Cognitive-behavioral therapy for medication-resistant symptoms

Cognitive-behavioral therapy for psychosis is described, It draws on the co gnitive models and therapy approach of Beck and colleagues, combined with a n application of stress-vulnerability models of schizophrenia and cognitive models of psychotic symptoms, There is encouraging evidence for the effica cy of this approach, Four controlled trials have found that cognitive-behav ioral therapy reduces symptoms of psychosis, and there is some evidence tha t it may contribute to relapse reduction. Studies that have examined factor s that predict treatment response are reviewed. There is preliminary eviden ce that a good outcome is partially predicted by a measure of cognitive fle xibility or a "chink of insight," People who present with only negative sym ptoms may show poorer outcome. However, there is no evidence that intellige nce or symptom severity is associated with outcome. Implications for select ing patients and for optimal duration of treatment are discussed, Finally, the importance of taking account of the heterogeneity of people with psycho sis, so that individual treatment goals are identified, is discussed.