Individual Cognitive Therapy
Cognitive therapy was defined by our cognitive therapy treatment
manual (13), the new elements of which include 1) using a
diathesis-stress model emphasizing the need for combined medication
and psychological therapies; 2) the use of cognitive therapy
skills to monitor prodromes and to modify behavior to prevent
prodromal stages from developing into full-blown episodes;
3) promoting the importance of regular sleep and routine; and
4) targeting extreme striving attitudes and behavior. The four
therapists were clinical psychologists (three male and one female)
with a minimum of 5 years of postqualification experience.
All therapy sessions were audiotaped for weekly peer supervision,
which lasted an hour. Therapy consisted of 12–18 individual sessions
within the first 6 months and two booster sessions in the
second 6 months. In reality, therapy lasted about 6 months. Patients
in the cognitive therapy group had an average of 13.9 sessions
(SD=5.5). Eight patients terminated cognitive therapy prematurely
before the sixth session (mean number of sessions=2.6,
SD=1.8). All patients in the inadequate treatment group were included
in “intent-to-treat” analyses whenever possible.