Original ArticlesInsight and Recovery From Acute Psychotic Episodes The Effects of Cognitive Behavior Therapy and Premature Termination of TreatmentStartup, Mike PhD*; Jackson, Mike C. PhD†; Startup, Sue BSc*Author Information *University of Newcastle, Australia; and †University of Wales at Bangor, United Kingdom. The North Wales trial of CBT was supported by grant RC012 from the Wales Office of R&D for Health and Social Care and by Conwy & Denbighshire, North West Wales, and North East Wales NHS Trusts. Send reprint requests to Mike Startup, PhD, School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia. E-mail: [email protected]. The Journal of Nervous and Mental Disease: October 2006 - Volume 194 - Issue 10 - p 740-745 doi: 10.1097/01.nmd.0000243081.97879.b9 Buy Metrics Abstract Research suggests that insight in schizophrenia is only weakly responsive to targeted psychosocial interventions. One of the aims of the present study was to examine the effects on insight of cognitive behavior therapy (CBT) for acutely psychotic patients. A second aim was to test predictions drawn from research on recovery styles that patients who reject psychological assistance will show a reduction in insight while those who continue to accept psychological assistance will show increases in insight over time. Patients with acute schizophrenia-spectrum disorders were assigned at random to treatment-as-usual (TAU) or TAU plus CBT. The latter were also divided into those who terminated treatment prematurely (dropouts) and those who did not (stay-ins). Insight was assessed at baseline and three follow-up assessments. Insight increased over the follow-up period, but there were no differences between the CBT and TAU groups. Within the CBT group, dropouts showed a reduction in insight at the 6-month assessment before returning to their baseline level, while the stay-ins showed linear improvement up to 12 months. Possible explanations for these contrasting patterns, in terms of resilience, attachment styles, and an insecure sense of self, are discussed. © 2006 Lippincott Williams & Wilkins, Inc.