Most data on this type of intervention comes from case reports and uncontrolled trials. However, six controlled trials (reported in nine separate research reports) exist. (6,,7 and 8,1J,14,18,1£,2:;í,25)

There is consistent evidence from five studies (611141£19> that cognitive-behavioural therapy for schizophrenia can reduce positive psychotic symptoms to a greater extent than that which can be achieved with standard care or non-specific counselling alone. The effect appears clinically significant, with about 50 per cent (1i> to 60 per cent(1:> of patients achieving good treatment responses and reductions of 25 to 50 per cent in the time to recovery from an acute psychotic episode. (24> Those studies that have separately examined changes in the measures of hallucinations and delusions have generally found more promising results for delusions, but conclusions must be tentative due to the limited data.(1. ,18)

There is suggestive evidence that some, if not all, of these positive effects are due to the specific effects of CBT on dysfunctional beliefs. (6J, l824. However, it has not always been possible to demonstrate changes in the detailed dimensions of the symptoms of psychosis, despite positive overall changes in psychotic symptomatology.(l ,,B25) However, Garety et al.(19) report that patients who had a 'chink' of insight, who were willing to consider that they may be wrong, were most likely to respond to cognitive-behavioural therapy, supporting the notion that part of the therapeutic action comes from a direct impact on delusional thinking.

No definite conclusions can be drawn with respect to the delay of relapse, since results are mixed and based on the evaluation of a single specific intervention. (7)

Finally, it appears that the management of depression associated with schizophrenia is not amenable to the cognitive-behavioural interventions reviewed above, as only one(l1) of the three studies(l. 1825) that examined changes in depression found a significant treatment-effect attributable to the cognitive-behavioural intervention. We have argued that this arises because critical beliefs held by patients about their psychosis are not addressed—for example, that psychosis is uncontrollable. (2.6>

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