Systems of Psychotherapy (Part 2)

In this video from Beck Institute’s recent CBT Workshop for Students and Faculty, Dr. Aaron Beck discusses cognitive behavior therapy within the context of systems of psychotherapy. Dr. Beck explains that CBT is rooted in a broad theoretical framework and refined and reformulated for each disorder. Therapeutic strategies are selected based on the individual conceptualization of the patient. According to Dr. Beck, basic methods of CBT, such as cognitive reframing, can be adapted for more complex cases. He refers to his recent research on schizophrenia to demonstrate how to adapt CBT strategies within the theoretical framework.

To view part 1 of this video, visit the Beck Institute YouTube page:

The Versatility of Cognitive Behavior Therapy

In this video clip from a recent 3-day CBT Workshop at the Beck Institute for Cognitive Behavior Therapy, Dr. Aaron Beck discusses the similarities and differences between CBT for Depression and CBT for Schizophrenia. Dr. Beck explains that both treatments aim to help patients relinquish their feelings of alienation and to elevate their beliefs about themselves and their future. Treatment for Schizophrenia also addresses the specific symptoms of schizophrenia, such as paranoia and hallucinations, which require specialized cognitive and behavioral techniques. For information about training in cognitive behavior therapy, 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