Cognitive Therapy is Safe & Effective for Schizophrenia, Without Drugs

Kermit Cole
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In “the first randomised trial of cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs”, researchers from the U.K. found cognitive therapy without medication was both safe and effective in reducing symptoms.” “Additionally, cognitive therapy significantly improved personal and social functioning and some dimensions of delusional beliefs (cognitive) and voice hearing (cognitive and physical).” The study appears today in The Lancet, with a commentary calling the study “ground-breaking evidence” for an alternative.

Article →

Morrison, A., Turkington, D., Pyle, M., Spencer, H.; Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet. Online February 6, 2014. http://dx.doi.org/10.1016/S0140-6736(13)62246-1

Interview with Anthony Morrison, lead author of the study. (BBC)

From the interview:

“There is an evidence base for cognitive therapy, but that’s as an adjunct to antipsychotic medication. There is a sizable proportion of people with the diagnosis of schizophrenia who either can’t tolerate antipsychotics because of the significant side effects or don’t derive benefit from them in terms of they are not specifically efficacious for them as an individual, and there’s also a proportion of people who don’t necessarily recognize that they might benefit from treatment and don’t necessarily see themselves as having a problem.”

“So for those variety of reasons a sizable proportion of people choose not to take antipsychotics, and currently there isn’t really any evidence-based alternative. So, because there’s a reasonable evidence base for CBT for people with psychosis in addition to medication, it seemed like an obvious alternative treatment to investigate in the absence of antipsychotics in people who’d chosen not to take them for one of the above reasons.”

“In terms of implications, I guess one of the main ones is that it looks like a group of people who have traditionally been viewed as difficult to engage by mental health services seem very ready and willing to participate in psychological therapy like CBT. Which would suggest that maybe their willingness to engage with services is going to be dependent on what services are offering them, and if they’re only offered antipsychotic medication, either if they have strong views that suggest they don’t want to take it, or they’ve had bad experience in terms of side effects, or they’ve tried it before and it’s not worked for them, if more of the same is all that’s on offer then people understandably might be reluctant to carry on engaging with services, whereas if there are potentially effective evidence-based choices which are an alternative then that might facilitate engaging and improving quality of life for people who have not necessarily been well catered for by services in the past.”

Cognitive therapy: at last an alternative to antipsychotics? (Commentary in The Lancet)

Of further interest:
‘Talking therapy’ could help schizophrenic sufferers that refuse drugs (Wired)
Schizophrenia: Time to Flush the Meds? (Science)
Schizophrenia: Talking therapies ‘effective as drugs’ (BBC)
Rethinking schizophrenia: Taming demons without drugs (NewScientist)
Cognitive therapy is safe alternative for people with schizophrenia not using antipsychotics, finds study (Community Care)

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

12 COMMENTS

  1. What works for anxiety works for more extreme anxiety which is what brought me into treatment in the first place, problems that I needed to sort out had gotten out of hand. Prior to quitting psychiatry I had been described as acutely and then chronically severely mentally ill. Basic understandable psychotherapy (CBT) provided the solutions I needed to make full longterm recovery.

  2. It’s good to see this study getting some coverage in the medical media. However there have been similar studies in the past, Bertram Karom’s work which resulted in a book called Psychotherapy of Schizophrenia – Treatment of Choice, comes to mind. It was promptly ignored by mainstream psychiatry.

    The facts that various types of social support are effective for extreme mental distress are there. It’s publicity and active campaigning that are needed to get them as standard practice.

  3. The psychiatric drugs are used to control people who don’t fit in or submit to authority. Only schizophrenics that don’t scare people might get this alternative.

    The drugs are not for the schizophrenic patient, they are for those people around the schizophrenic who need to feel safe from the one who “hears voices”.

    We sane people don’t hear voices (voice of consciousness) only crazy people do.

  4. The antipsychotics gave me “voices.”

    I had no idea what the therapist who misdiagnosed me (based on a list of lies and gossip from people who wanted to cover up the abuse of my children) was talking about when she was asking me about “voices” initially.

    But within two weeks of being put on antipsychotics, I understood what “voices” were. How sick psychiatrists are to put people on drugs that cause “voices.” Ick! It was appalling!

    What’s good, however, is the “voices” go away when taken off the antipsychotics.

    • Yes, Fiachra, my experience with psychiatrists is they are evil psychopaths, or the dumbest and most delusional people on this planet, not to mention insanely disrespectful. I can’t fathom psychiatrists think they can help a person, without knowing anything about the person, or what the person is going through. And even assuming the person is not a person, but merely a “mental illness.” How insane and ridiculous it was to deal with someone so deluded!

      If you can imagine, after I politely confronted my psychiatrist with the fact he was forcibly drugging me based upon lies and gossip from the people who abused my children, and I’d just been handed over the medical evidence of the child abuse. He freaked out and literally declared my entire life a “credible fictional story,” in his medical records! He’s a loon! But also a man who covers up child molestation by poisoning nice mommies, so a sicko, too.

  5. I doubt the many individuals who could benefit will be able to access cognitive therapy from a practitioner skilled in this approach. I and others have found that practitioners who represent their adherence to this approach often fail to do so.

    Sadly, in a system where everything is considered evidence based, person centered, best practices treatment what one gets is usually quite different from what is needed or represented.