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Cognitive therapy in schizophrenia

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.

REFERENCES

Curtis, D. (1999) Intensive cognitive behaviour therapy for chronic schizophrenia. Specific effect of cognitive behaviour therapy for schizophrenia is not proved (letter). British Medical Journal, 318, 331.[Free Full Text]

Drury, V., Birchwood, M., Cochrane, R., et al (1996) Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593-601.[Abstract/Free Full Text]

Kuipers, E., Garety, P., Fowler, D., et al (1997) London—East Anglia randomised controlled trial of cognitive—behavioural therapy for psychosis. I. Effects of the treatment phase. British Journal of Psychiatry, 171, 319-327.[Abstract/Free Full Text]

Sensky, T., Turkington, D., Kingdon, D., et al (2000) A randomised controlled trial of cognitive—behavioural therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57, 165-172.[Abstract/Free Full Text]

Tarrier, N., Yusupoff, L., Kinney, C., et al (1998) Randomised controlled trial of intensive cognitive behaviour therapy for patients with some schizophrenia. British Medical Journal, 317, 303-307.[Abstract/Free Full Text]

Thornicroft, G. & Susser, E. (2001) Evidence-based psychotherapeutic interventions in the community care of schizophrenia. British Journal of Psychiatry, 178, 2-4.[Free Full Text]

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