Early case studies and noncontrolled trial studies focusing on the treatment of delusions and hallucinations have laid the foundation for more recent developments in comprehensive cognitive behavioral therapy (CBT) interventions for schizophrenia. Seven randomized, controlled trial studies testing the efficacy of CBT for schizophrenia were identified by electronic search (MEDLINE and PsychInfo) and by personal correspondence. After a review of these studies, effect size (ES) estimates were computed to determine the statistical magnitude of clinical change in CBT and control treatment conditions. CBT has been shown to produce large clinical effects on measures of positive and negative symptoms of schizophrenia. Patients receiving routine care and adjunctive CBT have experienced additional benefits above and beyond the gains achieved with routine care and adjunctive supportive therapy. These results reveal promise for the role of CBT in the treatment of schizophrenia although additional research is required to test its efficacy, long-term durability, and impact on relapse rates and quality of life. Clinical refinements are needed also to help those who show only minimal benefit with the intervention.
1Centre for Addiction and Mental Health, Clarke Institute of Psychiatry and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; and 2Department of Psychiatry, University of Pennsylvania School of Medicine, 754 Science Center, Philadelphia, Pennsylvania.
The preparation of this manuscript was supported in part by a grant from the Ontario Mental Health Foundation (OMHF) awarded to the first author. The authors thank Anthony Morrison, Mary V. Seeman, Zindel V. Segal, and Til Wykes for their comments on a draft of this manuscript. The authors also thank Leslie Atkinson for his statistical assistance and Talia Hoffstein for her editorial assistance.