Skip to main content
. 2018 Dec 20;2018(12):CD007964. doi: 10.1002/14651858.CD007964.pub2

Freeman 2014.

Methods Allocation: randomised
Blinding: assessor blind
Location: Oxford Health NHS Foundation Trust, UK
Length of follow‐up: 12 weeks
Participants Diagnosis: schizophrenia (n = 22); schizoaffective disorder (n = 6); other (n = 2)
N = 30
Sex: 20 M, 10 F
Age: mean ˜ 41.9 years, SD ˜ 11.5 years
Included: length of illness: not reported; a current persecutory delusion; scoring at least 3 on the conviction scale of the PSYRATS; the delusion had persisted for at least three months; negative beliefs about the self as indicated by endorsing at least one negative schematic belief on the Brief Core Schema Scale (BCSS); aged between 18 and 70; and where major changes in medication are being made, entry to the study would not occur until at least a month after stabilisation of dosage
Excluded: a primary diagnosis of alcohol or substance dependency; organic syndrome or learning disability; a command of spoken English inadequate for engaging in therapy or the assessments; and currently having individual CBT (though previous experience of CBT was not an exclusion criterion)
Interventions 1. CBT group*: N = 15
Content: 1) negative thoughts about the self, 2) positive activities, and 3) positive thoughts about the self
Delivered by: clinical psychologists
Frequency: six sessions to each individual over eight weeks
Treatment duration: 8 weeks
2. Standard care group: N = 15
Content: Standard care was delivered according to national and
 local service protocols and guidelines. It usually consisted of prescription of anti‐psychotic medication, visits from a community mental health worker, and regular outpatient appointments with a psychiatrist.
Delivered by: not reported
Frequency: not reported
Treatment duration: 8 weeks
Outcomes Global state: rehospitalisation
Mental state: delusions (PsyRATS scores), anxiety (BAI scores), depression (BDI scores), self‐esteem (RSCQ, SCS, BCSS scores), paranoia (GPTS scores), well‐being (WEMWS scores)
Notes *Participants in the CBT group also received the standard care intervention.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "...randomisation was carried out by using varying randomised permuted blocks via a sequence obtained from web site." (p.2)
Comments: Randomisation was well conducted.
Allocation concealment (selection bias) Low risk Quote: "The randomisation was conducted by a researcher independent of recruitment and assessment process." (p.2)
Comments: Allocation was well concealed.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Quote: "Informing patients of allocation was carried out by a therapist." (p.2)
Comments: Participants and personnel knew the group assignment.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote: "Assessments were carried out by a rater, a graduate psychologist, blind to allocation." (p.2)
Comments: The outcome assessor could not foresee assignment.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Comments: no attrition
Selective reporting (reporting bias) Low risk Comments: All measured outcomes were reported.
Other bias Low risk Comments: none obvious