Cognitive-behavioural therapy for severe mental disorders.

O ver 4 decades, ago Aaron T Beck presented the basic theoretical and treatment approach of cognitivebehavioural therapy (CBT). Since then, hundreds of randomized controlled clinical trials (RCTs) have demonstrated the efficacy of CBT for the broad range of psychiatric conditions, including severe mental disorders such as bipolar disorder, refractory obsessive–compulsive disorder (OCD), substance abuse, suicide, personality disorders, and schizophrenia. Increasingly, we see the integration of CBT with biological psychiatry resulting in optimized treatment outcomes. This may be no better illustrated than in the recent efforts to develop and test cognitive and behavioural interventions for patients experiencing persistent symptoms of psychosis with only partial response to pharmacologic interventions. Although it has been noted that, as late as the 1980s, schizophrenia was the “forgotten child of behaviour therapy” (1), significant developments in the use of CBT for medicationresistant symptoms in schizophrenia have occurred over the past 15 years.