Skip to main content Accessibility help
×
Home

London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis: III: Follow-up and economic evaluation at 18 months

  • Elizabeth Kuipers (a1), David Fowler (a2), Phiuppa Garety (a3), Daniel Chisholm (a4), Daniel Freeman (a1), Graham Dunn (a5), Paul Bebbington (a6) and Clare Hadley (a7)...

Abstract

Background

A randomised controlled trial of cognitive — behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline.

Method

Forty-seven (78% of original n=60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed.

Results

Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CB Tappear to have been offset by reductions in service utilisation and associated costs during follow-up.

Conclusions

Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.

Copyright

Corresponding author

Professor Elizabeth Kuiperi, Department of Clinical Psychology, Institute of Psychiatry, De Oespigny Park, London, SES 8AF

Footnotes

Hide All

Part I, ‘Effects of the treatment phase’, published in October 1997 (171. 319–327); part II, ‘Predictors of outcome’, published in November 1997 (171, 420–426).

Footnotes

References

Hide All
Amador, X. , F. Strauss, D. H. Yale, S. , A. et al (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873879.
Beck, A. Ward, C. H. Mundelson, M. et al (1961) An inventory for measuring depression. Archives of General Psychiatary, 4, 561571.
Beck, A. Weissman, A. W. Letter, D. et al (1974) The assessment of pessimism: the hopelessness sale. Journal of Consulting and Clinical Psychology, 42, 861865.
Beck, A. Epstein, N. Brown, G. et al (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 693897.
Beecham, J. & Knapp, M. R. J. (1992) Coning psychiatric interventions. I. Measuring Mental Health Meeds (eds Thornicroft, G. Brewin, C. & Wing, J.), pp. 163183. London: Gaskell.
Birchwood, M. Smith, J. Cochrane, R. et al (1990) The social functioning scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853859.
Brett-Jones, J. Garety, P. A. & Hemsley, D. (1907) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 257265.
Buchanan, A. Reed, A. Wessely, S. et al (1993) Acting on delusions. II: The phenomenological correlates of acting on delusions. British Journal of Psychiatry, 163, 7781.
Drury, V. Birchwood, M. Cochrane, R. et al (1996a) Cognitive therapy and recovery from acute psychosis: a controlled trial, I: Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593601.
Drury, V. Birchwood, M. Cochrane, R. et al (1996b) Cognitive therapy and recovery from psychosis: a controlled trial. II: Impact on recovery time. British Journal of Psychiatry, 169, 602607.
Fowler, D. Cerety, P. A. & Kuipers, L. (1995) Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Chichester: Wiley.
Garety, P. Kuipen, L. Fowler, D. et al (1994) Cognitive behavioural therapy for drug-resistant psychosis. British Journal of Medical Psychology, 67, 259271.
Garety, P. Fowler, D. Kulpen, E. et al (1997) London — East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis II: Predictors of outcome. British Journal of Psychiatry, 171, 420426.
Healey, A. Knapp, M. R. J. Artin, J. et al (1997) Cost-effectiveness evaluation of compliance therapy for people with psychosis. British Journal of Psychiatry, 172, 420424.
Hustig, H. H. & Hafner, R. J. (1990) Persistent auditory hallucinations and their relationship to delusions and mood. Journal of Nervous and Mental Disease, 178, 264267
Kuipers, E. Garety, P. Fowler, D. et al (1997) London-East Anglia randomised controlled trial of cognitive — behavioural therapy for psychosis. I: Effects of the treatment phase. British Journal of Psychiatry, 171, 319327.
Matthews, J. N. S. Altman, D. G. Campbell, M. J. et al (1990) Analysis of serial measurements in medical research. British Medical Journal, 300, 230235
Nelston, H. E. (1982) National Adult Reading Test (NART) far the Assessment of Premorbid Intelligence in Patients with Dementia: Test Manual. Windsor: NFER-Nelson.
Netten, A. & Dennett, J. (1996) Unit Costs of Health and Social Care. Canterbury: Personal Social Services Research Unit, University of Kent.
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale Psychological Reports, 10, 799812
Robson, P. (1989) Development of anew self-report questionnaire to measure self-esteem Psychological Medicine, 19, 513518.
Shapiro, D. A. (1996) Outcome research. I. Behavioural and Mental Health Research. 2nd edn (eds Parry, G. & Watts, F.). Hove: Lawrence Erlbaum.
Terrier, N. Lowson, K. & Barrowtclough, C. (1991) Some aspects of family interventions in schizophrenia, I: Financial considerations. British Journal of Psychiatry, 159, 481484.
Terrier, N. Beckett, P. Harwood, S. et al (1991) A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. I: Outcome. British Journal of Psychiatry, 162, 524532
Williams, J. M. G. (1992) The Psychological Treatment of Depression. A Guide to Theory and Practice of Cognitive Behaviour Therapy. London: Routledge.
World Health Organization (1992) SCAN Schedules for Clinical Assessment in Neuropsychiatry. Geneva: WHO.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis: III: Follow-up and economic evaluation at 18 months

  • Elizabeth Kuipers (a1), David Fowler (a2), Phiuppa Garety (a3), Daniel Chisholm (a4), Daniel Freeman (a1), Graham Dunn (a5), Paul Bebbington (a6) and Clare Hadley (a7)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *