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Implementing cognitive–behavioural therapy for first-episode psychosis

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

JOHN GLEESON, PhD

Department of Psychology, University of Melbourne, Melbourne

Correspondence: Dr Jean Addingtion, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, M5S 2S1, Canada. Tel: +1 416 535 6936; fax: +1 416 979 693; e-mail: jean_addington{at}camh.net

Declaration of interest None.

*Paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

Significant symptomatic improvement after a first episode of psychosisis not matched by a similar improvement in functional outcome. Thus, increased attention has been given to psychological intervention, in particular cognitive cognitive–behavioural therapy (CBT), with the hope of enhancing functional recovery. Outcome trials of CBT for schizophrenia are few, in particular for the first episode, and have been occasionally criticised for their lack of significance compared with supportive therapies. We describe a modular CBT approach for those with a first episode of psychosis that addresses adaptation as well as both functional and symptomatic outcome and one that parallels the theoretical shift in CBT that has occurred in the lastdecade. Guidelines for integrating CBT into an early psychosis service are presented.

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