Tayside–Fife clinical trial of cognitive–behavioural therapy for medication-resistant psychotic symptoms

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Abstract
Background: Evidence for the efficacy of cognitive–behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited.Aims: To test the effectiveness of cognitive–behavioural therapy delivered by clinical nurse specialists in routine practice.Method: Of 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive–behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months.Results: Treatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%).Conclusions: Cognitive–behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis.