A Trial of Two Cognitive-Behavioural Methods of Treating Drug-Resistant Residual Psychotic Symptoms in Schizophrenic Patients: I. Outcome

1993 ◽  
Vol 162 (4) ◽  
pp. 524-532 ◽  
Author(s):  
Nicholas Tarrier ◽  
Richard Beckett ◽  
Sue Harwood ◽  
Amanda Baker ◽  
Lawrence Yusupoff ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Controlled Trial ◽  
Psychotic Symptoms ◽  
Behavioural Treatment ◽  
Treatment Benefit ◽  
Residual Symptoms ◽  
Cognitive Behavioural ◽  
Schizophrenic Patients ◽  
Demand Condition

Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counterdemand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in pyschotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

scholarly journals Cognitive Behavioural Therapy for Auditory Hallucinations: Effectiveness and Predictors of Outcome in a Specialist Clinic

2010 ◽  
Vol 39 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Neil Thomas ◽  
Susan Rossell ◽  
John Farhall ◽  
Frances Shawyer ◽  
David Castle
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Negative Symptoms ◽  
Rating Scales ◽  
Behavioural Therapy ◽  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Predictors Of Outcome ◽  
Formal Thought Disorder ◽  
Behavioural Treatment ◽  
Cognitive Behavioural

Background: Cognitive behavioural therapy has been established as an effective treatment for residual psychotic symptoms but a substantial proportion of people do not benefit from this treatment. There has been little direct study of predictors of outcome, particularly in treatment targeting auditory hallucinations. Method: The Psychotic Symptom Rating Scales (PSYRATS) and Positive and Negative Syndrome Scale (PANSS) were administered pre- and post-therapy to 33 people with schizophrenia-related disorders receiving CBT for auditory hallucinations in a specialist clinic. Outcome was compared with pre-therapy measures of insight, beliefs about the origin of hallucinations, negative symptoms and cognitive disorganization. Results: There were significant improvements post-treatment on the PSYRATS and PANSS Positive and General Scales. Improvement on the PSYRATS was associated with lower levels of negative symptoms, but was unrelated to overall insight, delusional conviction regarding the origins of hallucinations, or levels of cognitive disorganization. Conclusions: Lack of insight and presence of formal thought disorder do not preclude effective cognitive-behavioural treatment of auditory hallucinations. There is a need to further understand why negative symptoms may present a barrier to therapy.

scholarly journals Cognitive–behavioural therapy and motivational intervention for schizophrenia and substance misuse

2003 ◽  
Vol 183 (5) ◽  
pp. 418-426 ◽  
Author(s):  
Gillian Haddock ◽  
Christine Barrowclough ◽  
Nicholas Tarrier ◽  
Jan Moring ◽  
Robert O'Brien ◽  
...  
Keyword(s):  
Service Use ◽  
Substance Misuse ◽  
Controlled Trial ◽  
Routine Care ◽  
Control Treatment ◽  
Health Economy ◽  
Motivational Intervention ◽  
Behavioural Treatment ◽  
Cognitive Behavioural

BackgroundComorbid substance misuse in people with schizophrenia is associated with poor clinical and social outcomes. There are few studies of psychological treatments for this population and little long-term follow-up of their benefits.AimsTo investigate symptom, substance use, functioning and health economy outcomes for patients with schizophrenia and their carers 18 months after a cognitive–behavioural treatment (CBT) programme.MethodPatients with dual diagnosis from a randomised controlled trial of motivational intervention, individual CBT and family intervention were assessed on multiple outcomes at 18-month follow-up. Carers were assessed on symptom, functioning and needs over 12 months. Health economy data were collected over 18 months.ResultsThere were significant improvements in patient functioning compared with routine care over 18 months. No significant differences between treatment groups were found in carer or cost outcomes.ConclusionsThe treatment programme was superior to routine care on outcomes relating to illness and service use, and the cost was comparable to the control treatment.

scholarly journals Outcomes of an effectiveness trial of cognitive–behavioural intervention by mental health nurses in schizophrenia

2006 ◽  
Vol 189 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Douglas Turkington ◽  
David Kingdon ◽  
Shanaya Rathod ◽  
Katie Hammond ◽  
Jeremy Pelton ◽  
...  
Keyword(s):  
Mental Health ◽  
Negative Symptoms ◽  
Community Sample ◽  
Symptom Burden ◽  
Treatment Resistance ◽  
Psychotic Symptoms ◽  
Behavioural Intervention ◽  
Mental Health Nurses ◽  
Cognitive Behavioural

BackgroundLittle is known about the medium-term durability of cognitive–behavioural therapy (CBT) in a community sample of people with schizophrenia.AimsTo investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up.MethodParticipants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. =53) by raters masked to treatment allocation (CBT or usual care).ResultsAt 1-year follow-up, participants who received CBT had significantly more insight (P=0.021) and significantly fewer negative symptoms (P=0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up.ConclusionsMental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.

Durability of the effects of cognitive–behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up

1999 ◽  
Vol 174 (6) ◽  
pp. 500-504 ◽  
Author(s):  
Nicholas Tarrier ◽  
Anja Witttkowskj ◽  
Caroline Kinney ◽  
Eilis McCarthy ◽  
Juue Morris ◽  
...  
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Psychotic Symptoms ◽  
Cognitive Behavioural ◽  
Supportive Counselling ◽  
One Year

BackgroundPersistent drug-resistant psychotic symptoms are a pervasive problem in the treatment of schizophrenia.AimsTo evaluate the durability of the treatment effects of cognitive–behavioural therapy for chronic schizophrenia one year after treatment termination.MethodA comparison of clinical outcomes was made at one-year follow-up from a randomised trial of cognitive–behavioural therapy, supportive counselling and routine care alone in the treatment of chronic schizophrenia.ResultsSeventy out of the 72 patients (97%) who completed treatment were assessed at follow-up. There were significant differences between the three groups when positive and negative symptoms were analysed by means of ANCOVAs. Between-group comparisons indicated significant differences between cognitive–behavioural therapy and routine care at follow-up for positive symptoms. There was a trend towards significance for both cognitive–behavioural therapy and supportive counselling to be superior to routine care alone on negative symptoms.ConclusionsAt 12-month follow-up the significant advantage of cognitive– behavioural therapy compared to routine care alone remained.

Cognitive Behavioural Therapy for Medically Unexplained Physical Symptoms: A Pilot Study

1996 ◽  
Vol 24 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Anne E. M. Speckens ◽  
Philip Spinhoven ◽  
Keith E. Hawton ◽  
Jan H. Bolk ◽  
Albert M. van Hemert
Keyword(s):  
Controlled Trial ◽  
Physical Symptoms ◽  
Small Sample ◽  
Social Consequences ◽  
Behavioural Treatment ◽  
Medically Unexplained Physical Symptoms ◽  
Cognitive Behavioural ◽  
Medically Unexplained ◽  
Unexplained Physical Symptoms

The aim of the study was to develop a cognitive behavioural treatment model for medically unexplained physical symptoms and assess its feasibility and effect in a small sample of patients. This study was the first step in the realization of a randomized controlled trial. The study population consisted of consecutive patients presenting at a general medical outpatient clinic, whose symptoms could not be explained by objective abnormal findings. The treatment was based on a general model of the disorder, consisting of the physical symptoms, the patient's attribution and perceived control and the cognitive, behavioural, physical and social consequences. It incorporated record keeping concerning physical symptoms and emotions, identification of cognitions about the symptoms, challenging dysfunctional thoughts and behavioural experiments. At 6–months follow-up, four of the five treated patients were improved with regard to frequency and intensity of the symptoms, psychological distress and functional impairment. The improvement was sustained at 1–year follow-up.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

ARE SOME TYPES OF PSYCHOTIC SYMPTOMS MORE RESPONSIVE TO COGNITIVE-BEHAVIOUR THERAPY?

2001 ◽  
Vol 29 (1) ◽  
pp. 45-55 ◽  
Author(s):  
Nicholas Tarrier ◽  
Caroline Kinney ◽  
Ellis McCarthy ◽  
Anja Wittkowski ◽  
Lawrence Yusupoff ◽  
...  
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Negative Symptoms ◽  
Controlled Trial ◽  
Chronic Schizophrenia ◽  
Routine Care ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Supportive Counselling

Results are presented from a randomized controlled trial indicating which psychotic symptoms respond to cognitive behaviour therapy. The aim of the study was to investigate whether different types of psychotic symptoms are more or less responsive to cognitive-behaviour therapy compared to treatment received by control groups. Seventy-two patients suffering from chronic schizophrenia who experienced persistent positive psychotic symptoms were assessed at baseline and randomized to either cognitive-behaviour therapy and routine care, supportive counselling and routine care, or routine care alone and were re-assessed after 3 months of treatment (post-treatment). Independent and blind assessment of outcome indicated delusions significantly improved with both cognitive behaviour therapy and supportive counselling compared to routine care. Hallucinations significantly decreased with cognitive-behaviour therapy compared to supportive counselling. There was no difference in the percentage change of hallucinations compared to delusions in patients treated by cognitive behaviour therapy. There was little change in measures of affective symptoms but there was no evidence that a reduction in positive symptoms was associated with an increase in depres sion. In fact, a reduction in positive symptoms was positively correlated with a reduction in depression. There were significant differences in the reductions in thought disorder and negative symptoms with an advantage of cognitive-behaviour therapy compared to routine care.

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