The interventions were carried out independently
of clinical staff, who were kept unaware
of treatment allocation. Direct family
interventions were not undertaken. Procedures
to standardise routine clinical care,
including drug treatment, were not used.
The CBT was manual-based and conducted
by one of five therapists trained in
CBT in psychosis, supervised by experienced
cognitive therapists. The design of
the delivery was to aim for 15–20 hours
within a 5-week treatment envelope, plus
‘booster’ sessions at a further 2 weeks and
1, 2 and 3 months. Details of the treatment
are given in Haddock et al (1999b). In
summary, treatment was conducted in four
stages. The first stage was engagement and
a detailed assessment of mental state and
symptom dimensions (psychotic and nonpsychotic)
to allow a cognitive–behavioural
analysis of how symptoms might relate to
cognitions, behaviour and coping strategies.
Education about the nature and
treatment of psychosis, using a stress
vulnerability model to link biological and
psychological mechanisms, was used to
help engagement. Second, a problem list
was generated collaboratively with the
patient. This was then prioritised according
to the degree of distress attached, feasibility
and, where relevant, clinical risk involved.
Prioritised problems were assessed in detail
and a formulation was agreed which included
such issues as trigger situations and
cognitions. Third and fourth stages were
intervention and monitoring. Interventions
particularly addressed positive psychotic
symptoms of delusions and hallucinations,
generating alternative hypotheses for
abnormal beliefs and hallucinations, identifying
precipitating and alleviating factors
and reducing associated distress