Cognitive behaviour therapy for schizophrenia: relationship between anxiety symptoms and therapy

To explore the relationship between symptoms of anxiety and cognitive behaviour therapy (CBT) in patients with schizophrenia.

Separate subanalyses of two randomized controlled trials comparing CBT for schizophrenia against befriending in the London Newcastle (LN) study, and against treatment as usual in the insight into schizophrenia (IS) study.

Assessment of anxiety symptoms using the Brief Scale for Anxiety (BSA) derived from the Comprehensive Psychopathological Rating Scale (CPRS), at baseline, end of therapy and follow-up.

In both studies, anxiety symptoms positively correlated with overall psychopathology, hallucinations and depression. In the LN study, patients with persecutory delusions and with distress due to akathisia and incapacity due to abnormal movements scored significantly higher on the BSA. In the IS study, anxiety scores were also positively correlated with; delusions, negative symptoms, relationship problems and problems with activities of daily living, living conditions, occupation and activities. Both subanalyses showed CBT had beneficial effects on anxiety symptoms compared with the control groups. Overall prognosis was found to be better in those with low anxiety in the LN study.

CBT improves anxiety symptoms in psychosis. We did not find an association between anxiety symptoms at baseline and outcome of cognitive therapy in this group of patients with schizophrenia.