The British Journal of Psychiatry (2001) 178: 379-380
© 2001 The Royal College of Psychiatrists
Cognitive therapy in schizophrenia
P. J. McKenna
Fulbourn Hospital, Cambridge CBI 5EF
EDITED BY MATTHEW HOTOPF
In the course of a favourable review of cognitive therapy in schizophrenia,
Thornicroft & Susser (2001)
cite the recent trial by Sensky et al
(2000), but fail to mention
that it had negative results. This 90-patient, 9-month randomised controlled
trial, carried out under blind conditions, compared this form of treatment
with a control intervention (befriending) and found no significant difference
between the two. It is true that differences emerged 9 months after completion
of treatment, but this latter part of the study was uncontrolled.
Of the other trials of cognitive therapy cited in their article, that of
Drury et al (1996) did
not use blind evaluations, and that of Kuipers et al
(1997) employed neither blind
evaluations nor a condition to control for the non-specific effects of
intervention (the Hawthorne effect). Only one other published study
(Tarrier et al, 1998)
incorporated both these design features; this found a non-significant
advantage of cognitive therapy over supportive counselling
(Curtis, 1999).
Rather than being ready for an assessment of its effectiveness and
cost-effectiveness in non-experimental settings, as Thornicroft & Susser
argue, cognitive therapy may be in the process of meeting the fate of an
earlier treatment for schizophrenia where advocacy preceded rigorous
evaluation insulin coma.
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