Background Cognitive–behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias. Aims To conduct a systematic review and meta-analysis of the effectiveness of CBT for schizophrenic symptoms that includes an examination of potential sources of bias. Method Data were pooled from randomised trials providing end-ofstudy data on overall, positive and negative symptoms. The moderating effects of randomisation, masking of outcome assessments, incompleteness of outcome data and use of a control intervention were examined. Publication bias was also investigated. Results Pooled effect sizes were 70.33 (95% CI 70.47 to 70.19) in 34 studies of overall symptoms, 70.25 (95% CI 70.37 to

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Cognitive-behavioural therapy for the symptoms of schizophrenia : systematic review and meta-analysis with examination of potential bias

Behaviour research and therapy

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.

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Dissociation, Trauma, and the Role of Lived Experience: Toward a New Conceptualization of Voice Hearing.

Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review.

The trauma of psychosis: Posttraumatic stress disorder and recent onset psychosis

http://www.brown.uk.com/schizophrenia/jacksonc.pdf

Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

Objective: To evaluate a cognitive therapy based intervention designed to reduce the traumatic symptoms and emotional dysfunction, which can follow a first episode of psychosis.
Materials and methods: 66 first episode patients were randomized to receive either a cognitive therapy intervention or treatment as usual and assessed at baseline, post intervention (6 months) and follow-up (12 months) on a variety of measures including Impact of Events Scale, Calgary Depression Scale and PANSS.
Results: Interim analysis revealed significant benefit for those receiving the cognitive therapy intervention in terms of reduced trauma symptoms and other outcome measures.
Conclusions: The findings are discussed in the context of
current models of trauma and psychosis and their implications for clinical practice.

K. Barton

Papers

Improving psychological adjustment following a first episode of psychosis: A randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms

Preventing the Traumatic Sequelae of First Episode Psychosis: A Randomised Controlled Trial