Cognitive Therapy Reduces Psychotic Symptoms in Schizophrenia

Summary and Comment |
February 14, 2014

Cognitive Therapy Reduces Psychotic Symptoms in Schizophrenia

  1. Peter Roy-Byrne, MD

The reductions in psychotic symptoms in unmedicated but engaged schizophrenia patients are comparable to those seen with traditional antipsychotics.

  1. Peter Roy-Byrne, MD

Antipsychotic medications reduce psychotic symptoms and mortality and prevent relapses in schizophrenia, but medication adherence is very poor, and the drugs have significant medical and neurologic adverse effects. Because cognitive therapy (CT) has been shown to add to the effects of medication in schizophrenia patients, researchers in the U.K. examined the effects of 26 weekly CT sessions over 9 months or usual care in 74 unmedicated outpatients with schizophrenia. Patients were not taking antipsychotics for at least 6 months but were engaged with their local mental health care systems.

CT-treated patients had greater decreases in schizophrenia symptoms on the Positive and Negative Syndrome Scale (PANSS), with a small-to-medium effect size (0.4). At 9 months, 32% of CT-treated patients and 13% of controls achieved at least a 50% reduction in PANSS scores. CT improved social functioning but not symptoms of anxiety and depression.


This important study suggests that cognitive therapy offers significant benefits to schizophrenia patients who are already engaged in the mental health care system. However, these effects cannot be generalized to patient subgroups having greater morbidity and requiring more costly care — i.e., hospitalized or recently hospitalized patients, those with comorbid substance abuse, or those unable to engage with the mental health care system. Despite these qualifiers, the moderate effect size is comparable to that seen with antipsychotic medication. When patients are appropriately selected, CT seems to have a place in “personalized” treatment of schizophrenia. Although CT does not improve anxiety or depression, protocol changes to target these symptoms might expand the treatment's impact.

Editor Disclosures at Time of Publication

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Treasurer)


Reader Comments (1)

Rachna George MBBS Resident, Psychiatry, Thiruvalla, Kerala

gave me a new insight

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