Cognitive behavior therapy without antipsychotics: is it effective across the continuum of psychotic disorders?

Presentation First Author: 
Tony Morrison

Cognitive behaviour therapy (CBT) for psychosis has traditionally been delivered in addition to antipsychotic medication. However, antipsychotics are frequently associated with severe side effects and do not work for everyone, meaning many people with psychosis choose not to take them and making them unsuitable as an initial intervention for people at high risk of developing psychosis. In order to facilitate informed choice and decision making for service users, research is required to explore evidence-based alternatives to antipsychotic medication, since the most likely candidates, such as psychosocial treatments including CBT, have almost exclusively been evaluated as an adjunct to medication. Data will be presented from several clinical trials evaluating the use of CBT without antipsychotics for people across the continuum of psychotic disorders: a large randomised controlled trial comparing CBT with treatment as usual in 288 patients with at-risk mental states (ARMS) has been conducted, and a recent meta-analysis of the data regarding prevention and symptom improvement will also be described; results from an open trial across 2 sites evaluating CBT in 20 patients with psychosis will be described, and current progress in a randomised controlled trial comparing CBT with treatment as usual in 74 patients who have chosen not to take antipsychotics will also be described. In addition to the quantitative data regarding efficacy, qualitative data regarding the subjective experience of receiving CBT in our trials will also be presented. Future directions for research and practice will also be considered.

Conference Name: 
Presentation Date: 
January, 2013
Additional Authors: 
Tony Morrison
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