[Introduction of CBT for psychosis in inpatient settings]

At present, CBT for psychosis (CBTp) is recommended as an evidence-based psychological therapy for schizophrenia. However, introducing CBTp in inpatient settings in Japan is not an easy task, because, unlike randomized controlled studies, patients are not limited to those who fulfil strict inclusion criteria and many of the therapists are not trained in CBTp. In order to introduce CBTp to our inpatient service, assumptions for addressing symptoms, therapists' skill development, and program development plans must be put in place. Discussing symptoms in the therapeutic relationship should not be viewed by patients as an impediment to discharge. Care must be taken so that psychological models for delusion presented to patients do not contradict information given to them through other psychoeducation. In terms of therapists' skill development, the use of a group program is recommended since they can be manualized and make it easier to train and, therefore, aid in continuously securing multiple staff who are capable of leading the group. It is recommended that group CBTp, which is cost-effective and reproducible, and individual CBTp, where case formulation and a tailored approach are possible, both be developed and provided according to patient's needs.