A naturalistic, randomized, controlled trial combining cognitive remediation with cognitive–behavioural therapy after first-episode non-affective psychosis
Abstract
Background: Cognitive remediation (CR) preceding cognitive–behavioural therapy for psychosis (CBTp) was trialled within routine clinical services, with the hypothesis that following first-episode non-affective psychosis CR would enhance CBTp efficacy by improving neuropsychological performance. Method: A total of 61 patients with DSM-IV non-affective psychoses waiting for routine CBTp were randomized to computerized CR over 12 weeks, supported by a trained support worker, or time-matched social contact (SC). Primary outcome was the blind-rated Psychotic Symptoms Rating Scale (PSYRATS). Secondary outcomes included measures of CBTp progress, cognition, symptoms, insight and self-esteem: all at baseline, after CR (12 weeks) and after CBTp (42 weeks). PSYRATS and global neuropsychological efficacy were tested using mixed-effects models with a group × time interaction term. Measures of CBTp progress and some neuropsychological measures were modelled by regression. Results: There was no significant difference between the CR and SC groups in PSYRATS (group × time coefficient 0.3, 95% confidence interval −0.4 to 1.1, p = 0.39). However, after CR CBTp was shorter [median 7 sessions, interquartile range (IQR) 2–12 after CR; median 13, IQR 4–18 after SC; model p = 0.011] and linked to better insight (p = 0.02). Global cognition did not improve significantly more after CR (p = 0.20) but executive function did (Wisconsin Card Sort, p = 0.012). Conclusions: CBTp courses preceded by CR were far shorter but achieved the same outcome as CBTp preceded by an active control, consistent with neuropsychological improvement enhancing CBTp. CR was delivered by staff with minimal training, offering the potential to reduce the costs of CBTp considerably.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Cognitive therapy following cognitive remediation is linked to greater improvements in clinical insight in psychosis.
“Drake et al 164 found that cognitive therapy which followed cognitive remediation was linked to greater improvements in clinical insight in psychosis.”
From Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments (2018) · cites this paper as [164]
Cites
Society and the Adolescent Self-Image
Rosenberg, M. (1965) · doi:10.1515/9781400876136 · Cited by 30,126 · see citing works
The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378 · see citing works
The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity
Nuechterlein, K. H., Green, M. F., Kern, R. S., Baade, L. E., Barch, D. M., Cohen, J. D., Essock, S., Fenton, W. S., Frese, F. J., Gold, J. M., et al. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07010042 · Cited by 2,342 · see citing works
A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes
Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10060855 · Cited by 1,693 · see citing works
Self-citationNeuropsychological Assessment, 2nd Ed
Fisher, J. M. (1985) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198502000-00014 · Cited by 1,592 · see citing works
HADDOCK, G., McCARRON, J., TARRIER, N., & FARAGHER, E. B. (1999) · Psychological Medicine · doi:10.1017/s0033291799008661 · Cited by 1,461 · see citing works
Revising axis V for DSM-IV: a review of measures of social functioning
Goldman, H. H., Skodol, A. E., & Lave, T. R. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.9.1148 · Cited by 1,408 · see citing works
Assessing Depression in Schizophrenia: The Calgary Depression Scale
Addington, D. E., Addington, J., & Maticka‐Tyndale, E. (1993) · The British Journal of Psychiatry · doi:10.1192/s0007125000292581 · Cited by 1,177 · see citing works
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2007) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm114 · Cited by 1,029 · see citing works
Self-citationFirst, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997) · American Psychiatric Press eBooks · Cited by 983 · see citing works
Research governance framework for health and social care
Taylor, M. (2002) · Health & Social Care in the Community · doi:10.1046/j.0966-0410.2001.00336.x · Cited by 798 · see citing works
The Schizophrenia Patient Outcomes Research Team (PORT): Updated Treatment Recommendations 2003
Lehman, A. F., Kreyenbuhl, J. A., Buchanan, R. W., Dickerson, F., Dixon, L. B., Goldberg, R., Green-Paden, L. D., Tenhula, W. N., Boerescu, D. A., Tek, C., et al. (2004) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a007071 · Cited by 758 · see citing works
A self‐report Insight Scale for psychosis: reliability, validity and sensitivity to change
Birchwood, M. J., Smith, J., Drury, V., Healy, J., Macmillan, F., & Slade, M. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb01487.x · Cited by 676 · see citing works
Activation of the prefrontal cortex in a nonspatial working memory task with functional MRI
Cohen, J. D., Forman, S. D., Braver, T. S., Casey, B. J., Servan‐Schreiber, D., & Noll, D. C. (1994) · Human Brain Mapping · doi:10.1002/hbm.460010407 · Cited by 576 · see citing works
Cognitive Enhancement Therapy for Schizophrenia
Hogarty, G. E., Flesher, S., Ulrich, R. F., Carter, M., Greenwald, D. P., Pogue‐Geile, M. F., Kechavan, M., Cooley, S., DiBarry, A. L., Garrett, A., et al. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.9.866 · Cited by 536 · see citing works
Bird, V., Premkumar, P., Kendall, T., Whittington, C., Mitchell, J., & Kuipers, E. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.074526 · Cited by 468 · see citing works
Bertelsen, M., Jeppesen, P., Petersen, L., Thorup, A. A. E., Øhlenschlæger, J., le Quach, P., Christensen, T. Ø., Krarup, G., Jørgensen, P., & Nordentoft, M. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.7.762 · Cited by 457 · see citing works
Rorabacher, D. B. (1991) · Analytical Chemistry · doi:10.1021/ac00002a010 · Cited by 450 · see citing works
London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis
Kuipers, E., Garety, P. A., Fowler, D. G., Dunn, G., Bebbington, P., Freeman, D. H., & Hadley, C. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.171.4.319 · Cited by 450 · see citing works
Cognitive remediation therapy in schizophrenia
Wykes, T., Reeder, C., Landau, S., Everitt, B. J., Knapp, M. R. J., Patel, A. K., & Romeo, R. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.026575 · Cited by 321 · see citing works
Self-citationCognitive Training for Supported Employment: 2-3 Year Outcomes of a Randomized Controlled Trial
McGurk, S. R., Mueser, K. T., Feldman, Wolfe, & Pascaris (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.3.437 · Cited by 318 · see citing works
London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis
Garety, P. A., Fowler, D., Kuipers, E., Freeman, D. H., Dunn, G., Bebbington, P., Hadley, C., & Jones, S. H. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.171.5.420 · Cited by 316 · see citing works
Bowie, C. R., McGurk, S. R., Mausbach, B., Patterson, T. L., & Harvey, P. D. (2012) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.11091337 · Cited by 312 · see citing works
Eack, S. M., Greenwald, D. P., Hogarty, S. S., Cooley, S., DiBarry, A. L., Montrose, D. M., & Keshavan, M. S. (2009) · Psychiatric Services · doi:10.1176/appi.ps.60.11.1468 · Cited by 290 · see citing works
Eack, S. M., Greenwald, D. P., Hogarty, S. S., Cooley, S. J., DiBarry, A. L., Montrose, D. M., & Keshavan, M. S. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.11.1468 · Cited by 289 · see citing works
Cognitive–behavioural therapy in first-episode and early schizophrenia
Tarrier, N., Lewis, S. W., Haddock, G., Bentall, R. P., Drake, R., Kinderman, P., Kingdon, D., Siddle, R., Everitt, J., Leadley, K., et al. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.184.3.231 · Cited by 269 · see citing works
Self-citationIntegrated Psychological Therapy (IPT) for Schizophrenia: Is It Effective?
Roder, V. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl021 · Cited by 260 · see citing works
Wykes, T., Newton, E., Landau, S., Rice, C. D., Thompson, N., & Frangou, S. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.03.030 · Cited by 212 · see citing works
Self-citationDrake, R., Haddock, G., Tarrier, N., Bentall, R., & Lewis, S. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2006.04.024 · Cited by 194 · see citing works
Self-citationPrevention of Negative Symptom Psychopathologies in First-Episode Schizophrenia
Melle, I. S., Larsen, T. K., Haahr, U., Friis, S., Johannesen, J. O., Opjordsmoen, S., Rund, B. R., Simonsen, E. H., Vaglum, P., & McGlashan, T. H. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.6.634 · Cited by 188 · see citing works
The neuropsychological basis of insight in first-episode schizophrenia: a pilot metacognitive study
Koren, D. (2004) · Schizophrenia Research · doi:10.1016/j.schres.2004.02.004 · Cited by 187 · see citing works
London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis
Kuipers, E., Fowler, D. G., Garety, P. A., Chisholm, D., Freeman, D. H., Dunn, G., Bebbington, P., & Hadley, C. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.173.1.61 · Cited by 187 · see citing works
Cognitive Remediation Therapy for Schizophrenia
Wykes, P. T., & Reeder, C. (2006) · Routledge eBooks · doi:10.4324/9780203098707 · Cited by 165 · see citing works
Self-citationLindenmayer, J., McGurk, S. R., Mueser, K. T., Khan, A., Wance, D., Hoffman, L., Wolfe, R. S., & Xie, H. (2008) · Psychiatric Services · doi:10.1176/ps.2008.59.3.241 · Cited by 157 · see citing works
A Randomized, Controlled Trial of Computer-Assisted Cognitive Remediation for Schizophrenia
Dickinson, D., Tenhula, W. N., Morris, S. E., Brown, C., Peer, J. E., Spencer, K., Li, L., Gold, J. M., & Bellack, A. S. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09020264 · Cited by 157 · see citing works
Haddock, G., Devane, S., Bradshaw, T., McGovern, J., Tarrier, N., Kinderman, P., Baguley, I., Lancashire, S., & Harris, N. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801002089 · Cited by 143 · see citing works
Guo, X., Zhai, J., Liu, Z., Fang, M., Wang, B., Wang, C., Hu, B., Sun, X., Lv, L., Lu, Z., et al. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.105 · Cited by 142 · see citing works
Durability and Mechanism of Effects of Cognitive Enhancement Therapy
Hogarty, G. E., Greenwald, D. P., & Eack, S. M. (2006) · Psychiatric Services · doi:10.1176/ps.2006.57.12.1751 · Cited by 120 · see citing works
Hooper, S. R., & Willis, W. G. (1989) · Springer eBooks · doi:10.1007/978-1-4613-8810-4_6 · Cited by 113 · see citing works
A randomized, controlled trial of computer-assisted cognitive remediation for schizophrenia
d’Amato, T., Bation, R., Cochet, A., Jalenques, I., Galland, F., Giraud-Baro, É., Pacaud-Troncin, M., Augier-Astolfi, F., Llorca, P., Saoud, M., et al. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.10.023 · Cited by 109 · see citing works
Silverstein, S. M., Hatashita-Wong, M., SOLAK, B. A., Uhlhaas, P. J., Landa, Y., WILKNISS, S. M., Goicochea, C., Carpiniello, K. E., Schenkel, L. S., Savitz, A. J., et al. (2004) · Psychological Medicine · doi:10.1017/s0033291704003356 · Cited by 90 · see citing works
Silverstein, S. M., Spaulding, W. D., Menditto, A. A., Savitz, A. J., Liberman, R. P., Berten, S., & Starobin, H. (2008) · Schizophrenia Bulletin · doi:10.1093/schbul/sbm150 · Cited by 89 · see citing works
Greig, T. C., Zito, W., Wexler, B. E., Fiszdon, J. M., & Bell, M. D. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.07.003 · Cited by 82 · see citing works
Reeder, C. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl019 · Cited by 82 · see citing works
Self-citationKurtz, M. M. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.02.008 · Cited by 81 · see citing works
Remission and relapse in psychosis: operational definitions based on case-note data
Bebbington, P., Craig, T., Garety, P. A., Fowler, D. G., Dunn, G., Colbert, S., Fornells‐Ambrojo, M., & Kuipers, E. (2006) · Psychological Medicine · doi:10.1017/s0033291706008579 · Cited by 57 · see citing works
Cunje, A., Molloy, D. W., Standish, T. I. M., & Lewis, D. L. (2006) · International Psychogeriatrics · doi:10.1017/s1041610206003425 · Cited by 56 · see citing works
STARTUP, M., JACKSON, M. C., EVANS, K. E., & BENDIX, S. (2005) · Psychological Medicine · doi:10.1017/s0033291705005003 · Cited by 43 · see citing works
Treating Chronic and Severe Mental Disorders: A Handbook of Empirically Supported Interventions
Hofmann, S. G., & Tompson, M. C. (2002) · Cited by 33 · see citing works
Is Memory Impairment a Rate Limiter in Cognitive Behavioural Therapy for Chronic Schizophrenia?
Penadés, R., Catalán, R., Pujol, N., Puig, O., Guarch, J., Masana, G., Navarro, V., & Gastó, C. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000276378 · Cited by 14 · see citing works
Memantine Dosing in Patients With Dementia
Dolder, C. R., Nelson, M., & McKinsey, J. (2009) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e318186bd7b · Cited by 11 · see citing works
Cognitive-behavioural therapy for schizophrenia: A case formulation approach.
Morrison, A. S., Haddock, G., Barrowclough, C., et al. (2001) · Cited by 2 · see citing works
Sansone (1998) · doi:10.1002/(sici)1097-4679(199811)54:7
Flagged first, then by citations
Cited by
Sorted by citations
Lysaker, P. H., Pattison, M. L., Leonhardt, B. L., Phelps, S., & Vohs, J. L. (2018) · World Psychiatry · doi:10.1002/wps.20508 · Cited by 247 · see citing works
Recovery from schizophrenia: is it possible?
Vita, A., & Barlati, S. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000407 · Cited by 187 · see citing works
Thibaudeau, E., Bowie, C. R., Montreuil, T., Baer, L., Lecomte, T., Joober, R., Abdel-Baki, A., Jarvis, G. E., Margolese, H. C., De Benedictis, L., et al. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116243 · Cited by 3 · see citing works
“However, some studies have reported higher attrition rates ranging from 32 % to 48 % (Drake et al., 2014; Fisher et al., 2015; Puig et al., 2014) and up to 52 % (Wojtalik et al., 2023) in long-term trials.”
- Authors
- Drake, R. J., Day, C. J., Picucci, R., Warburton, J., Larkin, W., Husain, N., Reeder, C., Wykes, T., & Marshall, M.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- Lancashire Care NHS Foundation Trust (GB)
- Oxleas NHS Foundation Trust (GB)
- King's College London (GB)
- Corresponding author
- Drake, R. J.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-10-30
- Volume
- 44
- Issue
- 9
- Pages
- 1889-1899
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2142316371
- Cited by
- 58
- References
- 53
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 7 · 2017: 7 · 2016: 4 · 2015: 8 · 2014: 2
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0509-10023, RP-PG-0606-1302)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive remediation, cognitive behavioural therapy for psychosis, first-episode psychosis, non-affective psychosis, computer-based intervention, insight, executive function, neuropsychological performance, treatment duration
- MeSH terms
- Adult, Female, Humans, Male, Psychotic Disorders, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Early Medical Intervention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
