Cognitive Behavioral Therapy for Schizophrenia: An Empirical...

: The Journal of Nervous and Mental Disease

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Journal of Nervous & Mental Disease:

May 2001 - Volume 189 - Issue 5 - pp 278-287 Articles

Cognitive Behavioral Therapy for Schizophrenia: An Empirical Review

RECTOR, NEIL A. Ph.D.1; BECK, AARON T. M.D.2
Author Information
1

Centre for Addiction and Mental Health, Clarke Institute of Psychiatry and Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. Send reprint requests to Dr. Rector.

Department of Psychiatry, University of Pennsylvania School of Medicine, 754 Science Center, 3600 Market Street, Philadelphia, Pennsylvania 19104-2648. The preparation of this manuscript was supported in part by a grant from the Ontario Mental Health Foundation (OMHF) awarded to the first author. The authors thank Anthony Morrison, Mary V. Seeman, Zindel V. Segal, and Til Wykes for their comments on a draft of this manuscript. The authors also thank Leslie Atkinson for his statistical assistance and Talia Hoffstein for her editorial assistance.

Abstract Early case studies and noncontrolled trial studies focusing on the treatment of delusions and hallucinations have laid the foundation for more recent developments in comprehensive cognitive behavioral therapy (CBT) interventions for schizophrenia. Seven randomized, controlled trial studies testing the efficacy of CBT for schizophrenia were identified by electronic search (MEDLINE and PsychInfo) and by personal correspondence. After a review of these studies, effect size (ES) estimates were computed to determine the statistical magnitude of clinical change in CBT and control treatment conditions. CBT has been shown to produce large clinical effects on measures of positive and negative symptoms of schizophrenia. Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy. These results reveal promise for the role of CBT in the treatment of schizophrenia although additional research is required to test its efficacy, long-term durability, and impact on relapse rates and quality of life. Clinical refinements are needed also to help those who show only minimal benefit with the intervention. The notable results from the introduction of atypical antipsychotics in the treatment of schizophrenia have paralleled promising research findings for cognitive behavioral therapy (CBT) in the treatment of patients with persistent symptoms. Although CBT has become a widely practiced and empirically supported psychotherapeutic approach (e.g., Chambless and Gillis, 1993; Dobson, 1989), only in the past decade has its use been advocated in the treatment of schizophrenia. CBT for schizophrenia draws on the principles and the intervention strategies previously developed in CBT for anxiety (Beck et al., 1985) and depression (Beck et al., 1979) but is tailored to treat specific symptoms of schizophrenia within a diathesis-stress, bio-psycho-social framework (Zubin and Spring, 1977). Empirical reviews of other psychosocial interventions for schizophrenia, such as social skills training, personal therapy, family therapy, and supportive therapy, have been provided (Huxley et al., 2000; Penn and Mueser, 1996). There have also been several recent reviews on the early empirical research on CBT for schizophrenia (Dickerson, 2000; Garety et al., 2000; Jones et al., 2000; Norman and Townsend, 1999). Since their publication, a number of multisite controlled studies have been completed that shed new light on the ability of CBT to target symptom domains other than hallucinations and delusions. Further, we provide a quantitative analysis of the extant literature to determine the magnitude and pattern of symptom changes between CBT and supportive psychotherapies. Finally, we suggest possible lines of inquiry for future research in this area.
Pharmacotherapy as a Front-Line Treatment

Recent reviews point to the potential treatment benefits of atypical antipsychotics (Stahl, 1999; Stephenson and Pilowski, 1999). Although pharmacotherapy is largely effective in treating acute psychosis and in preventing the frequency of relapse, a significant proportion of patients continue to experience occasional, sometimes persistent, hallucinations and delusions, negative symptoms, cognitive impairment, and chronic disability due to disrupted social and occupational functioning. Previous research with the more conventional neuroleptics has shown that between 25 and 60% of patients may continue to experience florid symptoms even when adhering to treatments (Curson et al., 1985; Harrow et al., 1985). There is significant variability in clinical response with the atypical neuroleptics. Upwards of 25% of patients are typically maintained on multiple atypical antipsychotics (Stahl, 1999). Medication noncompliance continues to present a special problem. It has been estimated that 75% of inpatients in a first episode (Kissling, 1992) and stabilized outpatients (Corrigan et al., 1990) treated in the community with standard neuroleptics will be noncompliant. Selective studies with atypical neuroleptics show similar high discontinuation rates (Ratakonda et al., 1997). Noncompliance may be due to lack of awareness of the illness (Kent and Yellowlees, 1994), concerns about stigmatization and fear of dependency (Corrigan et al., 1990), dissatisfaction with side effects, and/or the patient's perception that he/she is "cured." Thus, there is continuing need for the http://journals.lww.com/jonmd/Fulltext/2001/05000/Cognitive_Behavioral_Therapy_for_Schizophrenia__An.2.aspx 26/12/2012 18:08:40

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development of treatments that target persistent symptoms, the secondary aspects of the disorder, such as depression and anxiety, and that do not lead to pernicious secondary effects.
Cognitive Models of Psychopathology

Just as information-processing biases are seen to be important in the initiation and maintenance of depressed (Beck, 1967, 1976) and anxious (Beck et al., 1985) mood, cognitive accounts have been proposed to explain, in part, the development and maintenance of unrealistic beliefs and aberrant perceptual processes. Basic research on cognitive processes in psychosis has suggested that hallucinations and delusions may be extreme variants of ordinary appraisal processes and belief formation. For instance, cognitive processes that may lead to delusional beliefs consist, in part, of a tendency to overestimate coincidences (Maher, 1988), to "jump to conclusions" (Garety and Hemsley, 1994; Garety et al., 1991), and to engage in self-serving biases to protect vulnerable self-esteem (Bentall et al., 1994b) . These tendencies are more prevalent in schizophrenia than in the general population. Deluded patients also evidence attentional biases toward threat-related stimuli (Kaney et al., 1991). Once formed, delusional beliefs may be maintained in a similar way to ordinary beliefs: supporting evidence is recruited and disconfirming evidence is ignored or minimized. Hallucinations may be associated with similar biases. Five percent of the general population is believed to experience auditory hallucinations (Tien, 1992) but, for the most part, recognize that they are of internal origin and remain untroubled by them. By contrast, patients with schizophrenia are more prone to adhere to the notion that their auditory hallucinations are generated by an external, often malevolent agent (Bentall, 1990). Psychotic patients who hear voices in their heads are also likely to misinterpret ambiguous external stimuli; for example, interpreting muffled sounds as if they were words (Bentall, 1990; Haddock et al., 1993). Once formed, expectancy sets (Young et al., 1987), ongoing stress (Slade, 1973), or beliefs about the identity of the voice (Bentall et al., 1994a; Chadwick and Birchwood, 1994; Haddock et al., 1993) may maintain the hallucinations. Work by Chadwick and Birchwood (Birchwood and Chadwick, 1997; Chadwick and Birchwood, 1994) suggests that the serious disturbance associated with hearing voices is not due to the frequency, duration, form, or content of the voices but rather to the idiosyncratic beliefs that the person has about the voices' identity. Beliefs about the voices' power and authority, and the consequences of not complying are especially important.
Cognitive Behavioral Therapy for Schizophrenia

Specific cognitive and behavioral techniques for the treatment of delusions (Beck, 1952; Chadwick and Lowe, 1994; Hole et al., 1979; Watts et al., 1973) and hallucinations (Haddock et al., 1998; Slade and Bentall, 1988; Wykes et al., 1999) have been reported for decades. A recent quantitative summary of these early studies on the treatment of hallucinations and/or delusions (N = 15) concluded that cognitive restructuring led to significant decreases on measures specific to these symptom domains (Bouchard et al., 1996). The promise shown with pioneering treatment strategies led to the creation of comprehensive CBT interventions designed to treat a greater breadth of symptoms within a stress-vulnerability model of the disorder (Chadwick et al., 1996; Fowler et al., 1995; Kingdon and Turkington, 1994; Tarrier, 1992) .3 These interventions differ to some extent in their treatment targets. For instance, while Kingdon and Turkington (1994) emphasize the importance of 'normalizing' symptoms, Tarrier (1992) places greater attention on expanding the patients' repertoire of coping strategies. Chadwick and colleagues (1996) focus on cognitive strategies to elicit and correct self-and other-evaluative beliefs that are associated with positive symptoms, while Fowler and colleagues (1995) outline a comprehensive intervention of six treatment modules that incorporate many of the features described in the other manuals. Notwithstanding these important differences (see Dickerson, 2000 for review), they overlap in their cognitive conceptualization of psychotic disturbance, and in their defined goals and tasks of therapy. The shared goals of CBT include: a) the establishment of a strong therapeutic alliance, which is characterized by acceptance, support, and collaboration; b) psychoeducation about the nature of psychosis within a bio-psycho-social model with the goal of reducing stigma and normalizing these experiences; c) reducing the distress associated with the disorder; d) cognitive and behavioral interventions to reduce the occurrence and distress associated with delusions and hallucinations; e) targeting comorbid affective states, such as anxiety and depression; and f) reducing relapse.
Current Review

For the current review, we surveyed MEDLINE and PsychInfo for empirical studies on cognitive behavioral therapy for schizophrenia. Search terms included schizophrenia, psychosis, cognitive therapy, and cognitive behavioral therapy. In an attempt to locate unpublished studies, reference sections of published studies were examined and correspondence was undertaken with researchers known to be working in the area. Although a wide range of early case reports and noncontrolled studies on the cognitive and behavioral treatment of delusions and hallucinations were identified, only randomized controlled trial studies testing comprehensive cognitive behavioral therapy interventions for patients with a schizophrenia-spectrum disorder were selected for review. This search uncovered seven controlled experimental studies on CBT treatment, six published in peer-reviewed journals and one unpublished. These studies are outlined in Table 1.

Table 1

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CBT Plus Routine Care vs. Routine Care Only

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An early nonrandom allocation controlled pilot study by Garety and colleagues (1994) pointed to the potential benefits of manual-based CBT for long-term, chronic schizophrenia. Compensating for the limitations associated with the early nonrandomized pilot study, Kuipers and colleagues (1997) subsequently conducted a multisite, randomized controlled trial, comparing patients receiving CBT plus routine care (CBT-RC; N = 28) to patients receiving routine care only (RC-only; N = 32). Routine care comprised pharmacotherapy and active case management. Admission to the study was determined by the presence of at least one distressing positive symptom during the previous 6 months. In the assessment of clinical outcomes at 9 months, the CBT-RC group showed a greater reduction in overall psychopathology in comparison with the RC-only treatment group. Patients receiving CBT-RC showed continued gains in measures of overall symptomatology at 9-month follow-up (Kuipers et al., 1998). An important methodological weakness of this study was that posttreatment and follow-up assessments were not conducted by raters blind to the patient's treatment assignment. Further, although medication use and its changes were monitored throughout the study, no attempt was made to examine, statistically, the relationship between medication use and treatment response. In this way, it is possible that improvements were due to the effects of medication change rather than the CBT intervention. have recently completed a randomized controlled study comparing CBT-RC versus RC-only for patients experiencing persistent symptoms. In this study, clinical raters were blind to patient treatment allocation at each assessment phase. Medication use was monitored also for the duration of the study. In this study, CBT was comprised of 20 individual sessions across 6 months and routine care included pharmacotherapy, active case management, and access to day services within a specialized multidisciplinary treatment context. Whereas Kuipers and colleagues (1997) selected for entry patients who were experiencing distressing positive symptoms, Rector and colleagues (2000) had a broader inclusion criteria that included patients experiencing clinical distress as a result of positive or negative symptoms. Forty-two patients completed the active phase of treatment. The clinical outcomes were found to be consistent with those reported by Kuipers and colleagues (1997). Patients receiving CBT-RC demonstrated better outcomes than those receiving RC-only on interview-based measures of overall schizophrenia symptomatology. At 6-month follow-up, patients in both treatment groups continue to maintain their gains achieved during the active intervention although patients who received CBT-RC show a significantly greater reduction of negative symptoms as compared to those in RC-only. These differences were not due to medication use as treatment groups were found to be equivalent throughout the duration of the study. Although these studies show promise that CBT-RC provides additional benefits above-and-beyond enriched routine care, it is not possible to determine whether the outcomes are specific to the effects of CBT in the absence of a comparison therapy condition that controls for the nonspecific benefit of therapist contact. Five studies have been now conducted that compared CBT versus alternative, supportive therapy interventions.
CBT Plus Routine Care vs. Alternative/Supportive Psychotherapy Plus Routine Care Rector and colleagues (2000)

conducted a randomized controlled trial study comparing CBT-RC (which Tarrier and colleagues have termed "coping strategy enhancement"; N = 12), problem-solving therapy plus routine care (PS-RC; N = 12), and a wait-list condition (i.e., RC-only; N = 14) in the alleviation of persistent delusions and hallucinations (of 6 months' duration). RC-only comprised pharmacotherapy and active case management. Patients receiving CBT-RC had better clinical outcomes on measures of positive symptoms and their associated distress than did patients in the two comparison conditions. In terms of the clinical significance of these changes, defined as a 50% or greater reduction in symptoms, 60% of the patients receiving CBT-RC were rated treatment "responders," whereas only 25% of patients receiving PS-RC were rated "responders." have more recently conducted a randomized controlled trial comparing: a) CBT-RC, b) supportive counseling (SC) plus routine care (SC-RC), and c) RC-only. Eighty-seven patients were randomly allocated and stratified based on severity of symptoms and gender to one of the three treatment conditions. Criteria for entry to the study included the persistence of positive symptoms for the previous 6 months, stable use of medications, and no psychological- or family-based intervention running concurrently. Treatments were conducted over the course of 10 weeks for a total of 20 hours of individualized treatment. This study assured that clinical raters were blind to treatment condition. Medication use between treatment groups was monitored throughout the study and determined not to differ either in medication type or dosage levels. This study also systematically assessed the degree of treatment fidelity: 97% of CBT and SC tapes were identified correctly as such. Patients receiving CBT-RC demonstrated a significant reduction in both the number and severity of positive symptoms; this reduction was greater than the reductions achieved in either the SC-RC or RC-only treatment conditions. Patients treated with CBT-RC were more likely to respond successfully (as defined by a 50% reduction in positive symptoms) to treatment than were patients in SC-RC or RC-only. Although no patients receiving CBT-RC or SC-RC relapsed in this study, four patients in the RC-only condition relapsed, for an aggregate total of 204 days of hospitalization. At 12-month follow-up (Tarrier et al., 1999), significant advantages remained for patients who received CBT-RC. These patients continued to have significantly fewer positive symptoms than patients who received either SC-RC or RC-only. Subsequent to an early pilot study (Kingdon and Turkington, 1991), Sensky and colleagues (2000) randomly assigned 90 patients with persistent symptoms to receive either CBT-RC (N = 46) or "befriending" therapy plus routine care (BF-RC; N = 44). Befriending therapy consisted of sympathetic conversation with a therapist about pleasant or neutral topics for 20 sessions. CBT was also conducted across 20 sessions, in an individual format, and according to the author's published treatment manual (Kingdon and Turkington, 1994) . Patients received 45-minute sessions, initially weekly, then biweekly and finally, on a monthly basis, over a 9month period. There were an equal number of dropouts in CBT-RC (N = 9) and BF-RC (N = 8).
Tarrier and colleagues (1998)

Tarrier and colleagues (1993a)

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A total of 74 of the original 90 patients were assessed at a 9-month follow-up. Outcomes focused on measures of overall psychopathology, change in global measures of schizophrenia symptoms, as well as change on scales designed to assess negative symptoms and depression. At treatment termination, treatment groups showed significant and equivalent improvement across the assessment measures. However, at 9-month follow-up, patients in CBT-RC were shown to have superior outcomes on all measures and these differences were not due to medication use or its changes throughout the study period. There were a number of methodological advances in this study: attrition was minimized so that only four of 46 patients failed to complete 10 sessions of cognitive therapy (only two patients failed to complete 10 sessions of befriending); treatment fidelity was ensured by assessing a random selection of 89 audiotapes for a 100% accuracy rate in identifying patients who were treated with cognitive therapy; and finally, raters at posttreatment and 9-month follow-up remained blind to the patients' treatment allocation. reported on a randomized controlled study comparing 6 months of CBT-RC (N = 19) versus supportive therapy and routine care (ST-RC; N = 18) in DSM-IV-defined inpatients and outpatients experiencing persistent symptoms. In this study, all patients were said to have "failed" to respond to at least two previous neuroleptic interventions and were started on an adequate clinical dose of clozapine. CBT was conducted according to the Fowler and colleagues' (1995) manual and also included selected elements of social skills training. Supportive therapy consisted of basic psychoeducation about the nature and treatment of schizophrenia, crisis management, and patient advocacy. Both treatments were shown to produce statistically significant improvement on overall psychotic symptoms, positive symptoms, and negative symptoms. Patients receiving CBT-RC showed greater reductions on measures of overall schizophrenia symptoms and positive symptoms than did patients receiving ST-RC, whereas no group differences were noted on the measure of negative symptoms. The beneficial effects of CBT-RC were not due to differences in medication use; daily clozapine use was equivalent between the groups during the active phase of treatment. At 6-month follow-up (Pinto, 1999), patients who received CBT-RC continued to have significantly better outcomes on measures of total symptoms and positive symptoms. Significant differences were also observed on negative symptom ratings compared with patients who received ST-RC. Adherence to the treatment protocol was said to be high, ranging from 75 to 85%, although the method of determining adherence was not described. Clinical outcomes, however, were not rated by blind assessors. Further, it was noted by Pinto and colleagues (1999) that patients were not evenly matched on the number of sessions received.
Combined CBT and Routine Care in Acute Schizophrenia Pinto and colleagues (1999)

In the first examination of the efficacy of CBT plus routine care in the acute phase of schizophrenia, Drury and colleagues (1996a) conducted a randomized controlled study of a combined 12-week intensive individual and group CBT-RC intervention compared with an informal support therapy intervention plus routine care (IST-RC). Forty patients in their first or second episode were randomly allocated using a stratified sampling procedure. CBT-RC was delivered according to the manual-based intervention described by Chadwick and colleagues (1996), with a combination of individual therapy and group therapy. The IST-RC involved leisure and social activities away from the inpatient ward and informal support. Both groups showed marked change across the 12 weeks of treatment, although patients receiving CBT-RC showed superior change scores on the positive symptom index and the delusional conviction score. These differential effects were present at the halfway point of treatment. A 6-month follow-up assessment pointed to the maintenance of the differential treatment effects, where 95% of patients in the CBT-RC versus 44% of patients in IST-RC reported either full remission or the presence of only minor positive symptoms. A companion paper (Drury et al., 1996b) further indicated that the CBT-RC group had better recovery at 6-month followup, with an associated 25 to 50% (or 42 to 84 days) reduction in recovery time (depending on the specific definition of "recovery" employed). Finally, Drury and colleagues (1999) have recently reported on the long-term follow-up of the original 40 patients in this study (5 years after treatment completion). For patients in the study who relapsed a maximum of once, observer rated hallucinations and delusions were significantly lower in CBT-RC than in IST-RC. There were a number of methodological limitations to this study including a high exclusionary rate (35%) after randomization and the lack of monitoring and control of medication use. Drury and colleagues (1996a) tested the effects of their intervention on a sole outcome measure that assessed broad domains of functioning (e.g., delusions, depression) on a single 4-point Likert rating scale. The scale items may very well have failed to capture the breadth of the constructs they aimed to assess and thus, inadvertently, increased the probability of type II errors.
Assessing the Cumulative Effects in Cognitive Behavioral Therapy and Supportive Therapy with Routine Care

To determine the magnitude and clinical significance of change on the outcomes reviewed in the randomized controlled studies, pretest-posttest effect size estimates were computed for the different symptom measures according to Cohen (1988), where the pretest mean is subtracted from the posttest mean, divided by the pooled standard deviation ((Mpretest - Mposttest)/SDpooled)). An effect size (i.e., Cohen's d) reflects the extent of (standardized) change on symptom measures, where an effect size of 0 would indicate no change across treatment, an effect size of 1.00 would indicate that the psychopathology scores were one standard deviation unit lower on the measure at posttreatment, and an effect size of -1.00 would indicate that the scores worsened by one standard deviation unit on the measure at posttreatment. Cohen (1988) has identified a small effect size as equal to .2, a moderate effect size as equal to .5, and a large effect size as equal to .8. Rosenthal (1995) has indicated that a quantitative review of as few as two studies may be undertaken to probe for patterns within an extant empirical literature. The aim of this summary was not to provide a definitive statement about the overall efficacy of CBT for schizophrenia at this early stage of investigation but rather to determine whether the findings hold enough promise for further study. The study conducted by Rector and colleagues (2000) was not retained in the effect size summary to minimize the inflation of effects based on an unpublished study. Further, in light of the limited number of comparisons between CBT-RC and RC-only and between ST-RC and RC-only, average effect size estimates were only calculated

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for the CBT-RC and ST-RC comparisons (although all effect sizes have been tabled for inspection). The effect size estimates for six studies can be seen in Table 2 and summarized graphically in Figure 1.

Table 2 Fig. 1
Change on Measures of Positive Symptoms

Five studies (Drury et al., 1996a; Kuipers et al., 1997; Pinto et al., 1999; Sensky et al., 2000; Tarrier et al., 1993a, 1998) reported pretest-posttest change scores on composite measures of positive symptoms. The average effect size on measures of positive symptom functioning is 1.31 (SD = .71) in CBT-RC and .63 (SD = .53) in ST-RC. Clinical improvements in the frequency and distress associated with hallucinations and delusions following CBT-RC appear to be sustained throughout the follow-up period, with the pretest-follow-up effect sizes being 1.48 (SD = .95) in CBT-RC and .64 (SD = .50) in ST-RC (Pinto et al., 1999; Sensky et al., 2000; Tarrier et al., 1998).4
Change on Measures of Negative Symptoms

Three studies have also reported (Pinto et al., 1999; Sensky et al., 2000; Tarrier et al., 1998) on CBT-RC for negative symptoms. Large treatment effects for CBT-RC (ES = 1.08, SD = .83) and medium effects for ST-RC (ES = .47, SD = 24) have been observed. Even though CBT-RC and ST-RC produced significant effects at post-treatment in the Sensky and colleagues' study (2000), the effect sizes at 9month follow-up point to continued large gains for those treated with CBT-RC (ES = .88), whereas those in ST-RC show slippage (ES = .22). The summary of results in follow-up for the same three studies demonstrate the maintenance of gains CBT-RC (ES = 1.19, SD = .95) and ST-RC (ES = .39, SD = .21), although to a lesser extent.
Between-Group Effect Size Comparisons

To avoid disproportionate representation of individual samples, a single effect size was selected based on the primary dependent variable of each of the six published studies comparing CBT-RC and ST-RC.5 We first examined the homogeneity of effect sizes across the different studies. This analysis provides an index as to whether the effect sizes are "cut from the same cloth" (Rosenthal, 1995) , representing uniform results. We next examined whether the weighted, between-group effect size difference between CBT-RC and ST-RC was statistically significant. The between-group effect size was calculated as follows: posttest mean of CBT-RC subtracted from the posttest mean of ST-RC, divided by the pooled standard deviation ((MposttestCBT-RC - MposttestST-RC)/ SDpooled)). These effects were then weighted by sample size. The CBT-RC and ST-RC effect size estimates were found to be homogeneous (2 [4, N = 239] = 4.79, p > .31). The mean weighted between-group effect size was .91 (SD = 0.14), demonstrating a large and significant effect size difference in favor of CBT-RC, z = 6.59, p < .00001.6
Patient Variables Related to Treatment Outcomes

The absence of heterogeneity in the effect size estimates suggests that treatment moderators, if and when present, have played only a minor role in predicting treatment outcomes (Rosenthal, 1995). Studies have pointed to the potential moderating role of cognitive flexibility (Garety et al., 1997), awareness of stigma (Drury et al., 1999), and coping skills (Tarrier et al., 1993b), although these findings require replication with standardized rating instruments (see Dickerson, 2000 and Garety et al., 2000 for critical reviews). Conclusions and Future Research Considerations The strength of the studies reviewed include the inclusion of patients with reliable diagnoses, the employment of reliable and valid outcome measures (for the majority of studies), the delivery of standardized manual-based treatments, the close monitoring of medication use in the more recent studies, and the employment of valid control treatment conditions (for the majority of studies). However, there are also important methodological shortcomings that qualify the positive effects reported, including the absence of representative sampling (Drury et al., 1996a, 1996b), the absence of blind ratings (Kuipers et al., 1997; Pinto et al., 1999), the absence of reliable and valid multidimensional symptoms measures (Drury et al., 1996a, 1996b; Tarrier et al., 1993a), the failure to control for potential between-group differences in the use of medications (Kuipers et al., 1997; Tarrier et al., 1993a), and the failure to ensure treatment adherence and competence of CBT therapists (Drury et al., 1996a, 1996b; Kuipers et al., 1997). In addition to these methodological limitations, studies have yet to examine whether improvement in core symptom domains impact positively on aspects of social functioning and quality of life. Further, few studies have addressed whether secondary aspects of the illness, such as depression and/or anxiety are targeted successfully. The treatment of associated affective states in schizophrenia is very important. Estimates of the prevalence of severe depression at the time of relapse are between 20 and 50%, and upwards of two-thirds of patients receiving a diagnosis of schizophrenia will also experience a major depressive episode (Siris, 1995) . Affective states serve to maintain symptoms and constitute risk for relapse and suicide (Johnson, 1988; Siris, 1995). Only Senksy and colleagues (2000) have reported on pretest-posttest and pretest-follow-up change in depression severity scores in a randomized controlled study and the effects in CBT were found to be large at posttreatment and follow-up, suggesting promise. Relatedly, the

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potential for CBT to reduce relapse rates when delivered in conjunction with adequate routine care remains a critical question for future research considering the high rates of relapse and recurrence in this population. Seven randomized controlled studies have been conducted, and so clearly, more controlled and methodologically rigorous research is needed to test its efficacy. Although not an exhaustive list, future research would ideally aim to address the following questions. What combination of medications and CBT would represent the optimal "dose" of treatment? CBT and medication-based treatments may provide separate additive effects or they may even work synergistically. For instance, it may be that prompt treatment of acute psychosis with effective novel antipsychotics could prevent further consolidation of delusional conviction by increasing insight and making the patient more amenable to early intervention with CBT? Does CBT offer additive benefits above and beyond those achieved with other effective psychosocial interventions, such as social skills training or family therapy? Or relatedly, is there a multiplier effect on clinical outcomes if CBT is delivered in tandem with family therapy or social skills training? What are the active ingredients of change in CBT? Successful outcomes may be dependent, in part, on a reduction in general negative self-beliefs (such as those measured by the Dysfunctional Attitude Scale (DAS; Weissman and Beck, 1978) or specific cognitive aspects related to the maintenance of delusions (e.g., conviction, rigidity) or hallucinations (e.g., belief in the omnipotence of voices). The identification of the active ingredients of change in CBT may help to refine interventions to aid those patients currently unable to benefit from this intervention. There is now research suggesting that CBT interventions aimed at enhancing medication compliance may be helpful in the longterm adherence to prescriptions (Kemp et al., 1996, 1998). This is important because there is a problem of low compliance with all existing treatments for schizophrenia. The low attrition rates (cf. Drury et al., 1996a, 1996b) and apparent satisfaction of patients receiving CBT is promising. For example, Kuipers and colleagues (1997) reported that that 80% of the sample were "very satisfied" with their CBT treatment. Future research could aim to identify the pertinent attitudes and beliefs that predict medication noncompliance and the extent to which, if targeted in treatment, result in improved compliance. Compliance issues within CBT treatment also need to be assessed as homework compliance has been shown to predict outcomes to CBT in the treatment of the emotional disorders (Burns and Nolen-Hoeksema, 1991). Effectiveness studies in "real life" clinical settings are also needed to determine the feasibility of CBT for schizophrenia outside of the well-controlled efficacy study. Research is also required to determine whether early intervention can change the long-term trajectory of the disorder. Finally, whereas Kuipers and colleagues (1998) have pointed to the cost-effectiveness of CBT for schizophrenia in the context of the socialized National Health Service (NHS) in the United Kingdom, the feasibility and cost utility of CBT in the United States and Canada will need to be determined. References Beck At (1952) Successful outpatient psychotherapy with a schizophrenic with a delusion based on borrowed guilt. Psychiatry 15:305-312. Beck AT (1967) Depression: Clinical, experimental, and theoretical aspects. New York: Harper and Row. Beck At (1976) Cognitive therapy and the emotional disorders. New York: International Universities Press. Beck AT, Emery G, Greenberg RL (1985) Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books. Beck AT, Rush AJ, Shaw BF, Emery G (1979) Cognitive therapy of depression. New York: Guilford Press. Bentall RP (1990) The illusion of reality: A review and integration of psychological research on hallucinations. Psychol Bull 107:82-95. Bentall RP, Haddock G, Slade PD (1994a) Cognitive behaviour therapy for persistent auditory hallucinations: From theory to therapy. Behav Ther 25:51-66. Bentall RP, Kinderman P, Kaney S (1994b) The self, attribution processes and abnormal beliefs: Towards a model of persecutory delusions. Behav Res Ther 32:331-341. Birchwood M, Chadwick PDJ (1997) The omnipotence of voices: Testing the validity of a cognitive model. Psychol Med 27:1345-1353. Bouchard S, Vallieres A, Roy MA, Maziade M (1996) Cognitive restructuring in the treatment of psychotic symptoms in schizophrenia: A critical analysis. Behav Ther 27:257-278. Burns D, Nolen-Hoeksema S (1991) Coping styles, homework compliance, and the effectiveness of cognitive behavioral therapy. J Consult Clin Psychol 59:305-311. Chadwick PD, Birchwood MJ (1994) Challenging the omnipotence of voices: A cognitive approach to auditory hallucinations. Br J Psychiatry 164:190-201. Chadwick PDJ, Birchwood M, Trower P (1996) Cognitive therapy for delusions, voices, and paranoia. New York: Wiley. Chadwick PDJ, Lowe CF (1994) A cognitive approach to measuring and modifying delusions. Behav Res Ther 32:355-367. Chambless DL, Gillis MM (1993) Cognitive therapy of anxiety disorders. J Consult Clin Psychol 61:248-260.

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3

Although a number of British authors have used the term "psychosis" in their treatment manuals and outcome studies, it is clear that their samples receiving treatment consisted of patients diagnosed with schizophrenia or schizoaffective disorder. Cited Here...
4

One study (Kuipers et al., 1997) compared the BPRS Total Score between CBT-RC and RC-only, and two studies compared different "total" symptom scores between CBT-RC and ST-RC. These symptom indices include aspects of positive symptom functioning but also assess broader domains of symptom functioning. The average effect size across these three studies is 1.43 (SD = .73) in CBTRC. Two studies have also reported on total symptom functioning at follow-up (Pinto et al., 1999; Sensky et al., 2000) and have shown sustained clinical effects for CBT-RC (ES = 2.16, SD = .71). Cited Here...

The between-group effect size comparison was based on the following measures: Kuipers et al., 1997 (BPRS Total); Tarrier et al., 1993a (PSE-positive symptom scale score); Tarrier et al., 1998 (PSE-positive symptom scale score (severity)); Drury et al., 1996a (PAS-positive symptom scale score); Sensky et al., 2000 (CPRS Total); and Pinto et al., 1999 (BPRS Total). Cited Here...
6

Even though very large effect sizes were reported by Pinto and colleagues (1999) for both the CBT and supportive therapy treatment conditions, we replicated the weighted between-group effect size comparisons for CBT-RC and ST-RC with the Pinto et al. (1999) results removed. The CBT-RC and ST-RC effect size estimates were found still to be homogeneous (2 [4, N = 239] = 4.76, p > .19). Further, the mean weighted between-group effect size was nearly identical (ES = .92; SD = 0.15) and statistically significant (z = 6.15, p < .00001). Cited Here...
Section Description

Theodore Lidz, M.D. 1910-2001 Ted Lidz, who died on February 16th, was a valued member of the Advisory Board of this Journal. Resignations We have agreed, with regret, to the retirement of two of our long-term and much valued Editorial Advisory Board members. To Professors Jerome Frank, M.D., Ph.D. and Russell R. Monroe, M.D., we express our deep appreciation and gratitude for their generous help over many years. Cited By: This article has been cited 116 time(s). Verhaltenstherapie Individualized cognitive-behavioral therapy for schizophrenic patients with negative symptoms and social disabilities: II. Responder analyses and predictors of treatment response Bailer, J; Takats, I; Schmitt, A Verhaltenstherapie, 12(3): 192-203. Risk and Protective Factors in Schizophrenia Cognitive-behavior therapy in the treatment of schizophrenia Tarrier, N Risk and Protective Factors in Schizophrenia, (): 295-301. European Archives of Psychiatry and Clinical Neuroscience German research network on schizophrenia - Bridging the gap between research and care Wolwer, W; Buchkremer, G; Hafner, H; Klosterkotter, J; Maier, W; Moller, HJ; Gaebel, W European Archives of Psychiatry and Clinical Neuroscience, 253(6): 321-329. 10.1007/s00406-003-0468-8 CrossRef Psychotherapy and Psychosomatics Cognitive behaviour therapy for schizophrenia - A review of development, evidence and implementation Tarrier, N Psychotherapy and Psychosomatics, 74(3): 136-144. 10.1159/000083998 CrossRef Nervenarzt Evidence basis of psychotherapy for schizophrenia patients in Germany Puschner, B; Vauth, R; Jacobi, F; Becker, T Nervenarzt, 77(): 1301-+. http://journals.lww.com/jonmd/Fulltext/2001/05000/Cognitive_Behavioral_Therapy_for_Schizophrenia__An.2.aspx 26/12/2012 18:08:40

Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease

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10.1007/s00115-006-2102-2 CrossRef Schizophrenia Research Functional Adaptation Skills Training (FAST): A randomized trial of a psychosocial intervention for middle-aged and older patients with chronic psychotic disorders Patterson, TL; Mausbach, BT; McKibbin, C; Goldman, S; Bucardo, J; Jeste, DV Schizophrenia Research, 86(): 291-299. 10.1016/j.schres.2006.05.017 CrossRef Frontiers in Human Neuroscience Why do delusions persist? Corlett, PR; Krystal, JH; Taylor, JR; Fletcher, PC Frontiers in Human Neuroscience, 3(): -. ARTN 12 CrossRef Cognitive Therapy and Research Does cognitive therapy have an enduring effect? Hollon, SD Cognitive Therapy and Research, 27(1): 71-75. Psychiatric Clinics of North America Evidence-based treatment for schizophrenia Lehman, AF; Buchanan, RW; Dickerson, FB; Dixon, LB; Goldberg, R; Green-Paden, L; Kreyenbuhl, J Psychiatric Clinics of North America, 26(4): 939-+. 10.1016/S0193-953X(03)00070-4 CrossRef Behaviour Change Co-morbidity and associated clinical problems in schizophrenia: Their nature and implications for comprehensive cognitivebehavioural treatment Tarrier, N Behaviour Change, 22(3): 125-142. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie Guest editorial - Cognitive-behavioural therapy for severe mental disorders Rector, NA Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 50(5): 245-246. Nervenarzt Effectiveness of Integrated Psychological Therapy for schizophrenia patients. A meta-analysis including 28 independent studies Muller, D; Roder, V; Brenner, H Nervenarzt, 78(1): 62-73. 10.1007/s00115-005-1974-x CrossRef International Journal of Group Psychotherapy Cognitive Behavior Therapy for Early Psychosis: A Comprehensive Review of Individual vs. Group Treatment Studies Saksa, JR; Cohen, SJ; Srihari, VH; Woods, SW International Journal of Group Psychotherapy, 59(3): 357-383. Schizophrenia Bulletin Efficacy of psychological therapy in schizophrenia: Conclusions from meta-analyses Pfammatter, M; Junghan, UM; Brenner, HD Schizophrenia Bulletin, 32(): S64-S80. 10.1093/schbul/sb1030 CrossRef Schizophrenia Research Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia Granholm, E; McQuaid, JR; Link, PC; Fish, S; Patterson, T; Jeste, DV Schizophrenia Research, 100(): 133-143. 10.1016/j.schres.2007.11.032 CrossRef Cognitive Therapy and Research A cognitive model of hallucinations Beck, AT; Rector, NA Cognitive Therapy and Research, 27(1): 19-52. Journal of Abnormal Psychology Reasoning, emotions, and delusional conviction in psychosis Garety, PA; Freeman, D; Jolley, S; Dunn, G; Bebbington, PE; Fowler, DG; Kuipers, E; Dudley, R Journal of Abnormal Psychology, 114(3): 373-384. 10.1037/0021-843X.114.3.373 CrossRef

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease European Archives of Psychiatry and Clinical Neuroscience Recent approaches to psychological interventions for people at risk of psychosis Bechdolf, A; Phillips, LJ; Francey, SM; Leicester, S; Morrison, AP; Veith, V; Klosterkotter, J; McGorry, PD European Archives of Psychiatry and Clinical Neuroscience, 256(3): 159-173. 10.1007/s00406-006-0623-0 CrossRef Psychiatric Clinics of North America Rehabilitation and recovery in schizophrenia Velligan, DI; Gonzalez, JM Psychiatric Clinics of North America, 30(3): 535-+. 10.1016/j.psc.2007.05.001 CrossRef Cognitive and Behavioral Practice Homework use in cognitive therapy for psychosis: A case formulation approach Rector, NA Cognitive and Behavioral Practice, 14(3): 303-316.

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Australian and New Zealand Journal of Psychiatry Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998 Tsang, HWH; Leung, AY; Chung, RCK; Bell, M; Cheung, WM Australian and New Zealand Journal of Psychiatry, 44(6): 495-504. Behaviour Research and Therapy Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations Freeman, D; Garety, PA Behaviour Research and Therapy, 41(8): 923-947. 10.1016/S0005-7967(02)00104-3 CrossRef Clinical Neuroscience Research Psychiatric rehabilitation in schizophrenia: advances and challenges Glynn, SM Clinical Neuroscience Research, 3(): 23-33. 10.1016/S1566-2772(03)00016-1 CrossRef Psychological Medicine North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: outcomes at 6 and 12 months Startup, M; Jackson, MC; Bendix, S Psychological Medicine, 34(3): 413-422. 10.1017/S0033291703001211 CrossRef Psychiatric Rehabilitation Journal Integration of cognitive behavioral therapy into psychiatric rehabilitation day programming Randall, M; Finkelstein, SH Psychiatric Rehabilitation Journal, 30(3): 199-206. 10.2975/30.3.2007.199.206 CrossRef Cognitive and Behavioral Practice Kingdon and Turkington's cognitive therapy of schizophrenia Glynn, SM Cognitive and Behavioral Practice, 13(1): 105-106. European Archives of Psychiatry and Clinical Neuroscience Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment Wittorf, A; Wiedemann, G; Buchkremer, G; Klingberg, S European Archives of Psychiatry and Clinical Neuroscience, 258(1): 48-58. 10.1007/s00406-007-0761-z CrossRef Cognitive and Behavioral Practice Behavioral experiments in the treatment of paranoid schizophrenia: A single case study Hagen, R; Nordahl, HM Cognitive and Behavioral Practice, 15(3): 296-305. Schizophrenia Bulletin What Are the Components of CBT for Psychosis? A Delphi Study Morrison, AP; Barratt, S Schizophrenia Bulletin, 36(1): 136-142. 10.1093/schbul/sbp118 CrossRef Acta Psychiatrica Scandinavica Evaluation of a cognitive behaviourally oriented service for relapse prevention in schizophrenia

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease Klingberg, S; Wittorf, A; Fischer, A; Jakob-Deters, K; Buchkremer, G; Wiedemann, G Acta Psychiatrica Scandinavica, 121(5): 340-350. 10.1111/j.1600-0447.2009.01479.x CrossRef Psychological Medicine Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy Pilling, S; Bebbington, P; Kuipers, E; Garety, P; Geddes, J; Orbach, G; Morgan, C Psychological Medicine, 32(5): 763-782. 10.1017/S0033291702005895 CrossRef Journal of Clinical Psychology Moving from empirically supported treatment lists to practice guidelines in psychotherapy: The role of the placebo concept Herbert, JD; Gaudiano, BA Journal of Clinical Psychology, 61(7): 893-908. 10.1002/jclp.20133 CrossRef British Journal of Psychiatry Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment Bechdolf, A; Ruhrmann, S; Wagner, M; Kuhn, KU; Janssen, B; Bottlender, R; Wieneke, A; Schulze-Lutter, F; Maier, W; Klosterkotter, J British Journal of Psychiatry, 187(): S45-S48. Clinical Psychology & Psychotherapy Cognitive-behavioural group treatment of depression in patients with psychotic disorders Hagen, R; Nordahl, HM; Grawe, RW Clinical Psychology & Psychotherapy, 12(6): 465-474. 10.1002/cpp.474 CrossRef Clinical Psychology-Science and Practice Cognitive behavior therapies for psychotic disorders: Current empirical status and future directions Gaudiano, BA Clinical Psychology-Science and Practice, 12(1): 33-50. 10.1093/clipsy/bpi004 CrossRef Schizophrenia Research The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: A meta-analysis Zimmermann, G; Favrod, J; Trieu, VH; Pomini, V Schizophrenia Research, 77(1): 1-9. 10.1016/j.schres.2005.02.018 CrossRef Psychology and Psychotherapy-Theory Research and Practice Cognitive behaviour therapy in patients with schizophrenia who are not prescribed antipsychotic medication: A case series Christodoulides, T; Dudley, R; Brown, S; Turkington, D; Beck, AT Psychology and Psychotherapy-Theory Research and Practice, 81(): 199-207. 10.1348/147608308X278295 CrossRef Schizophrenia Bulletin Social Disinterest Attitudes and Group Cognitive-Behavioral Social Skills Training for Functional Disability in Schizophrenia Granholm, E; Ben-Zeev, D; Link, PC Schizophrenia Bulletin, 35(5): 874-883. 10.1093/schbul/sbp072 CrossRef Community Mental Health Journal Cognitive Behavioral Therapy and Schizophrenia: A Survey of Clinical Practices and Views on Efficacy in the United States and United Kingdom Kuller, AM; Ott, BD; Goisman, RM; Wainwright, LD; Rabin, RJ Community Mental Health Journal, 46(1): 2-9. 10.1007/s10597-009-9223-6 CrossRef Journal of Mental Health Cognitive behavioural therapy in vocational rehabilitation with the severely mentally ill: Review, design and implementation Binnie, J Journal of Mental Health, 17(1): 105-117. 10.1080/09638230701529665 CrossRef Neuroquantology Implications of Bohmian Quantum Ontology for Psychopathology Pylkkanen, P Neuroquantology, 8(1): 37-48. Pharmacopsychiatry Modern treatment concepts in schizophrenia

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease Gaebel, W; Janssen, B; Riesbeck, M Pharmacopsychiatry, 36(): S168-S175. Search for the Causes of the Schizophrenia, Vol 5 Schizophrenia: treatment issues in the 21(st) century Gaebel, W Search for the Causes of the Schizophrenia, Vol 5, (): 459-469. Behaviour Research and Therapy Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Tarrier, N; Wykes, T Behaviour Research and Therapy, 42(): 1377-1401. 10.1016/j.brat.2004.06.020 CrossRef Cognitive and Behavioral Practice Cognitive behavioral therapy across the stages of psychosis: Prodromal, first episode, and chronic schizophrenia Valmaggia, LR; Tabraham, P; Morris, E; Bourrian, TK Cognitive and Behavioral Practice, 15(2): 179-193. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie Cognitive therapy for schizophrenia: From conceptualization to intervention Rector, NA; Beck, AT Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 47(1): 39-48. Psychology and Psychotherapy-Theory Research and Practice Lessons from psychotherapy research for psychological interventions for people with schizophrenia Paley, G; Shapiro, DA Psychology and Psychotherapy-Theory Research and Practice, 75(): 5-17. British Journal of Clinical Psychology Dissociation as a mediator of the relationship between recalled parenting and the clinical correlates of auditory hallucinations Offen, L; Thomas, G; Waller, G British Journal of Clinical Psychology, 42(): 231-241. Psychotherapy and Psychosomatics The effectiveness of cognitive therapy for schizophrenia: What can we learn from the meta-analyses? Sensky, T Psychotherapy and Psychosomatics, 74(3): 131-135. 10.1159/000083997 CrossRef Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie The negative symptoms of schizophrenia: A cognitive perspective Rector, NA; Beck, AT; Stolar, N Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 50(5): 247-257. American Journal of Psychiatry Cognitive behavior therapy for schizophrenia Turkington, D; Kingdon, D; Weiden, PJ American Journal of Psychiatry, 163(3): 365-373. Psychological Medicine Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial Rohricht, F; Priebe, S Psychological Medicine, 36(5): 669-678. 10.1017/S0033291706007161 CrossRef Acta Neuropsychiatrica Do psychotherapies produce neurobiological effects? Kumari, V Acta Neuropsychiatrica, 18(2): 61-70. Cognitive and Behavioral Practice Cognitive coping tool kit for psychosis: Development of a group-based curriculum Goldberg, JO; Wheeler, H; Lubinsky, T; Van Exan, J Cognitive and Behavioral Practice, 14(1): 98-106.

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Journal of Music Therapy Quantitative Comparison of Cognitive Behavioral Therapy and Music Therapy Research: A Methodological Best-Practices Analysis to Guide Future Investigation for Adult Psychiatric Patients Silverman, MJ Journal of Music Therapy, 45(4): 457-506.

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease Acta Psychiatrica Scandinavica A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in acute patients with schizophrenia: outcome at 24 months Bechdolf, A; Kohn, D; Knost, B; Pukrop, R; Klosterkotter, J Acta Psychiatrica Scandinavica, 112(3): 173-179. 10.1111/j.1600-0447.2005.00581.x CrossRef Schizophrenia Bulletin Psychoeducation: A basic psychotherapeutic intervention for patients with schizophrenia and their families Bauml, J; Frobose, T; Kraemer, S; Rentrop, M; Pitschel-Walz, G Schizophrenia Bulletin, 32(): S1-S9. 10.1093/schbul/sb1017 CrossRef Canadian Psychology-Psychologie Canadienne Psychology's pursuit of prescriptive authority: Would it meet the goals of Canadian health care reform? Westra, HA; Eastwood, JD; Bouffard, BB; Gerritsen, CJ Canadian Psychology-Psychologie Canadienne, 47(2): 77-95. 10.1037/cp2006001 CrossRef Schizophrenia Research Daily activities, cognition and community functioning in persons with schizophrenia Aubin, G; Stip, E; Gelinas, I; Rainville, C; Chapparo, C Schizophrenia Research, 107(): 313-318. 10.1016/j.schres.2008.08.002 CrossRef Zeitschrift Fur Klinische Psychologie Und Psychotherapie Research in the clinical psychology of schizophrenia Bailer, J; Rist, F Zeitschrift Fur Klinische Psychologie Und Psychotherapie, 30(4): 225-228. Schizophrenia Bulletin Supportive therapy for schizophrenia: Possible mechanisms and implications for adjunctive psychosocial treatments Penn, DL; Mueser, KT; Tarrier, N; Gloege, A; Cather, C; Serrano, D; Otto, MN Schizophrenia Bulletin, 30(1): 101-112. Psychiatric Rehabilitation Journal Skills training for people with severe mental illness Bellack, AS Psychiatric Rehabilitation Journal, 27(4): 375-391. American Journal of Orthopsychiatry Campus mental health services: Recommendations for change Mowbray, CT; Megivern, D; Mandiberg, JM; Strauss, S; Stein, CH; Collins, K; Kopels, S; Curlin, C; Lett, R American Journal of Orthopsychiatry, 76(2): 226-237. 10.1037/0002-9432.76.2.226 CrossRef Psychiatric Services Clinicians' perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness Frueh, BC; Cusack, KJ; Grubaugh, AL; Sauvageot, JA; Wells, C Psychiatric Services, 57(7): 1027-1031. Schizophrenia Bulletin Followup of psychotic outpatients: Dimensions of delusions and work functioning in schizophrenia Harrow, M; Herbener, ES; Shanklin, A; Jobe, TH; Rattenbury, F; Kaplan, KJ Schizophrenia Bulletin, 30(1): 147-161. American Journal of Psychiatry A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia Granholm, E; McQuaid, JR; McClure, FS; Auslander, LA; Perivoliotis, D; Pedrelli, P; Patterson, T; Jeste, DV American Journal of Psychiatry, 162(3): 520-529. Psychological Record The common factors, empirically validated treatments, and recovery models of therapeutic change Reisner, AD Psychological Record, 55(3): 377-399. Schizophrenia Research Suicide behaviour over 18 months in recent onset schizophrenic patients: The effects of CBT Tarrier, N; Haddock, G; Lewis, S; Drake, R; Gregg, L Schizophrenia Research, 83(1): 15-27.

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease 10.1016/j.schres.2005.12.846 CrossRef Annual Review of Clinical Psychology Cognitive approaches to schizophrenia: Theory and therapy Beck, AT; Rector, NA Annual Review of Clinical Psychology, 1(): 577-606. 10.1146/annurev.clinpsy.1.102803.144205 CrossRef Revista Brasileira De Psiquiatria Cognitive therapy: foundations, conceptual models, applications and research Knapp, P; Beck, AT Revista Brasileira De Psiquiatria, 30(): S54-S64. Clinical Psychology Review The empirical status of cognitive-behavioral therapy: A review of meta-analyses Butler, AC; Chapman, JE; Forman, EM; Beck, AT Clinical Psychology Review, 26(1): 17-31. 10.1016/j.cpr.2005.07.003 CrossRef Nervenheilkunde Early intervention in the prodromal phase of schizophrenia Bechdolf, A; Ruhrmann, S; Wagner, M; Maier, W; Klosterkotter, J Nervenheilkunde, 25(): 17-+. Rivista Di Psichiatria Cognitive-behavioural therapy for combined treatment of psychosis Politi, R; Fagiolo, D; Delle Chiaie, R Rivista Di Psichiatria, 43(1): 15-24. Psychologische Rundschau Effects of cognitive interventions for schizophrenia: a meta-analysis Lincoln, TM; Suttner, C; Nestoriuc, Y Psychologische Rundschau, 59(4): 217-232. 10.1026/0033-3042.59.4.217 CrossRef Neuropsychiatrie Psycho-educational coping-oriented group therapy for schizophrenia patients Haller, C; Andres, K; Hofer, A; Hummer, M; Gutweniger, S; Kemmler, G; Pfammatter, M; Meise, U Neuropsychiatrie, 23(3): 174-183.

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American Journal of Psychiatry Diagnosis and Treatment of a Patient With Both Psychotic and Obsessive-Compulsive Symptoms Rodriguez, CI; Corcoran, C; Simpson, HB American Journal of Psychiatry, 167(7): 754-761. 10.1176/appi.ajp.2009.09070997 CrossRef American Journal of Psychiatry Relationship of cognition and psychopathology to functional impairment in schizophrenia Mohamed, S; Rosenheck, R; Swartz, M; Stroup, S; Lieberman, JA; Keefe, RSE American Journal of Psychiatry, 165(8): 978-987. 10.1176/appi.ajp.2008.07111713 CrossRef Psychiatry Research The role of effort, cognitive expectancy appraisals and coping style in the maintenance of the negative symptoms of schizophrenia Avery, R; Startup, M; Calabria, K Psychiatry Research, 167(): 36-46. 10.1016/j.psychres.2008.04.016 CrossRef British Medical Journal Commentary: Yes, cognitive behaviour therapy may well be all you need Tarrier, N British Medical Journal, 324(): 291-292. Behaviour Research and Therapy The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study Hall, PL; Tarrier, N Behaviour Research and Therapy, 41(3): 317-332. 10.1016/S0005-7967(02)00013-X CrossRef Schizophrenia Research Cognitive therapy for persistent psychosis in schizophrenia: a case-controlled clinical trial Temple, S; Ho, BC

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease Schizophrenia Research, 74(): 195-199. 10.1016/j.schres.2004.05.013 CrossRef Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie Results of inpatient psychiatric and psychotherapeutic treatment of patients with schizophrenias, schizoaffective and other psychotic disorders Leichsenring, F; Dumpelmann, M; Berger, J; Jaeger, U; Rabung, S Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, 51(1): 23-37.

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American Journal of Psychiatry Practice guideline for the treatment of patients with schizophrenia, second edition Lehman, AF; Lieberman, JA; Dixon, LB; McGlashan, TH; Miller, AL; Perkins, DO; Kreyenbuhl, J; McIntyre, JS; Charles, SC; Altshuler, K; Cook, I; Cross, CD; Mellman, L; Moench, LA; Norquist, G; Twemlow, SW; Woods, S; Yager, J; Gray, SH; Askland, K; Pandya, R; Prasad, K; Johnston, R; Nininger, J; Peele, R; Anzia, DJ; Benson, RS; Lurie, L; Walker, RD; Kunkle, R; Simpson, A; Fochtmann, LJ; Hart, C; Regier, D American Journal of Psychiatry, 161(2): 1-56. Cognitive and Behavioral Practice Cognitive Behavioral therapy for schizophrenia: An overview of treatment Warman, DM; Beck, AT Cognitive and Behavioral Practice, 10(3): 248-254. Archives of General Psychiatry The current state of cognitive therapy - A 40-year retrospective Beck, AT Archives of General Psychiatry, 62(9): 953-959. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie Functional cognitive-behavioural therapy: A brief, individual treatment for functional impairments resulting from psychotic symptoms in schizophrenia Cather, C Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 50(5): 258-263. Psychiatric Services The application of cognitive-behavioral therapy for psychosis in clinical and research settings Rollinson, R; Haig, C; Warner, R; Garety, P; Kuipers, E; Freeman, D; Bebbington, P; Dunn, G; Fowler, D Psychiatric Services, 58(): 1297-1302. Schizophrenia Bulletin Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor Wykes, T; Steel, C; Everitt, B; Tarrier, N Schizophrenia Bulletin, 34(3): 523-537. 10.1093/schbul/sbm114 CrossRef Actas Espanolas De Psiquiatria Cognitive therapy in early psychosis and "at risk mental state" Alvarez-Jimenez, M; Gonzalez-Blanch, C; Perez-Pardal, T; Rodriguez-Sanchez, JM; Crespo-Facorro, B Actas Espanolas De Psiquiatria, 35(1): 67-76. Behavioural and Cognitive Psychotherapy Measuring Adherence in CBT for Psychosis: A Psychometric Analysis of an Adherence Scale Rollinson, R; Smith, B; Steel, C; Jolley, S; Onwumere, J; Garety, PA; Kuipers, E; Freeman, D; Bebbington, PE; Dunn, G; Startup, M; Fowler, D Behavioural and Cognitive Psychotherapy, 36(2): 163-178. 10.1017/S1352465807003980 CrossRef American Family Physician When the side effect is really the symptom Elder, WG American Family Physician, 66(): 2008-+. Nordic Journal of Psychiatry Dementia: Management of behavioural and psychological symptoms Laroi, F Nordic Journal of Psychiatry, 57(2): 159-160. Schizophrenia Research Cognitive therapy for schizophrenia: a preliminary randomized controlled trial Rector, NA; Seeman, MV; Segal, ZV Schizophrenia Research, 63(): 1-11. 10.1016/S0920-9964(02)00308-0 CrossRef

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Cognitive Behavioral Therapy for Schizophrenia: An Empirical... : The Journal of Nervous and Mental Disease Schizophrenia Bulletin Hallucination focused integrative treatment: A randomized controlled trial Jenner, JA; Nienhuis, FJ; Wiersma, D; van de Willige, G Schizophrenia Bulletin, 30(1): 133-145. Nervenheilkunde Cognitive behavioral therapy on negative symptoms of schizophrenia disorders - background and therapy of the TONES-study Klingberg, S; Hesse, K; Herrlich, J; Kossow, S; Wiedemann, G; Wittorf, A; Wolwer, W; Buchkremer, G Nervenheilkunde, 27(): 997-+. Nervenheilkunde Treatment acceptance and therapeutic relationship in the early stage of cognitive behavioral therapy on negative symptoms of schizophrenia Wittorf, A; Weber, R; Herrlich, J; Wiedemann, G; Wolwer, W; Buchkremer, G; Klingberg, S Nervenheilkunde, 27(): 1007-+.

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Clinical Psychology Review The needs of older adults with schizophrenia implications for psychological interventions Berry, K; Barrowclough, C Clinical Psychology Review, 29(1): 68-76. 10.1016/j.cpr.2008.09.010 CrossRef Australian and New Zealand Journal of Psychiatry Randomized comparison of group cognitive behaviour therapy and group psychoeducation in acute patients with schizophrenia: effects on subjective quality of life Bechdolf, A; Knost, B; Nelson, B; Schneider, N; Veith, V; Yung, AR; Pukrop, R Australian and New Zealand Journal of Psychiatry, 44(2): 144-150. Suicide and Life-Threatening Behavior Suicidality and psychosis: Beyond depression and hopelessness Warman, DM; Forman, EM; Henriques, GR; Brown, GK; Beck, AT Suicide and Life-Threatening Behavior, 34(1): 77-86. Clinical Psychology & Psychotherapy Cognitive-behaviour therapy for people with psychosis and mild intellectual disabilities: A case series Haddock, G; Lobban, F; Hatton, C; Carson, R Clinical Psychology & Psychotherapy, 11(4): 282-298. 10.1002/cpp.414 CrossRef Current Opinion in Psychiatry Cognitive-behaviour therapy for schizophrenia: a review Rathod, S; Turkington, D Current Opinion in Psychiatry, 18(2): 159-163. PDF (76) The Journal of Nervous and Mental Disease Evidence-Based Psychotherapy for Schizophrenia Dickerson, FB; Lehman, AF The Journal of Nervous and Mental Disease, 194(1): 3-9. 10.1097/01.nmd.0000195316.86036.8a PDF (264) | CrossRef Journal of Psychiatric Practice Cognitive-Behavioral Therapy for Medication-Resistant Schizophrenia: A Review RATHOD, S; KINGDON, D; WEIDEN, P; TURKINGTON, D Journal of Psychiatric Practice, 14(1): 22-33. 10.1097/01.pra.0000308492.93003.db PDF (99) | CrossRef 2001 Lippincott Williams & Wilkins, Inc.

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