The future of psychological therapies for psychosis

The need for psychological therapies for psychosis is increasingly recognised. In recent years, two psychological approaches, cognitive behavioural therapy (CBT) and family interventions (FI), have emerged from among a range of psychological approaches as effective therapies with the strongest evidence base. The theoretical basis of these approaches, within a broader biopsychosocial stress-vulnerability framework, is described. The evidence of effectiveness, drawn from the results of recent systematic reviews of CBT and FI, is summarised. CBT is found to reduce symptoms and FI to reduce relapse, with some evidence of improvement in other outcomes for both approaches. Future directions for these therapies are considered, with particular emphasis on their role in early intervention services and relapse prevention. Promising newer applications of these approaches are also discussed, for example in work with people with a dual diagnosis of psychosis and substance misuse disorder. Finally, training and dissemination issues are addressed. It is emphasised that the integration of psychological therapies within comprehensive service provision is important.