Inherent to the explorative nature of this pilot study, we should mention a number of limitations that need to be addressed in future studies. First, although outpatients were randomly allocated to either TAU + CAT or TAU, inpatient were not, possibly causing selection bias. However, TAU inpatients did express their willingness to participate in CAT (and were told that they would receive CAT in the nearby future) therefore, differences between the inpatient TAU + CAT and TAU groups may be minimal. Nevertheless, the results should be interpreted with caution. Furthermore, we do not have information on the specific effects of CAT (e.g. increased attention), which may partly explain the trend in improvements on the outcome measures. Since the usual care in the Netherland is already very rich and all patients have contact with nurses on a regular basis, we do not expect this to have affected the results. At the same time, as a consequence of the rich usual care, the adopted outcome measurements may not have been sensitive enough to fully capture there small improvements. The SOFAS for example is a rather global scale that may be less sensitive to change in residential patients. In addition, we did not have follow-up measurements of the primary outcome measure (MCAS) after the initial study period of 8 months. We argue that statistically significant improvements may be present after that period, which is supported by our finding that differences in work-related activities reached statistical significance after the initial study period, namely after 10 months. Finally, the small sample size limits generalizability of finding. This also left us unable to make comparisons between the impatient and outpatient group. Due to the abovementioned study limitations, we should interpret the findings of the current pilot study with caution. The results do show promise for CAT as a nursing intervention. More research in the form of randomized controlled trials is necessary for both inpatients and outpatients in countries with other health care systems than in the US, addressing the abovementioned limitations