Cognitive behavioural therapy—a valid alternative to antipsychotics for psychosis?

For the past 60 years, the mainstay of treatment for people with psychotic illnesses has been antipsychotic drugs. 1 Barnes TR Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2011; 25: 567 Crossref PubMed Scopus (275) Google Scholar Antipsychotics, however, are not usually fully effective, and are associated with side-effects ranging from weight gain and metabolic syndrome to the irreversible movement disorder tardive dyskinesia. In the past 20 years, modern psychological interventions have been explored as alternative treatments. The most studied of these interventions is cognitive behavioural therapy (CBT), which has been examined in at least 50 trials 2 Jauhar S McKenna PJ Radua J Fung E Salvador R Laws KR Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry. 2014; 204: 20-29 Crossref PubMed Scopus (270) Google Scholar and is recommended by the UK's National Institute for Health and Care Excellence. 3 Kuipers E Yesufu-Udechuku A Taylor C Kendall T Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ. 2014; 348: g1173 Crossref PubMed Scopus (96) Google Scholar Antipsychotic drugs versus cognitive behavioural therapy versus a combination of both in people with psychosis: a randomised controlled pilot and feasibility studyA head-to-head clinical trial of CBT versus antipsychotics versus the combination of the two is feasible and safe in people with first-episode psychosis. Full-Text PDF Open Access