In the North Wales randomised controlled trial of cognitive behaviour therapy (CBT) for acute schizophrenia spectrum disorders, patients who received CBT as an adjunct to treatment-as-usual (TAU) had significantly better outcomes at 12 months than patients who received only TAU. However, patients who were offered CBT but dropped out of treatment early had outcomes that were no worse than patients who stayed in. The explanation for this curious finding might be that the drop-outs and the stay-ins had different but equally valid recovery styles. Two case studies from the trial are presented to illustrate these recovery styles: sealing-over and integrating. Discussion focuses on the idea that, rather than try to alter patients' recovery styles, a more appropriate aim might be to match treatment to the patients' styles.
Similar content being viewed by others
REFERENCES
Amador, X. F., Flaum, M., Andreasen, N. C., Strauss, D. H., Yale, S. A., Clark, S. C., & Gorman, J. M. (1994). Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry, 51 826–836.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edn) (DSM-IV). Washington, DC: APA.
Andreasen, N. C. (1984). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.
Andreasen, N. C. (1989). Scale for the Assessment of Negative Symptoms (SANS). British Journal of Psychiatry, 155 (suppl. 7), 53–58.
Birchwood, M., Iqbal, Z., Chadwick, P., & Trower, P. (2000). Cognitive approach to depression and suicidal thinking in psychosis: I. Ontogeny of post-psychotic depression. British Journal of Psychiatry, 177 516–521.
Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The Social Functioning Scale: The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157 853–859.
Drury, V., Birchwood, M., Cochrane, R., & MacMillan, F. (1996a). Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. British Journal of Psychiatry, 169 593–601.
Drury, V., Birchwood, M., Cochrane, R., & MacMillan, F. (1996b). Cognitive therapy and recovery from acute psychosis: A controlled trial. II. Impact on recovery time. British Journal of Psychiatry, 169 602–607.
Fowler, D., Garety, P., & Kuipers, E. (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Chichester, UK: John Wiley & Sons.
Garety, P. A., & Freeman, D. (1999). Cognitive approaches to delusions: A critical review of theories and evidence. British Journal of Clinical Psychology, 38 113–154.
Gaudiano, B. A. (2005) Cognitive behavior therapies for psychotic disorders: Current empirical status and future directions. Clinical Psychology: Science and Practice, 12 33–50.
Gould, R. A., Mueser, K. T., Bolton, E., Mays, E., & Goff, D. (2001). Cognitive therapy for psychosis in schizophrenia: An effect size analysis. Schizophrenia Research, 48 335–342.
Harrow, M., MacDonald, A. W., Sands, J. R., & Silverstein, M. L. (1995). Vulnerability to delusions over time in schizophrenia and affective disorders. Schizophrenia Bulletin, 21 95–109.
Jackson, H., McGorry, P., Henry, L., Edwards, J., Hulbert, C., Harrigan, S., Dudgeon, P., Francey, S., Maude, D., Cocks, J., & Power, P. (2001). Cognitively oriented psychotherapy for early psychosis (COPE): A 1-year follow-up. British Journal of Clinical Psychology, 40 57–70.
Johnson, M. K. (1988). In T. F. Oltmans & B. A. Maher (Eds.) Delusional beliefs. New York: Wiley.
McGlashan, T. H. (1987). Recovery style from mental illness and long-term outcome. Journal of Nervous and Mental Disease, 175681–685.
McGlashan, T. H., Levy, S. T., & Carpenter, W. T. (1975) Integration and sealing over: Clinically distinct recovery styles from schizophrenia. Archives of General Psychiatry, 32 1269–1272.
Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, et al. (1998). Trauma and post-traumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66 493–499.
Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Martindale, B., Orbach, G., & Morgan, C. (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32 763–782.
Rector, N. A., & Beck, A. T. (2001). Cognitive behavioral therapy for schizophrenia: An empirical review. Journal of Nervous and Mental Disease, 189 278–287.
Rossau, C. D., & Mortensen, P. B. (1997). Risk factors for suicide in patients with schizophrenia: Nested case-control study. British Journal of Psychiatry, 171 355–359.
Startup, M., Jackson, M. C., & Bendix, S. (2004) North Wales randomised controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: Outcomes at six and twelve months. Psychological Medicine, 34 413–422.
Startup, M., Jackson, M. C., & Startup, S. (In press) Insight and recovery from an acute psychotic episode: the effects of cognitive behaviour therapy and premature termination of treatment. Journal of Nervous and Mental Disease.
Tait, L., Birchwood, M., & Trower, P. (2004). Adapting to the challenge of psychosis: Personal resilience and the use of sealing-over (avoidant) coping strategies. British Journal of Psychiatry, 185 410–415.
Tarrier, N., Lewis, S., Haddock, G., Bentall, R., Drake, R., Kinderman, P., Kingdon, D., Siddle, R., Everitt, J., Leadley, K., Benn, A., Grazebrook, K., Haley, C., Akhtar, S., Davies, L., Palmer, S., & Dunn, G. (2004) Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry, 184 231–239.
Thompson, K. N., McGorry, P. D., & Harrigan, S. M. (2003). Recovery style and outcome in first-episode psychosis. Schizophrenia Research, 62 31–36.
Acknowledgments
The North Wales trial of CBT was supported by grant RC012 from the Wales Office of R&D for Health & Social Care and by Conwy & Denbighshire, North West Wales, and North East Wales NHS Trusts.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Startup, M. Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles. J Contemp Psychother 36, 19–24 (2006). https://doi.org/10.1007/s10879-005-9002-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-005-9002-9