CBT under challenge


Cognitive Behavioural Therapy (CBT) became part of the mainstream treatment for psychoses in 2002, when the National Institute for Health and Care Excellence (NICE) endorsed it as the main psychological treatment for schizophrenia. In 2009, they further recommended that CBT be offered ‘to all people with schizophrenia’, repeating this endorsement in the latest 2014 NICE update  (http://www.nice.org.uk/nicemedia/live/14382/66534/66534.pdf). Despite this ringing endorsement from NICE, Professor of Cognitive Neuroscience Keith Laws, writing in The Guardian this week, believes that CBT as a treatment for schizophrenia has been ‘oversold’.

Laws points to the fact that recent meta-analyses of the effectiveness of CBT as a treatment for schizophrenia suggest its effectiveness may actually be lower than originally thought. One recent large-scale meta-analysis (Jauhar et al., 2014) revealed only a ‘small’ therapeutic effect on the key symptoms of schizophrenia, such as hallucinations and delusions. However, even these small effects disappeared when symptoms were assessed ‘blind’ (i.e. when assessors were unaware of whether the patient was in the therapy or control condition).

Another recent meta-analysis (Turner et al., 2014) likewise found only a small beneficial effect of CBT on positive symptoms. The authors also noticed that this beneficial effect disappeared when they controlled for ‘researcher allegiance’, i.e. a bias that inflates the observed effectiveness of a researcher’s preferred therapy. Turner et al. found that controlling for such allegiance bias removed any observed superiority of CBT over other forms of psychological intervention. If these findings were not damning enough, Laws goes on to point out that over 75% of published studies find ‘no significant reductions in the positive or negative symptoms of schizophrenia’. Although CBT is commonly used in conjunction with antipsychotic medication rather than on its own, claims that it is a ‘promising alternative to antipsychotics’ (The Guardian, March 2014) or that ‘Talking therapies: effective as drugs’ (BBC, 2014) appear, as yet, wide of the mark.


2 thoughts on “CBT under challenge

  1. Richard Bentall says:

    Er, Turner found that CBT was not more efficacious than other psychological interventions when controlling for researcher allegiance, not that CBT was ineffective. The abstract reads:

    Cognitive-behavioral therapy (CBT) was significantly more efficacious than other interventions pooled in reducing positive symptoms (g=0.16). This finding was robust in all sensitivity analyses for risk of bias but lost significance in sensitivity analyses for researcher allegiance, which suffered from low power. Social skills training was significantly more efficacious in reducing negative symptoms (g=0.27). This finding was robust in sensitivity
    analyses for risk of bias and researcher allegiance. Significant findings for CBT, social skills training, and cognitive remediation
    for overall symptoms were not robust after sensitivity analyses. CBT
    was significantly more efficacious when compared directly with befriending for overall symptoms (g=0.42) and supportive
    counseling for positive symptoms (g=0.23).

    Please get your facts right!

    • Rob Bircher says:

      Many thanks for your post, Richard, and apologies that the Easter hols have delayed our getting back to you. We’ve made the changes you indicate on the original post and are very grateful to you for your feedback.

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