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Reconsider widening access to CBT for schizophrenia, say researchers

Plans to widen access to cognitive behavioural therapy for patients with schizophrenia should be ‘reconsidered’, say researchers

They have urged the Government to reconsider current policy promoting CBT for schizophrenia, after their meta-analysis of 52 randomised controlled trials of CBT in schizophrenia conducted over the past 20 years showed little benefit.

The study, published in the British Journal of Psychiatry this month, revealed that CBT resulted in small therapeutic improvements in both positive and negative symptoms.

However, these benefits disappeared when the team analysed only trials where the assessments were masked, ie, where the assessor was not allowed to know which intervention – CBT or control – was used.

The researchers said their results cast further doubt on the effectiveness of CBT designed for schizophrenia, and questioned why the Government is continuing to encourage its use. The expansion of CBT for use in patients with psychosis is currently being encouraged throught the Improving Access to Psychological Therapies programme.

The team concluded: ‘Our finding of non-significant effects on positive symptoms of the disorder in a relatively large set of 21 masked studies also suggests that claims that CBT is effective against these symptoms are no longer tenable.

‘The same appears to apply to negative symptoms, although here the possibility that specially adapted forms of therapy will have an effect cannot be excluded.’

Study author Professor Keith Laws, professor of cognitive neuropsychology at the University of Hertfordshire, said: ‘With this evidence, the current Government policy which mandates this treatment for all patients with schizophrenia in England and Wales needs to be reconsidered.’

Readers' comments (3)

  • Vinci Ho

    I always thought to ensure CBT works , the patient should at least have some stability and insight on his/her mental condition . Because it involves self reflection on behaviour by evidences and challenging negative dysfunctional thoughts . That is probably the reason why CBT is not so helpful in severe as compared to mild to moderate depression . One would expect similar problem with symptomatic (positive or negative)schizophrenics as their thought processes are relatively chaotic.

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  • That's exactly right. It's horses for courses. CBT is certainly not a panacea, it is helpful for some and not for others, nor do those experiencing/at risk of further episodes of psychosis come without other issues. There are multiple factorswhich may exacerbate, contribute to their difficulties etc. and which are amenable to psychological therapies. Clients frequently require a bespoke approach, at an appropriate time, within the context of a wider supportive team of MH professionals. Max Brichwood et al's response to the study highlights the wider issues.

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  • It is entirely dependant upon the ability of the client to engage and the level of distress caused by their symptoms as to whether you would choose not to intervene at all, whether you would aim for a partial amelioration or full amelioration. Anecdotally - Most of my patients it has helped a bit, some not at all and one it resulted in a complete cessation of auditory and visual hallucinations. Most being helped a bit, particularly where that has avoided hospital admission and the costs involved in that, seems worth it to me

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