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Objectives: Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). Design: Case series. Methods: A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6‐month intervention window. Participants were assessed four times over a 12‐month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental‐health and recovery measures. Results: Sixteen participants engaged in the intervention and were included in last‐observation‐carried‐forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post‐traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. Conclusions: The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. Practitioner points: Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma.Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices.Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation. [ABSTRACT FROM AUTHOR]

There is general agreement that “the group of schizophrenias” comprises a very heterogeneous group of patients with diverse problems. Schizophrenia itself is a highly stigmatised term and yet has continued in use for nearly one hundred years. The development of cognitive behaviour therapy for psychosis and psychosocial epidemiological research has led to increased interest in finding alternative ways of conceptualisation. This study investigated attitudes of patients, care coordinators and consultant psychiatrists to the term, schizophrenia, and to psychosocial alternatives. It found that 63% of patients expressed negative attitudes to schizophrenia compared to 19% to the alternatives. However, concordance between the terms selected by patients, psychiatrists and care coordinators with those of the researchers was low. Such terms and subgroups may be more acceptable to patients but further work is needed on establishing their reliability and validity. [ABSTRACT FROM AUTHOR]

Abstract: Meta-analyses of randomized controlled trials support the efficacy of cognitive behavioral therapy (CBT) in the treatment of symptoms of schizophrenia refractory to antipsychotic medication. This article addresses the issue of medium term durability. A five-year follow-up was undertaken of a sample of 90 subjects who participated in a randomized controlled trial of CBT and befriending (BF). Patients received routine care throughout the trial and the follow-up period. Intention to treat multivariate analysis was performed by an independent statistician following multiple imputation of missing data. Fifty-nine out of ninety patients were followed up at 5 years (CBT=31, BF=28). In comparison to BF and usual treatment, CBT showed evidence of a significantly greater and more durable effect on overall symptom severity (NNT=10.36, CI −10.21, 10.51) and level of negative symptoms (NNT=5.22, CI −5.06 −5.37). No difference was found between CBT and BF on either overall symptoms of schizophrenia or depression. The initial cost of an adjunctive course of CBT for individuals with medication refractory schizophrenia may be justified in light of symptomatic benefits that persist over the medium term. [Copyright &y& Elsevier]

Aims. To explore the relationship between symptoms of anxiety and cognitive behaviour therapy (CBT) in patients with schizophrenia Design. Separate subanalyses of two randomized controlled trials comparing CBT for schizophrenia against befriending in the London Newcastle (LN) study, and against treatment as usual in the insight into schizophrenia (IS) study. Main outcome measures. Assessment of anxiety symptoms using the Brief Scale for Anxiety (BSA) derived from the Comprehensive Psychopathological Rating Scale (CPRS), at baseline, end of therapy and follow-up. Results. In both studies, anxiety symptoms positively correlated with overall psychopathology, hallucinations and depression. In the LN study, patients with persecutory delusions and with distress due to akathisia and incapacity due to abnormal movements scored significantly higher on the BSA. In the IS study, anxiety scores were also positively correlated with; delusions, negative symptoms, relationship problems and problems with activities of daily living, living conditions, occupation and activities. Both subanalyses showed CBT had beneficial effects on anxiety symptoms compared with the control groups. Overall prognosis was found to be better in those with low anxiety in the LN study. Conclusions. CBT improves anxiety symptoms in psychosis. We did not find an association between anxiety symptoms at baseline and outcome of cognitive therapy in this group of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology ( p = 0.01), insight ( p = 0.00) and depression ( p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis. [ABSTRACT FROM AUTHOR]

Background: Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive-behavioural therapists in patients with schizophrenia.Aims: To assess the effectiveness and safety of a brief cognitive-behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings.Method: A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual.Results: Patients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]=13), insight (P<0.001; NNT=10) and depression (P=0.003; NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio=1.15, 95% CI 1.01-1.31). There was no increase in suicidal ideation.Conclusions: Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers. [ABSTRACT FROM AUTHOR]

The present work examined the question ‘can cognitive behaviour therapy be successfully adapted to treat schizophrenia and become a recognized adjunct CBT treatment approach by frontline services?’ It was proposed that this was possible, and that a significant barrier to this was the ‘mental set’ of the wider clinical community. Prevailing attitudes of (1) believing that symptoms are not amenable to reasoning and may be made worse on enquiry, (2) patients are too severely disturbed to benefit from a psychological intervention, were related to a strict categorical model of psychopathology, where schizophrenia is viewed as a discrete entity. The premise was put forward that, the realistic benefits of categorical models, i.e. the identification of distinguishing features of a disorder, specific treatment approaches, and relatively homogeneous groups for research, have caused undue emphasis to be placed on identifying differences disorders. In consequence considerably less attention has been paid to scientific evidence showing important similarities across disorders. To protect against the error of unable to see the wood from the trees a preliminary descriptive continuum model of psychopathology was proposed to supplement existing categorical models. Analysis of the literature showed considerable support for a continuum model and the legitimacy of adapting traditional cognitive behaviour therapy approaches for use with schizophrenic patients. Reports of successful cognitive behaviour therapy interventions, particularly with positive symptoms suggest that patients can improve with this adapted approach and that the wider clinical community should be encouraged to assist its further development through research and training initiatives. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Recent research progress showing the benefits of cognitive therapy in schizophrenia leaves the general psychiatrist unsure whether to attempt to use such techniques.Aims: To test whether cognitive-behavioural techniques are beneficial in the management of patients with schizophrenia in general psychiatric practice.Method: A randomised controlled study comparing the use of cognitive-behavioural techniques and befriending in schizophrenia.Results: Significant improvement in symptoms occurred in the group treated with cognitive-behavioural techniques but not in the befriending group. During the 6-month follow-up period the cognitive-behavioural group tended to have shorter periods in hospital.Conclusions: General psychiatrists could help their patients with schizophrenia by using cognitive-behavioural techniques. Such techniques are well within the capability of general psychiatrists, but their application would involve more of the consultant's time spent in direct contact with patients with psychoses. [ABSTRACT FROM AUTHOR]

A single case study is used to explore the therapeutic factors contributing to symptom reduction in a 48-year-old woman with a 29-year diagnosis of ‘chronic schizophrenia’. Eight sessions of cognitive therapy were given and progress followed up over two years. The therapy was based on a model accounting for the function, thematic content and psychological maintaining mechanisms of the hallucinatory experience, which was collaboratively constructed and combined with standard cognitive-behavioural techniques. This increased the client's understanding of and control over her functional auditory hallucinations and her secondary delusional interpretation of these as ‘telepathic’ communication from Cod. The CPRS, self-report and observed behaviour showed marked symptom reduction, reduced distress and increased self-esteem and self confidence. The therapy is described in detail, as a basis for discussion of the specific and non-specific factors contributing to this outcome. [ABSTRACT FROM AUTHOR]

The article examines the effectiveness of cognitive behavioral therapy of schizophrenia. According to the authors, cognitive behavioral techniques have shown grounds for optimism that they can complement pharmacological and other psychosocial techniques in schizophrenia. The author stress that these techniques challenge conventional belief about delusions and hallucinations by presenting evidence that they can be amenable to reasoning approaches. [ABSTRACT FROM AUTHOR]

The article deliberates if cognitive-behavioral therapy (CBT) is a worthwhile treatment for psychosis. It is a known fact that CBT is of proven benefit for treatment of depression and has been increasingly recommended as a treatment modality for schizophrenia. According to the authors, there has been considerable enthusiasm for the use of CBT in schizophrenia from psychiatrists, psychologists, and psychiatric nurses and users alike. The position and perspective of the authors, voting "for" and "against" on issue is presented.

The article focuses on the article "Brief cognitive–behavioural therapy for patients inthe community with schizophrenia: Randomisedcontrolled trial in Beijing, China" in the 2017 issue being retracted by the publisher.

A response by Douglas Turkington to a letter to the editor about his article on the efficacy of cognitive behavior therapy for schizophrenia in the 2006 issue is presented.

Examines the procedure of cognitive-behavioral therapy (CBT) for schizophrenia, the evidence for its use and the implications for practicing psychiatrists. Progress in the efficacy of CBT in treating patients with persistent symptoms of schizophrenia; Use of Socratic questioning by the therapist to help the patient appreciate potentially illogical deductions and conclusions.

Abstract: Insight in schizophrenia is an evolving concept with widespread use in clinical practice. Results are presented from a multicentre randomised trial in which patients with schizophrenia and carers received a short insight-focused Cognitive Behaviour Therapy (CBT) intervention from trained nurses in the community. The CBT group demonstrated significantly greater improvement in insight into compliance with treatment and the ability to re-label their psychotic symptoms as pathological compared with the control group at post-therapy assessment. Those participants who demonstrated improved insight into having a mental illness tended to become depressed. At the end of therapy and at 1-year follow-up, there was a statistically significantly increased dropout rate in African-Caribbean and Black African participants. The Black Caribbean group showed a significantly smaller change in insight compared to the white group. At 1-year follow-up, the result on total insight and compliance was durable. The change in insight in the Black African group was significantly lower compared to the white group. The study emphasizes the role of a short insight-focused CBT intervention in improving patients'' insight into compliance and its implications. The results confirm previous findings of difficulties in engaging patients of Afro-Caribbean origin and their poor response to psychological therapies as currently delivered. [Copyright &y& Elsevier]