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Cognitive-behavioural therapy in first-episode and early schizophrenia

18-month follow-up of a randomised controlled trial

School of Psychiatry and Behavioural Sciences, University of Manchester

Richard Bentall, PhD

Department of Psychology, University of Manchester

Richard Drake, MRCPsych

School of Psychiatry and Behavioural Sciences, University of Manchester

Peter Kinderman, PhD

University Department of Clinical Psychology, University of Liverpool

David Kingdon, FRCPsych

University Department of Mental Health, University of Southampton

Ronald Siddle, PhD, Julie Everitt, Karen Leadley, MPhil, Andy Benn, MSc, Katy Grazebrook, MPsychol, Cliff Haley, MRCPsych, Shahid Akhtar, MBBS and Linda Davies, MSc

School of Psychiatry and Behavioural Sciences, University of Manchester

Steve Palmer, MSc

Centre for Health Economics, University of York

Graham Dunn, PhD

School of Epidemiology and Health Sciences, University of Manchester, UK

Correspondence: Professor Nicholas Tarrier, Education and Research Building (2nd Floor), Wythenshawe Hospital, Manchester M23 9LT, UK. Tel: 44 161 291 5883; fax: 44 161 275 5882; e-mail: nicholas.tarrier{at}man.ac.uk

Declaration of interest None.

Background The initial phase of a trial of cognitive-behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.

Aims To testthe hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.

Method This was an18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.

Results There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre-treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBTand supportive counselling. Medication dosage and compliance did not explain group differences.

Conclusions Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction.

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