Cognitive behavior therapy for schizophrenia and psychosis: current status and future directions

Cognitive behavior therapy (CBT) is an empirically based psychological treatment, which has a strong evidence base in a range of psychological disorders and, more recently, has also been applied to more serious disorders such as schizophrenia and psychoses (CBTp). This review outlines the background to this development and the theoretical bases to CBTp. There is good evidence from a considerable number of clinical trials that CBTp has a consistent clinical benefit when used in addition to standard care. There is, however, some variation in the outcomes of these clinical trials which may be due, in part, to the variation in methodological rigor of the trials. There is evidence that smaller, albeit still significant, effect sizes are found in methodologically more robust clinical trials. This is consistent with results found in other branches of medicine and healthcare. The different clinical strategies and outcomes found with various phases of the illness are outlined. There are considerable clinical and research challenges posed by issues of: 1) risk; 2) treating serious comorbidity; and, 3) treating conditions that limit recovery. These clinical problems are being addressed by a second wave of clinical developments. Lastly, the perennial problem of dissemination and translation of research into clinical practice is discussed.