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.