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Cognitive therapy reduced psychotic symptoms in schizophrenia

Recent data show that cognitive therapy may be effective in treating patients with schizophrenia spectrum disorders who are not taking antipsychotic drugs.

The single blind, randomized controlled study included participants aged 16 to 65 years with schizophrenia, schizoaffective disorder or delusional disorder, who had never received antipsychotics or had recurring symptoms after stopping antipsychotic drug treatments for at least 6 months. They were randomly assigned to cognitive therapy in addition to standard treatment (n=74) or standard treatment alone (n=37).

Researchers assessed participants’ positive and negative syndrome scale scores to determine the efficacy of treatments. At the 9-month mark, 32% of participants receiving cognitive therapy had positive clinical outcomes compared with 13% of participants who underwent standard treatment. At 18 months, 41% of those receiving cognitive therapy and 18% of those receiving standard treatment had positive clinical outcomes.

The study findings show that cognitive therapy significantly reduced the severity of psychiatric symptoms and improved personal and social functioning. Cognitive therapy did not significantly affect stress associated with delusional beliefs, hearing voices, depression and social anxiety.

The study shows “that cognitive therapy is a safe and acceptable intervention for a population who are usually considered to be very challenging to engage by mental health services, with low rates of drop out and withdrawal, and very few referrals refusing randomization after assessment is eligible,” study researcher Anthony P. Morrison, DClinPsy, of the School of Psychological Sciences at the University of Manchester, and colleagues concluded.

In a comment accompanying the study, Oliver Howes, PhD, of the Clinical Sciences Centres and Institute of Psychiatry in London, said, “Morrison and colleagues’ findings provide proof of concept that cognitive therapy is an alternative to antipsychotic treatment. Clearly this outcome will need further testing, but, if further work supports the relative effectiveness of cognitive therapy, a comparison between such therapy and antipsychotic treatment will be needed to inform patient choice.”

Disclosure: Morrison and some of the other researchers received royalties from texts or books that they have published about cognitive therapy and have received royalties for conducting workshops about cognitive therapy. One researcher received lecture fees from pharmaceutical companies. For a full list of disclosures, see the study. Howes reports various financial ties with AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Lyden-Delta, Servier and Roche.