Rector 2003.

Methods	Allocation: randomised Blinding: assessor blind Location: two large psychiatric facilities in Canada Length of follow‐up: 12 months
Participants	Diagnosis: schizophrenia or schizoaffective disorder (DSM‐IV) N = 50 Sex: 20 M, 22 F Age: mean ˜ 37.5 years, SD ˜ 8.3 years Included: length of illness: not reported; the presence of persistent positive and negative psychotic symptoms in the past 6 months as determined by the SCID‐I interview; stable treatment with antipsychotic medications; age 18 ‐ 65 years old Excluded: suspected organic brain pathology; concurrent substance abuse or dependence; and past treatment with either behavioural or cognitive behavioural therapy in either individual or family format
Interventions	1. CBT group*: N= 24 Content: Cognitive behavioural therapy was delivered on an individual basis for 6 months. The CBT approach in this study was guided by the principles and strategies developed by Beck (1979, 1985). The first phase of therapy focused on engagement and assessment. The second phase of therapy aimed to socialise the participant to the cognitive model and to impart cognitive and behavioural coping skills, including self‐monitoring with a thought record and the completion of homework tasks. Overlapping with the first two phases of treatment, a third aspect of treatment focused on providing psychoeducation with a normalising rationale. Delivered by: two doctoral level psychologists and one psychiatrist, all with formal training and practice in cognitive behavioural interventions Frequency: weekly conducted for 20 sessions Treatment duration: 6 months 2. Standard care group*: N = 18 Content: enriched treatment‐as‐usual comprised comprehensive psychiatric management with medication optimisation and clinical case management Delivered by: not reported Frequency: not reported Treatment duration: 6 months
Outcomes	Mental state: positive symptoms, negative symptoms, affective symptoms (PANSS scores); depression (BDI scores) Satisfaction with treatment: leaving the study early Unable to use: Mean dosage of antipsychotic use (not predefined outcome for this review)
Notes	*The term 'Enhanced treatment‐as‐usual' was used in this paper. 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)	Unclear risk	Quote: "...randomised controlled..." (p.2). Comments: insufficient information about the sequence generation process to permit judgement of 'Low risk' or 'High risk'
Allocation concealment (selection bias)	Unclear risk	Comments: The method of concealment was not described.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comments: The author did not address this information. However, participants and personnel were not likely to be blinded because participants in the treatment group received CBT, and the control group only received standard care.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "...blind raters..." (p.2). Comments: blinding of outcome assessment ensured
Incomplete outcome data (attrition bias) All outcomes	High risk	Comments: Eight participants from each group left the study early. High attrition rate.
Selective reporting (reporting bias)	Low risk	Comments: All measured outcomes were reported.
Other bias	Low risk	Comments: none obvious