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For the millions living with schizophrenia, antipsychotic drugs have long been the only evidence-based option — and for the many who cannot or will not take them, there has been essentially nothing. That changed today. A groundbreaking randomised trial published in The Lancet found that cognitive therapy can safely and effectively reduce psychotic symptoms in people with schizophrenia who are not taking antipsychotic medication, offering the first proven alternative to drugs for one of psychiatry's hardest problems.
The trial
The study, led by researchers at Greater Manchester West Mental Health NHS Foundation Trust and the University of Manchester, enrolled 74 people aged 16 to 65 with schizophrenia spectrum disorders who had decided not to take — or had stopped taking — antipsychotics for at least six months. Half received cognitive therapy alongside their usual care; the rest continued with usual care alone. According to the researchers, therapy involved a therapist working collaboratively with each patient to reappraise psychotic experiences and reshape unhelpful thought patterns and behaviours. The result: those receiving therapy saw meaningful reductions in psychiatric symptoms and improvements in personal and social functioning compared with treatment as usual. The study was funded by the UK National Institute for Health Research and sponsored by the NHS trust.
Why it matters
The need is enormous. "Antipsychotic drugs are the mainstay of treatment for schizophrenia, but as many as half of all people with schizophrenia choose not to take drugs," explained lead author Professor Anthony Morrison of the University of Manchester — because of side effects that can include serious weight gain, metabolic disorders and increased risk of sudden cardiac death, because the drugs do not feel effective, or because patients do not believe they need treatment. Cognitive therapy had already shown it could help people taking medication; until now, nobody knew whether it worked on its own. "Currently no evidence-based safe and effective treatment alternative exists," Morrison noted — until this trial.
The honest caveats
Seventy-four patients is a small trial, and cognitive therapy is not a replacement for medication for everyone — antipsychotics remain the mainstay, and the sickest patients were not the ones studied here. Larger trials will need to confirm these results and work out who benefits most. But as a proof of principle, it cracks open a door that has been shut for decades: for people who have lived with the choice between punishing side effects and no treatment at all, there may finally be a third path. Follow Global Insight for the health research that matters.
This article is general information only and is not medical advice.