Effectiveness of a brief cognitive–behavioural therapy intervention in the treatment of schizophrenia
Open accessAbstract
Background: Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive–behavioural therapists in patients with schizophrenia. Aims: To assess the effectiveness and safety of a brief cognitive- behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings. Method: A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual. Results: Patients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]= 13), insight (P<0.001; NNT=10) and depression (P=0.003;NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio =1.15,95% C1 1.01-1.31).There was no increase in suicidal ideation. Conclusions: Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.
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Outcomes from trials of case managers delivering CBTp have been inconclusive.
“outcomes from trials have been inconclusive [16–19]”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [16]
The Results (page unavailable) report statistically significant improvements in overall symptoms, insight and depression with CBT compared with treatment as usual. The Conclusions say community psychiatric nurses can safely and effectively deliver the intervention. Durability remained uncertain, but this paper presents its trial outcome as positive, not inconclusive. (LLM, conf=0.83)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredCase managers cannot fulfil the role of delivering CBTp.
“Evidence to date suggests that case managers cannot fulfil this role”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [16]
The Conclusions state that community psychiatric nurses can safely and effectively deliver brief CBT for schizophrenia, contrary to the claim that case managers cannot fulfil this role. The Implications for training specify the condition: 10 days of intensive training and weekly supervision. The paper does not establish that all case managers can deliver CBTp, but it argues against a categorical inability. (LLM, conf=0.86)
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“The original results from this trial for end of therapy have already been published (Turkington et al, 2002).”
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“However, CBT studies in a group (14) or a brief (13) format or trials also using enriched packages of care as control conditions such as befriending (7) or supportive counselling (3, 6, 8–10) failed to show significant benefits for CBT on symptoms of schizophrenia at some assessment occasions, too.”
BackgroundCognitive Behavioral Therapy for Schizophrenia
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Self-citationPsychosocial interventions for people with both severe mental illness and substance misuse
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“Several studies have reported evidence for the efficacy of CBT on depression and negative symptoms, where these have been assessed as secondary outcomes (Sensky et al. 2000 ; Turkington et al. 2002 ; Durham et al. 2003 ; Gumley et al. 2003 ; Wykes et al. 2008).”
BackgroundPsychosocial interventions for people with both severe mental illness and substance misuse
Hunt, G. E., Siegfried, N., Morley, K. C., Sitharthan, T., & Cleary, M. L. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001088.pub3 · Cited by 117 · see citing works
A pilot study of functional Cognitive Behavioral Therapy (fCBT) for schizophrenia
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Implementing dialectical behaviour therapy: programme survival in routine healthcare settings
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“Evidence-based psychological therapies can transition effectively to routine practice (Foa et al., 2005; Franklin et al., 2000; Henggeler et al., 1995; Mufson et al., 2004; Turkington et al., 2002; Wade et al., 1998).”
BackgroundPsychological Interventions in Early Psychosis
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“reducing symptoms, increasing insight, and reducing depression in a randomized controlled trial with chronically psychotic patients.(62)”
BackgroundChanges in insight during treatment for psychotic disorders: A meta-analysis
Pijnenborg, G. H. M., van Donkersgoed, R. J. M., David, A. S., & Aleman, A. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2012.11.018 · Cited by 106 · see citing works
“All studies reported on the effects of CBT on depression and found that depression was reduced with CBT. Increased insight was not associated with lower mood or suicidal ideation (Turkington et al., 2002; Granholm et al., 2007).”
BackgroundResultInfluentialPsychosocial interventions for people with both severe mental illness and substance misuse
Hunt, G. E., Siegfried, N., Morley, K., Brooke-Sumner, C., & Cleary, M. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001088.pub4 · Cited by 105 · see citing works
Predictors of Outcome in Brief Cognitive Behavior Therapy for Schizophrenia
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“relatively quick and easy to train practitioners in its use [65].”
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Self-citationCognitive behaviour therapy versus other psychosocial treatments for schizophrenia
Jones, C. A., Hacker, D., Meaden, A., Cormac, I., & Irving, C. B. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000524.pub3 · Cited by 95 · see citing works
RetractedCognitive behavioural therapy versus other psychosocial treatments for schizophrenia
Jones, C. A., Hacker, D., Cormac, I., Meaden, A., & Irving, C. B. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008712.pub2 · Cited by 93 · see citing works
Myhr, G., & Payne, K. A. (2006) · The Canadian Journal of Psychiatry · doi:10.1177/070674370605101006 · Cited by 85 · see citing works
“Advantages of CBT over pharmacotherapy include fewer dropouts (10) and relapses (11), higher satisfaction (12), and fewer side effects.”
BackgroundCognitive Behaviour Therapy for Schizophrenia – A Review of Development, Evidence and Implementation
Tarrier, N. (2005) · Psychotherapy and Psychosomatics · doi:10.1159/000083998 · Cited by 86 · see citing works
“…cohort) CBT (n = 101) SP (n = 106) TAU (n = 102) yes independent yes + verifi ed PANSS PSYRATS described 18% ITT missing data estimated CBT > SP > TAU –0.12 Turkington et al. (2002) [50] chronic out-patient CBT (n = 257) SP (n = 165) yes independent yes CPRS described 16% ITT missing data…”
BackgroundInfluentialPeters, E., Landau, S., McCrone, P., Cooke, M. A., Fisher, P., Steel, C., Evans, R., Carswell, K., Dawson, K., Williams, S., et al. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01572.x · Cited by 91 · see citing works
Jones, C. A., Hacker, D., Meaden, A., Cormac, I., Irving, C. B., Xia, J., Zhao, S., Shi, C., & Chen, J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008712.pub3 · Cited by 80 · see citing works
Addis, M. E., Hatgis, C., Krasnow, A. D., Jacob, K., Bourne, L., & Mansfield, A. K. (2004) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.72.4.625 · Cited by 81 · see citing works
Naeem, F., Khoury, B., Munshi, T., Ayub, M., Lecomte, T., Kingdon, D., & Farooq, S. (2016) · International Journal of Cognitive Therapy · doi:10.1521/ijct_2016_09_04 · Cited by 80 · see citing works
Self-citationCognitive behaviour therapy for psychosis
Kuipers, E., & Bebbington, P. (2006) · Epidemiology and Psychiatric Sciences · doi:10.1017/s1121189x00002153 · Cited by 79 · see citing works
“maintaining hope (Turkington et al., 2002).”
BackgroundAn RCT of adherence therapy for people with schizophrenia in Chiang Mai, Thailand
von Bormann, S. M., Robson, D., Gournay, K., & Gray, R. J. (2007) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2007.01786.x · Cited by 78 · see citing works
“A reduction in symptoms of 25% has been used in previous studies of psychological interventions ( Turkington et al. 2002 ) as a definition of clinically meaningful improvement.”
MethodMacLeod, S., Elliott, L., & Brown, R. (2010) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2010.09.005 · Cited by 77 · see citing works
Buchy, L., Czechowska, Y., Chochol, C., MALLA, A. K., Joober, R., Pruessner, J. C., & Lepage, M. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp015 · Cited by 77 · see citing works
“styles underlying distorted cognitions, which are increasingly acknowledged as target for intervention.(7) Cognitive”
BackgroundNeural correlates of insight in dreaming and psychosis
Dresler, M., Wehrle, R., Spoormaker, V. I., Steiger, A., Holsboer, F., Czisch, M., & Hobson, J. A. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2014.06.004 · Cited by 72 · see citing works
Depp, C. A., Perivoliotis, D., Holden, J. L., Dorr, J., & Granholm, E. L. (2018) · Schizophrenia Bulletin · doi:10.1093/schbul/sby135 · Cited by 72 · see citing works
Enhancing medication adherence in people with schizophrenia: An international programme of research
Gray, R. J., White, J., Schulz, M., & Abderhalden, C. (2010) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2009.00649.x · Cited by 71 · see citing works
Polese, D., Fornaro, M., Palermo, M., Luca, V. D., & de Bartolomeis, A. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00210 · Cited by 70 · see citing works
Cordes, J. S., Mathiak, K. A., Dyck, M., Alawi, E. M., Gaber, T. J., Zepf, F. D., Klasen, M., Zvyagintsev, M., Gur, R. C., & Mathiak, K. (2015) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2015.00169 · Cited by 69 · see citing works
“Cognitive behavioral therapy was found to be effective in patients with schizophrenia (Pilling et al., 2002b; Rector and Beck, 2012), even as performed within brief interventions (Turkington et al., 2002) as well as in long-term follow-ups (Sensky et al., 2000; Gould et al., 2001).”
BackgroundSegarra, R., Ojeda, N., Peña, J., García‐Ormaza, J., Rodríguez-Morales, A., Ruiz, I., Hidalgo, R., Burón, J. A., Eguíluz, J. I., & Gutiérrez, M. (2010) · European Psychiatry · doi:10.1016/j.eurpsy.2010.06.003 · Cited by 64 · see citing works
“Poor insight in patients with unusual thought content and delusions may also potentially improve with cognitive behavioural techniques, as long as treatment adherence is maintained [42].”
BackgroundSin, J., & Spain, D. (2016) · Psychosis · doi:10.1080/17522439.2016.1167946 · Cited by 64 · see citing works
“Studies were undertaken in the UK (Jackson et al., 2009; Steel, 2010), the Netherlands (van den Berg et al., 2015), and North America (Mueser et al., 2015; Mueser et al., 2008).”
BackgroundMethodResultInfluentialKendrick, T., Simons, L., Mynors‐Wallis, L., Gray, A. R., Lathlean, J., Pickering, R. M., Harris, S., Rivero‐Arias, O., Gerard, K., & Thompson, C. V. (2005) · Health Technology Assessment · doi:10.3310/hta9370 · Cited by 64 · see citing works
Evidence-Based Psychotherapy for Schizophrenia
Dickerson, F., & Lehman, A. F. (2006) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000195316.86036.8a · Cited by 63 · see citing works
“…et al., 2001; Bradshaw, 2000; Durham et al., 2003; Garety et al., 1994; Granholm et al., 2005; Gumley et al., 2003; Kuipers et al., 1997; Pinto et al., 1999; Rector et al., 2003; Sensky et al., 2000; Tarrier et al., 1993; Tarrier et al., 1998; Trower et al, 2004; and Turkington et al., 2002.”
A Preliminary Controlled Trial of Cognitive Behavioral Therapy in Clozapine-Resistant Schizophrenia
Barretto, E. M. D. P., Kayo, M., Avrichir, B. S., de Sá, A. R., Camargo, M. D. G. M., Napolitano, I. C., Nery, F. G., Pinto, J. A., Bannwart, S., Scemes, S., et al. (2009) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181be7422 · Cited by 62 · see citing works
Morrison, A. P., Renton, J. C., Williams, S. R., Dunn, H., Knight, A., Kreutz, M., Nothard, S., Patel, U. J., & Dunn, G. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00299.x · Cited by 61 · see citing works
Low intensity cognitive behavioural therapy for psychosis: a pilot study.
Waller, H., Garety, P., Jolley, S., Fornells-Ambrojo, M., Kuipers, E., Onwumere, J., Woodall, A., Emsley, R., & Craig, T. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2012.07.013 · Cited by 62 · see citing works
Cognitive-Behavioral Therapy for Medication-Resistant Schizophrenia: A Review
Rathod, S., Kingdon, D., Weiden, P. J., & Turkington, D. (2008) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000308492.93003.db · Cited by 60 · see citing works
Self-citationPsychotic Disorders in Children and Adolescents: A Primer on Contemporary Evaluation and Management
Stevens, J. R., Prince, J. B., Prager, L. M., & Stern, T. A. (2014) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.13f01514 · Cited by 59 · see citing works
The Practice of Functional Analytic Psychotherapy
Kanter, J. W., Tsai, M., & Kohlenberg, R. J. (2010) · Springer eBooks · doi:10.1007/978-1-4419-5830-3 · Cited by 60 · see citing works
“More recently Turkington, Kingdon, and Turner (2002) provided evidence that cognitive behavioral therapy may assist in reducing residual psychotic symptoms.”
BackgroundThase, M. E., Kingdon, D., & Turkington, D. (2014) · World Psychiatry · doi:10.1002/wps.20149 · Cited by 58 · see citing works
Self-citationThomas, N., Rossell, S. L., Farhall, J., Shawyer, F., & Castle, D. J. (2010) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465810000548 · Cited by 57 · see citing works
“Another more comprehensive examination of predictors of outcome was conducted on data from the Insight into Schizophrenia Trial (Turkington, Kingdon and Turner, 2002), which examined a brief course of six sessions of CBT for psychosis delivered by community psychiatric nurses; higher levels of…”
Armijo, J., Méndez, E., Morales, R., Schilling, S., Castro, A., Alvarado, R., & Rojas, G. (2013) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2013.00116 · Cited by 52 · see citing works
Saksa, J. R., Cohen, S. J., Srihari, V. H., & Woods, S. W. (2009) · International Journal of Group Psychotherapy · doi:10.1521/ijgp.2009.59.3.357 · Cited by 54 · see citing works
Farhall, J., Freeman, N. C., Shawyer, F., & Trauer, T. (2009) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.2009.tb00456.x · Cited by 51 · see citing works
La conscience des troubles (insight) dans la schizophrénie : une revue critique
Raffard, S., Bayard, S., Capdevielle, D., Garcia, F., Boulenger, J.-P., & Gély-Nargeot, M.-C. (2008) · L Encéphale · doi:10.1016/j.encep.2007.10.008 · Cited by 53 · see citing works
Suicide and awareness of illness in schizophrenia: An overview
Pompili, M., Ruberto, A., Kotzalidis, G. D., Girardi, P., & Tatarelli, R. (2004) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.68.4.297.56643 · Cited by 52 · see citing works
Bornheimer, L. A., Zhang, A., Verdugo, J. L., Hiller, M., & Tarrier, N. (2020) · Psychiatric Services · doi:10.1176/appi.ps.201900487 · Cited by 52 · see citing works
Does Manualization Improve Therapy Outcomes?
Addis, M. E., Cardemil, E. V., Duncan, B. L., & Miller, S. D. (2006) · American Psychological Association eBooks · doi:10.1037/11265-003 · Cited by 51 · see citing works
Crowe, M., Whitehead, L., Wilson, L., Carlyle, D., O'Brien, A. J., Inder, M., & Joyce, P. R. (2010) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2010.02.012 · Cited by 49 · see citing works
Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia
Jones, C. R., Hacker, D., Xia, J., Meaden, A., Irving, C. B., Zhao, S., Chen, J., & Shi, C. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007964.pub2 · Cited by 48 · see citing works
Naeem, F., Kingdon, D., & Turkington, D. (2008) · Cognitive Therapy and Research · doi:10.1007/s10608-008-9186-x · Cited by 47 · see citing works
“Details of methods have been published elsewhere in detail (Turkington et al. 2002; Sensky et al. 2000).”
MethodSelf-citationKani, A. S., Shinn, A. K., Lewandowski, K. E., & Öngür, D. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.10.012 · Cited by 46 · see citing works
“CBTp has been shown to improve positive and negative symptoms (6, 7), adherence to treatment (8), depression (9) and insight in patients with schizophrenia (10).”
BackgroundCognitive-Behavioral Therapy of Schizophrenia
Kingdon, D., Turkington, D., & Friedberg, R. D. (1996) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.10.2.153 · Cited by 45 · see citing works
Self-citationValimaki, M. A., Hätönen, H. M., Lahti, M., Kuosmanen, L., & Adams, C. E. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007198.pub2 · Cited by 42 · see citing works
Insight and executive functioning in schizophrenia: A multidimensional approach
Raffard, S., Bayard, S., Gély-Nargeot, M.-C., Capdevielle, D., Maggi, M., Barbotte, E., Morris, D., & Boulenger, J. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.04.018 · Cited by 43 · see citing works
- Authors
- Turkington, D., Kingdon, D., & Turner, T.
- Affiliations
- Royal Victoria Infirmary (GB)
- University of Southampton (GB)
- Homerton University Hospital (GB)
- Corresponding author
- Turkington, Douglas
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2002-06
- Volume
- 180
- Issue
- 06
- Pages
- 523-527
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2159645373
- Cited by
- 350
- References
- 24
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 11 · 2023: 6 · 2022: 7 · 2021: 11 · 2020: 9 · 2019: 6 · 2018: 5 · 2017: 3 · 2016: 15 · 2015: 8 · 2014: 17 · 2013: 26 · 2012: 18
- FWCI
- 13.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- schizophrenia, community mental health nursing, nurse-led intervention, secondary care, symptom improvement, insight, depression, caregivers, suicidal ideation, treatment safety
- MeSH terms
- Adolescent, Adult, Aged, Algorithms, Community Mental Health Services, Female, Humans, Male, Middle Aged, Patient Education as Topic, Psychotherapy, Brief, Schizophrenia, Cognitive Behavioral Therapy, Chi-Square Distribution, Treatment Outcome
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