Are psychological therapies effective in treating schizophrenia and psychosis?
The recent British Psychological Society report, Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help [see: www.understandingpsychosis.net or download here], provides an accessible overview of the current state of knowledge about psychosis from a psychological perspective. Its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services.
The British Psychological Society’s report has been widely welcomed as helpful and possibly even revolutionary. It contains much more than just a statement of the benefits of psychological therapies –although those benefits are clear. It outlines, in clear and accessible language, the evidence that ‘psychotic’ experiences are understandable and often are a reaction to trauma or adversity which impacts on the way we experience and interpret the world. The report stresses the importance of respect for a plurality of perspectives and emphasises the need to invest much more in prevention. While the effectiveness of psychological therapy is not its main focus, its statement that ‘…on average, people gain around as much benefit from CBT as they do from taking psychiatric medication…’ is entirely appropriate.
CBT may also be effective in clozapine-resistant schizophrenia:
Barretto et al. conducted a controlled trial of CBT (n=21) in patients with clozapine-resistant TRS and found that CBT significantly improved general psychopathology compared with nonspecific psychosocial support (befriending) and that this effect persisted for 6 months. However, the sample size of this trial was small and it was not randomized. A recent meta-analysis of 12 RCTs (n=639) examining the effectiveness of CBT among outpatients with medication-resistant psychosis demonstrated beneficial effects of CBT on positive symptoms (effect size=0.47) and general symptoms (effect size=0.52) [1]
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