Outcomes of an effectiveness trial of cognitive–behavioural intervention by mental health nurses in schizophrenia
Open accessAbstract
Background: Little is known about the medium-term durability of cognitive–behavioural therapy (CBT) in a community sample of people with schizophrenia. Aims: To investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up. Method: Participants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. =53) by raters masked to treatment allocation (CBT or usual care). Results: At 1-year follow-up, participants who received CBT had significantly more insight (P=0.021) and significantly fewer negative symptoms (P=0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up. Conclusions: Mental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.
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Case 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 [17]
The Discussion says training mental health nurses to deliver brief CBT was safe and effective. The Conclusions recommend training them to provide brief CBT alongside case management, rather than saying case managers cannot deliver it. The paper does distinguish this brief intervention from expert therapy for treatment-resistant psychosis. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOutcomes 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 [17]
The Results (page not available) report benefits for insight, negative symptoms and hospital readmission, but no improvement in psychotic symptoms or occupational recovery. That mixed pattern lends some support to the characterization; however, the Discussion calls this trial's intervention safe and effective, and the paper does not establish that outcomes across trials were inconclusive. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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“In merito alle figure professionali che si occupano di erogare la TCC per le psicosi, è molto interessante lo studio di Turkington et al. (2006) che identifica gli infermieri psichiatrici come erogatori del trattamento, dopo un training di 10 giorni su un approccio di TCC breve, con ottimi…”
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“Considering this, it is difficult to interpret effectiveness type trials (Turkington et al., 2006) as the explanatory trials included in this review are not positive for the treatment.”
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“That intervention improved overall symptoms, insight, and depression and had a significant benefit on negative symptoms at follow-up (Turkington et al., 2006).”
BackgroundSelf-citationHusain, M. O., Chaudhry, I. B., Mehmood, N., Rehman, R. U., Kazmi, A., Hamirani, M. M., Kiran, T., Khoso, A. B., Bassett, P., Husain, M. I., et al. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2740-z · Cited by 27 · see citing works
“There is also RCT evidence that brief CBT delivered by mental health nurses is effective in reducing the severity of psychotic symptoms [9].”
BackgroundStuhlmiller, C., & Tolchard, B. (2009) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20090527-01 · Cited by 25 · see citing works
Kingdon, D., & Kirschen, H. (2006) · Psychiatric Services · doi:10.1176/ps.2006.57.12.1792 · Cited by 25 · see citing works
Self-citationHazell, C. M., Greenwood, K., Fielding-Smith, S. F., Rammou, A., Bogen‐Johnston, L., Berry, C., Bibby-Jones, A.-M., & Hayward, M. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00727 · Cited by 25 · see citing works
Guo, Z.-H., Li, Z.-J., Ma, Y., Sun, J., Guo, J.-H., Li, W.-X., Wang, Z.-Q., Xu, H.-L., Ng, R. M. K., Turkington, D., et al. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.183285 · Cited by 24 · see citing works
“…similar study comparing the efficacy of brief CBT plus TAU that of TAU using the Negative Symptom Rating Scale ) 32 found that brief CBT had modest effects on negative symptoms at 1-year follow-up, 12 but our study found only a strong trend for greater change in those receiving brief CBT.”
Self-citationRetractedReasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort
Ahmad, I., Khalily, M. T., & Hallahan, B. P. (2017) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2017.07.024 · Cited by 25 · see citing works
Irish psychiatric nurses' self‐reported sources of knowledge for practice
Yadav, B. L., & Fealy, G. (2011) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01751.x · Cited by 22 · see citing works
Howells, F. M., Kingdon, D., & Baldwin, D. S. (2017) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2628 · Cited by 21 · see citing works
“CBT is often seen as a “labour” or “clinically” intensive intervention, although the evidence shows the lasting long‐term benefits of brief interventions (Turkington et al., 2008) with some evidence of cost‐effectiveness (Turkington et al., 2006).”
BackgroundSelf-citationLysaker, P. H., Daroyanni, P., Ringer, J. M., Beattie, N. L., Strasburger, A. M., & Davis, L. W. (2007) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318093f437 · Cited by 20 · see citing works
“…that psychotherapy offers some with schizophrenia a cognitive prosthetic that enables them to make meaning of what is wrong and not wrong in their lives (Lysaker and Daroyanni, 2006) and studies suggesting cognitive psychotherapy assists persons to attain greater insight (Turkington et al., 2006).”
BackgroundPatient health outcomes in psychiatric mental health nursing
Montgomery, P., Rose, D. N., & CARTER, L. (2009) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2008.01327.x · Cited by 19 · see citing works
Kingdon, D. (2009) · Psychological Medicine · doi:10.1017/s0033291709990201 · Cited by 19 · see citing works
“(2009) justify excluding these beneficial effects because some other studies did not show this despite others – not quoted – which did (Drury et al. 2000 ; Turkington et al. 2006).”
BackgroundResultSelf-citationCognitive Behavior Therapy for Psychosis
Kingdon, D., & Turkington, D. (2022) · Springer eBooks · doi:10.1007/978-3-031-10239-4_44 · Cited by 19 · see citing works
Self-citationGroup cognitive behavioural therapy as a treatment for negative symptoms in first-episode psychosis
Gaynor, K., Dooley, B. A., Lawlor, E., Lawoyin, L. R., & O’Callaghan, E. (2011) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2011.00270.x · Cited by 18 · see citing works
“Startup et al.,8 Turkington et al.9 and Peters et al.10 have found improvements in negative symptoms following individual cognitive behavioural therapy (CBT) with people in later stages of psychoses, suggesting that CBT may offer a treatment option for negative symptoms, as evidence indicates that antipsychotics are l…”
BackgroundVelligan, D. I., Draper, M., Stutes, D. S., Maples, N. J., Mintz, J., Tai, S., & Turkington, D. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp075 · Cited by 18 · see citing works
“CBT has also previously been conducted on home visits.(32,33) It is possible that combining CAT with CBT into one in-home treatment would allow a broader focused therapy without greatly increasing economic burden.”
MethodSelf-citationTham, X. C., Xie, H., Chng, C. M. L., Seah, M.-Y., López, V., & Klainin‐Yobas, P. (2018) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2018.02.004 · Cited by 18 · see citing works
“Nurses are in a better position to impart illness knowledge to their patients than other healthcare professionals (Turkington et al., 2006).”
Cognitive therapy of psychosis: Research and implementation
Kingdon, D., & Turkington, D. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.09.023 · Cited by 17 · see citing works
Self-citationThe future of specialist community teams in the care of those with severe mental illness
Tyrer, P. J. (2007) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00002323 · Cited by 17 · see citing works
The use of psychological therapies by mental health nurses in A ustralia
Fisher, J. E. (2013) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12079 · Cited by 17 · see citing works
Psychotherapy for Schizophrenia: A Review of Modalities and Their Evidence Base
Brus, M., Novakovic, V., & Friedberg, A. (2012) · Psychodynamic Psychiatry · doi:10.1521/pdps.2012.40.4.609 · Cited by 17 · see citing works
Tanoue, H., Yoshinaga, N., Kato, S., Naono‐Nagatomo, K., Ishida, Y., & Shiraishi, Y. (2018) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2018.06.005 · Cited by 17 · see citing works
Cognitive-behaviour therapy and schizophrenia
Wykes, T. (2014) · Evidence-Based Mental Health · doi:10.1136/eb-2014-101887 · Cited by 16 · see citing works
Do antidepressants improve negative symptoms in schizophrenia?
Barnes, T. R. E., & Paton, C. (2011) · BMJ · doi:10.1136/bmj.d3371 · Cited by 16 · see citing works
“With regard to non-drug interventions, clinical trials show some limited evidence of a sustained effect of cognitive behavioural therapy.”
BackgroundCognitive Behavioral Therapy in Psychiatric Nursing in Japan
Yoshinaga, N., Nosaki, A., Hayashi, Y., Tanoue, H., Shimizu, E., Kunikata, H., Okada, Y., & Shiraishi, Y. (2015) · Nursing Research and Practice · doi:10.1155/2015/529107 · Cited by 16 · see citing works
Randomized controlled trials of mental health nurse‐delivered interventions: A systematic review
Dickens, G. L., Maqbali, M. A. H. A., Blay, N., Hallett, N., Ion, R. M., Lingwood, L., Schoultz, M., & Tabvuma, T. (2022) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12881 · Cited by 15 · see citing works
“Studies by Gilbody et al. (2017), Graham et al (2016), Lee et al (2014), Holt et al (2018, 2019), Simon et al. (2005), and Turkington et al. (2006) all 13652850, ja, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1111/jpm .12881 by T est, W iley O nline L ibrary on [24/10/2022].”
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Blakeman, P., & FORD, L. (2011) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01818.x · Cited by 14 · see citing works
Mouncey, P. R., Wade, D. M., Richards‐Belle, A., Sadique, Z., Wulff, J., Grieve, R., Emerson, L. M., Brewin, C. R., Harvey, S. E., Howell, D. C. J., et al. (2019) · Health Services and Delivery Research · doi:10.3310/hsdr07300 · Cited by 14 · see citing works
Cognitive Behavioral Therapy With a Paranoid Schizophrenic Patient
Kuller, A. M., & Björgvinsson, Þ. (2010) · Clinical Case Studies · doi:10.1177/1534650110383009 · Cited by 14 · see citing works
Clarke, P., Bibby-Jones, A.-M., & Hayward, M. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000143 · Cited by 12 · see citing works
“However, evaluations of brief CBT offered by briefly-trained therapists to psychosis patients have generated inconclusive findings (Harding et al., 2018; Turkington et al., 2002; Turkington et al., 2006) and there have been no evaluations specifically related to the delivery of CBT for voices.”
BackgroundSelf-poisoning with pesticides in India
Alex, R., Prasad, J. H., Kuruvilla, A., & Jacob, K. (2007) · The British Journal of Psychiatry · doi:10.1192/bjp.190.3.274a · Cited by 12 · see citing works
Mehl, S., Werner, D., & Lincoln, T. M. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01868 · Cited by 12 · see citing works
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“Despite this, initial research investigating CBT-based BPIs for depression and/or anxious avoidance in individuals with psychosis has found improvements in both depressive symptoms and negative symptoms of psychosis (Turkington et al., 2006; Waller et al., 2013), suggesting the potential for BPIs in more complex clien…”
BackgroundHutton, P., Wood, L., Taylor, P. J., Irving, K., & Morrison, A. P. (2013) · Psychosis · doi:10.1080/17522439.2013.825005 · Cited by 11 · see citing works
“also excluded CBT-favourable data from the largest study of CBTp to date (N = 422) because it used readmission as a proxy measure of relapse (Turkington et al., 2006), arguing that any CBT-favourable reduction in readmission rates would reflect a large-scale “Hawthorne effect” – i.”
Abbs, B., Achalia, R. M., Adelufosi, A. O., Aktener, A. Y., Beveridge, N. J., Bhakta, S. G., Blackman, R. K., Bora, E., Byun, M. S., Cabanis, M., et al. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2012.07.024 · Cited by 8 · see citing works
Community psychiatry's achievements
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“Its effectiveness remains controversial (Jauhar et al. 2014) and it is undoubtedly difficult to implement in routine settings, but is recommended in many guidelines and supported by some impressive studies (Turkington et al. 2002, 2006).”
BackgroundPsychological and social interventions for schizophrenia
Kingdon, D. (2006) · BMJ · doi:10.1136/bmj.333.7561.212 · Cited by 9 · see citing works
“a commitment that few services can make. Simpler, briefer interventions with families combined with cognitive therapy with individual patients have produced positive results and may, at least in the first instance, be the way forward.”
BackgroundSelf-citationMental Health Nursing Services
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A Model to Transform Psychosis Milieu Treatment Using CBT-Informed Interventions
Riggs, S. E., & Creed, T. A. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.08.001 · Cited by 7 · see citing works
Auditory Verbal Hallucinations in Patients with Borderline Personality Disorder
Slotema, C. W., & Kingdon, D. (2011) · Springer eBooks · doi:10.1007/978-1-4614-0959-5_10 · Cited by 7 · see citing works
Self-citationBurr, C. M., & Richter, D. (2021) · International Journal of Mental Health Nursing · doi:10.1111/inm.12917 · Cited by 8 · see citing works
Advances in Cognitive Behavior Therapy for Psychosis
Turkington, D., Wright, N. P., & Tai, S. (2013) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2013.6.2.150 · Cited by 7 · see citing works
Self-citationSocial Intervention as an Adjuvant Therapy for Patients with Schizophrenia
Dobrin, I., Chiriță, R., Dobrin, R., Bîrsan, M., Ștefănescu, C., Truş, C., & Cristofor, A. C. (2020) · Revista de Cercetare si Interventie Sociala · doi:10.33788/rcis.68.18 · Cited by 6 · see citing works
“The treatment consisted of simple, brief interventions with families mixed with cognitive therapy with individual patients and it produced visible improvements and may, at least in the fi rst part of the treatment, still be implemented today (Turkington et al., 2006).”
Kopelovich, S. L., Maura, J., Blank, J. M., & Lockwood, G. J. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08725-5 · Cited by 6 · see citing works
- Authors
- Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J., & Mehta, R.
- Affiliations
- Royal Victoria Infirmary (GB)
- University of Southampton (GB)
- Newcastle University (GB)
- Corresponding author
- Turkington, Douglas
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2006-07
- Volume
- 189
- Issue
- 1
- Pages
- 36-40
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2027906750
- Cited by
- 151
- References
- 25
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 7 · 2017: 10 · 2016: 9 · 2015: 8 · 2014: 7 · 2013: 11 · 2012: 13
- FWCI
- 8.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- schizophrenia, cognitive behavioral therapy, psychiatric nurses, brief psychotherapy, relapse prevention, hospital readmission, insight, negative symptoms, depression, symptom burden, community mental health services, treatment resistance
- MeSH terms
- Community Health Nursing, Community Psychiatry, Female, Follow-Up Studies, Hospitalization, Humans, Male, Patient Readmission, Psychiatric Nursing, Psychotherapy, Brief, Recurrence, Schizophrenia, Schizophrenic Psychology, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome
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