Psychological Medicine

Original Articles

Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial

A. P. Morrisona1a2 c1, P. Huttona2, M. Wardlea2, H. Spencera3a4, S. Barratta2, A. Brabbana5a6, P. Callcotta3, T. Christodoulidesa3, R. Dudleya3a4, P. Frencha2, V. Lumleya5, S. J. Taia1 and D. Turkingtona3a4

a1 School of Psychological Sciences, University of Manchester, UK

a2 Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK

a3 Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK

a4 Newcastle University, Newcastle-upon-Tyne, UK

a5 Tees, Esk and Wear Valley NHS Mental Health Foundation Trust, UK

a6 University of Durham, UK


Background Although antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.

Method Twenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.

Results T tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment; d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.

Conclusions This study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.

(Received March 25 2011)

(Revised August 10 2011)

(Accepted August 23 2011)

(Online publication September 14 2011)


c1 Address for correspondence: Professor A. P. Morrison, School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: