Cognitive-behaviour therapy for medication-resistant positive symptoms in early psychosis: a case series


  • David H. Erickson

    1. Fraser North Early Psychosis Program, New Westminster, British Columbia and Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Dr David H. Erickson, Fraser North Early Psychosis Program, 260 Sherbrooke Street, New Westminster, BC, Canada V3L 3M2. Email:


Introduction: Cognitive-behaviour therapy (CBT) for psychosis reduces the severity of medication-resistant positive symptoms in chronic schizophrenia, but its efficacy for early psychosis outpatients with a similar profile has not been established.

Objective: This paper describes an uncontrolled evaluation of CBT, added to medication and comprehensive care in an early psychosis program, in a group of stable outpatients.

Patients: The sample was drawn from 24 consecutive referrals. Fourteen were eligible, i.e. had positive symptom(s) and had been on the same medication regime for 3 months.

Treatment: Patients received an average of 16 individual sessions with a senior psychologist.

Measures: Symptom severity was assessed both by an independent rater, and by patient self-report.

Results: Eleven of 14 patients completed treatment. Both clinician and self-report post-treatment ratings of positive symptoms were significantly reduced following CBT. For positive symptom totals, effect sizes ranged from d = 1.0 to 1.3. Clinically significant changes were apparent in at least eight of 11 patients.

Discussion: While case-series studies have significant limitations, the large effect sizes described here suggest that CBT shows promise for effectiveness with early psychosis patients. A randomized trial is needed to establish both the effect size over and above a control condition, and the durability of gains of CBT for medication-resistant symptoms in early psychosis.