has developed and included some of the theoretical
underpinnings of CBT for other disorders. However,
unlike CBT for other disorders, which have its roots in
Beck Philadelphia Institute, CBTp developed independently
perhaps because the main research bases for the
2 types of CBT were separated by the Atlantic Ocean.
There is much speculation and argument about why
CBTp emerged first in the United Kingdom, but it
may be that the different service structures in the United
Kingdom within which clinical psychologists worked
were more encouraging for nonmedical approaches to
drug-resistant psychotic symptoms. The implementation
of CBTp was against a tide of skepticism about the development
of psychotherapy for people with psychosis in
both countries and specific evidence of poor outcomes.7
There was also optimism about the likelihood of improved
medication now somewhat tempered by the Clinical
Antipsychotic Trials in Intervension Effectiveness8
and Cost Utility in the Latest Antipsychotic Drugs in
Schizophrenia Study trials9 and the positive evidence
on behavioral approaches to psychosocial rehabilitation
which may have contributed to resistance about the development
of this form of treatment. However, although
the practice of CBTp was enthusiastically grasped by
UK clinical psychologists, it has now also developed
in the United States with studies approaching the provision
of CBTp differently, eg, by more group-based
approaches. Again, service structures and the availability
of skilled clinical psychology staff probably contribute to
these variations. Within the United Kingdom, psychological
treatments are typically individualized and based
upon an idiosyncratic case formulation (see Tarrier
and Calam10 and Tarrier11). In the United States, the
recent move to more evidence-based practice has been
to counter the past standard practice of providing psychological
treatment from a nonsystematic, nonmanualized
perspective. Thus, even if the actual intervention
techniques used were similar in the United States and
the United Kingdom, their strategic application could
differ.
Reviews of studies of CBTp have suggested that they
are useful for the treatment of schizophrenia.12–23 The
next step is therefore the incorporation of these treatments
into services. In the United Kingdom, the National
Institute for Clinical Excellence included cognitive behavior
therapy (CBTp) in its preferred list of treatments
for schizophrenia.24 UK National Health Services are
now implementing this guidance because patients in
UK services have the right to expect that this treatment
will be available. This therapy has also been considered in
the Schizophrenia Patient Outcome Report Team guidance
in the United States and has been recommended.25
There are now more published studies available, and
there has been an expansion of the likely symptom targets
for CBTp to include, in addition to positive symptoms,
negative symptoms, depression, and anxiety, and also