Cognitive behavior therapy (CBT) has been accepted as
a treatment for affective disorders for a number of years
and has been fully integrated into services since the 1980s.
However, despite the case studies by Beck1 and Shapiro
and Ravenette2 in the 1950s,’ specific symptom interventionsforschizophreniadidnotappearuntilmuchlater.Psychotherapyforschizophreniaintheformofpsychodynamic
therapies had been discredited and during the period of
deinstitutionalization symptoms were treated merely as
behaviors to be extinguished (eg, Liberman et al3 and
Meichenbaum and Cameron4
). However, despite earlier
optimism neither medication nor behavioral treatments
successfully extinguished symptomswhich were eitherpresentsporadicallyorremainedcontinuouslydespiteadequate
treatment. Theoretical underpinnings such as the stressvulnerability
models were developed to understand not
only the development of the disorder but also its maintenance.
These also began to be informed by research on
expressed emotion (eg, Brown et al5 and Butzlaff and
Hooley6
) and so began to include social and psychological
markers as well as biological ones. The difficulty in identifyingrigorousandunambiguouspsychosocialmarkersmay
have hampered further development of this area.
CBT for affective disorders became accepted in the
health services through government guidelines (eg, UK
National Institute for Health and Clinical Excellence),
but it also increased its theoretical research base. It
was inevitable that eventually some of the developed
techniques would be used for people with a diagnoses
of schizophrenia. The first controlled studies on cognitive
behavior therapy for psychosis (CBTp) emerged in the
early 1990s in the United Kingdom, and this treatment