© 2004 The Royal College of Psychiatrists
Correspondence |
Cognitive–behavioural therapy for psychosis
University of Southampton, Royal South Hants Hospital, Southampton SO14 0YG, UK. E-mail: dgk{at}soton.ac.uk
Like a magician pulling a rabbit from his hat, Turkington draws a positive result for cognitive therapy for schizophrenia from the literature – only for McKenna to put it back in again (Turkington/McKenna, 2003). Does it exist or not? McKenna’s arguments and table look convincing as, by excluding any study that does not have an active control, he reduces the number of studies he considers. But would he do the same for studies of antipsychotic medications? Or does he assume that patients, and raters evaluating patients, can detect no difference between taking, for example, placebo and haloperidol, or even haloperidol and olanzapine? In which case why are we giving them so much of the latter?
But even focusing only on the studies that he finds acceptable, he dismisses one (SoCRATES; Lewis et al, 2002) for having a positive effect over active control on auditory hallucinations (oh, for a drug that had such an effect over and above those currently available!) and another (Sensky et al, 2000) where a differential benefit of cognitive–behavioral therapy over befriending only became apparent 9 months after therapy ended. He completely omits other widely cited studies with active placebos and positive effects (e.g. Drury et al, 1996). He then does an unusual meta-analytic exercise in dismissing two small pilot studies by weighing them against each other and finding them to cancel out. Other meta-analyses (e.g. Pilling et al, 2002) using more conventional methodology have concluded differently and, fortunately, so has the National Institute for Clinical Excellence.
The rabbit exists and is multiplying rapidly (e.g. Durham et al, 2003).
D.K. has published books and gives workshops on cognitive–behavioural therapy for schizophrenia.
REFERENCES
- Drury, V., Birchwood, M., Cochrane, R., et al
(1996) Cognitive therapy and recovery from acute psychosis: a
controlled trial. II. Impact on recovery time. British Journal of
Psychiatry, 169, 602
–607.
[Abstract/Free Full Text] - Durham, R.C., Guthrie, M., Morton, R. V., et al
(2003) Tayside–Fife clinical trial of
cognitive–behavioural therapy for medication-resistant psychotic
symptoms: results to 3-month follow-up. British Journal of
Psychiatry, 182, 303
–311.
[Abstract/Free Full Text] - Lewis, S., Terrier, N., Haddock, G., et al (2002) Randomised controlled trial of cognitive–behavioural therapy in early schizophrenia: acute-phase outcomes. British Journal of Psychiatry, 181 (suppl. 43), s91 –s97.
- Pilling, S., Bebbington, P., Kuipers, E., et al (2002) Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32, 763 –782.[CrossRef][Medline]
- Sensky, T., Turkington, D., Kingdon, D., et al
(2000) A randomized 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] - Turkington, D./McKenna, P. J. (2003) Is
cognitive–behavioural therapy a worthwhile treatment for psychosis?
(debate). British Journal of Psychiatry,
182, 477
–479.
[Free Full Text]
Author’s reply
Fulbourn Hospital, Cambridge CB1 5EF. E-mail: peter.mckenna{at}virgin.net
Actually, the study of Durham et al (2003) which was carried out under blind conditions failed to find a significant advantage for cognitive therapy over active placebo. The authors state that ‘Repeated measures analyses of variance were first conducted with three levels of treatment (CBT v. SPT v. TAU) and three time points (baseline, post-treatment, follow-up). There were significant effects for time for all variables except the GAS but no significant time x treatment interaction effects or contrasts for any of the measures’. This was for ‘Changes in severity from baseline’, with an essentially similar finding for ‘Clinically significant improvement’.
REFERENCES
- Durham, R. C., Guthrie, M., Morton, R. V., et al
(2003) Tayside–Fife clinical trial of
cognitive–behavioural therapy for medication-resistant psychotic
symptoms. Results to 3-month follow-up. British Journal of
Psychiatry, 182, 303
–311.
[Abstract/Free Full Text]
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