Psychological Medicine

Original Articles

Patients' beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis

D. Freemana1 c1, G. Dunna2, P. Garetya3, J. Weinmana3, E. Kuipersa3, D. Fowlera4, S. Jolleya3 and P. Bebbingtona5

a1 Department of Psychiatry, Oxford University, UK

a2 School of Community Based Medicine, Manchester University, UK

a3 Department of Psychology, King's College London, Institute of Psychiatry, UK

a4 School of Medicine, Health Policy and Practice, University of East Anglia, UK

a5 Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, UK


Background There is evidence that patients with schizophrenia benefit from standard cognitive behaviour therapy (CBT) only if active techniques are used (‘full therapy’). By contrast, attending sessions but not proceeding beyond engagement and assessment strategies (‘partial therapy’), or simply not attending sessions (‘no therapy’), is not associated with better outcomes. The factors leading to full therapy are unknown. We hypothesized that patients' initial ideas about the nature and extent of their problems would predict use of CBT. A match between patients' views of their problems and the principles underlying treatment would lead to better outcomes.

Method Ninety-two patients with a recent relapse of psychosis completed the Illness Perception Questionnaire (IPQ) before receiving CBT. We examined whether their illness perceptions predicted the take-up of therapy.

Results Patients who did not attend sessions believed their problems would not last as long as those who attended them. Those who attended sessions but did not proceed to full therapy had a lower sense of control over their problems and a more biological view of their causes. Patients who took up full therapy were more likely to attribute the cause of their problems to their personality and state of mind. The take-up of therapy was predicted neither by levels of psychiatric symptoms nor by insight.

Conclusions People with psychosis who have psychologically orientated views of their problems, including the potential to gain control over them, may be more likely to engage fully and do well with standard CBT for psychosis, irrespective of the severity of their problems.

(Received January 25 2012)

(Revised May 02 2012)

(Accepted May 04 2012)

(Online publication July 10 2012)

Key words

  • CBT;
  • illness representations;
  • insight;
  • outcome;
  • psychosis;
  • schizophrenia


c1 Address for correspondence: Professor D. Freeman, Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, UK. (Email: