Cognitive therapy and recovery from acute psychosis: A controlled trial

TLDR

This study reports five‑year outcomes for patients who received cognitive therapy during an acute episode of non‑affective psychosis. Thirty‑four of the 40 original randomized participants were assessed at baseline with standardized instruments, with half assigned to a cognitive therapy programme and the other half to recreational activities and support. Over five years, cognitive therapy did not reduce relapse rates, positive symptoms, or insight compared to recreational activities, but it significantly improved perceived control over illness and, for those with at most one relapse, reduced residual delusional beliefs and hallucinations, indicating enduring clinical benefits when relapse is minimized.

Abstract

Background This paper describes the 5-year outcome of a cohort of patients who had received a cognitive therapy intervention during an acute episode of non-affective psychosis. Method Thirty-four out of the original 40 patients who had taken part in a randomised controlled trial of a cognitive intervention were assessed, using standardised instruments completed at entry into the study. In the original trial, half the patients received a cognitive therapy programme (CT group) and the other half received recreational activities and support (ATY group). Results At follow-up no significant differences in relapse rate, positive symptoms or insight between the groups were found, although the CT group did show significantly greater perceived ‘Control over illness’ than the ATY group. For individuals who had experienced a maximum of one relapse in the follow-up period, self-reported residual delusional beliefs and observer-rated hallucinations and delusions were significantly less in the CT than in the ATY group. Conclusion Cognitive therapy applied in the acute phase of a psychotic disorder can produce enduring and significant clinical benefits if experience of relapse can be minimised.