Compare schizophrenia treatments and evaluate Sensky et al. (2000)
Compare the syllabus treatments and use a randomised trial to evaluate CBT without turning study findings into medical advice.
Original StudyForA teaching mapped to the Cambridge 2028–2030 syllabus. The trial is summarised from its original article. This is educational content, not medical advice, an individual treatment plan, Cambridge material, an official mark scheme or an awarded grade.
Before you begin
- This is Clinical Psychology topic 1.1.3 in the 2028–2030 Version 1 syllabus. It follows the syllabus sections on diagnostic criteria and explanations. Do not use it to choose or change a treatment.
Work on paper. Try each question before revealing help, and explain why your method works.
Quick readiness check
What does the Sensky et al. (2000) comparison allow a student to conclude?
What you will learn
- Describe typical and atypical antipsychotic treatments as broad biochemical approaches and evaluate their limits
- Describe electro-convulsive therapy as a syllabus treatment topic while keeping its clinical role and limits explicit
- Summarise the design, findings and limitations of Sensky et al. (2000)
- Evaluate treatment evidence using experiments, follow-up, generalisation and ethics
Antipsychotics are biological treatments with individual benefits and risks
The Cambridge syllabus includes typical and atypical antipsychotics. These are broad groups of medicines used in clinical care; the terms do not mean that every medicine in a group has the same effects or suits every person. Many antipsychotics act on dopamine receptors, while drug profiles and effects differ.
Antipsychotic treatment can reduce some symptoms for some people, but response varies and unwanted effects matter. A treatment choice needs an individual discussion with qualified health professionals, including likely benefits, side effects and monitoring. This lesson does not recommend, compare or prescribe medicines for a learner or anyone they know.
For evaluation, symptom improvement can support usefulness, while variation in response and side effects are relevant limitations. Treatment response is not proof that one biochemical explanation is the whole cause of schizophrenia; a treatment can help through a pathway without explaining every aspect of the condition.
ECT is on the syllabus; its use must not be overstated
Electro-convulsive therapy (ECT) is a biological treatment that uses a controlled electrical stimulus under clinical anaesthesia and monitoring. The syllabus asks candidates to know it as a treatment topic, but a course summary should not present it as a routine or self-directed treatment.
Current UK NICE guidance says ECT is not recommended for general management of schizophrenia; it identifies a limited option for rapid short-term treatment of severe catatonia when other treatments have not worked or the condition is life-threatening. Guidance is jurisdiction-specific and can change. A Cambridge lesson is not clinical advice, and students should use the syllabus for exam scope and current local professional guidance for real care.
When evaluating ECT, state its actual context and evidence rather than assuming that appearing on a syllabus means it is a usual treatment. Discuss medical supervision, consent, potential risks and the limited population to which a recommendation applies.
CBT is a psychological therapy, not a test of whether a belief is true
Cognitive-behavioural therapy (CBT) is a structured psychological intervention. A therapist and client may explore links among thoughts, feelings, behaviour and distress, consider alternative interpretations, and develop coping strategies. It should be described respectfully and collaboratively, not as arguing with or blaming a person.
Sensky et al. (2000) compared a manualised CBT intervention with a befriending control for people with schizophrenia and persistent distressing symptoms despite antipsychotic treatment. The trial recruited 90 patients from five UK clinical services and randomly assigned 46 to CBT and 44 to befriending. Both groups continued routine care; outcome assessors were blind to group, and symptoms were measured after treatment and at follow-up.
Both interventions were associated with reduced positive and negative symptoms and depression by the end of treatment. At the nine-month follow-up, the CBT group continued to improve while the befriending group did not. The study therefore provides comparative evidence for this sample and intervention, not proof that CBT is best for every person or a substitute for other care.
Evaluate the trial with design, follow-up and ethics
Random allocation and a befriending comparison make the design stronger than a simple before-and-after case series. Blinded outcome assessors reduce one source of rating bias. Participants were recruited across five services, and follow-up extended beyond the end of treatment.
Therapists and participants could not be blind to whether they received CBT or befriending. Both groups improved during treatment, so some benefit may relate to structured contact, attention or other shared aspects; the comparison does not isolate every mechanism. The trial involved a specific clinical group in the UK and its results should not be generalised automatically to everyone or every treatment setting.
Ethics include informed consent, privacy, appropriate clinical support, independent assessment and monitoring of distress. The 2000 trial is evidence for evaluation practice, not a current treatment plan. Separate today's clinical guidance from what the exam requires students to describe about the study.
Sources for this lesson
Pause and explain
Why is it inaccurate to say that Sensky et al. tested CBT instead of all other care?
Worked example
A student concludes, ‘Sensky et al. proved CBT cures schizophrenia and should replace antipsychotics.’ Correct the claim.
Show the worked solution
- State who took part and what the comparison groups received.
- Summarise the result at treatment end and follow-up.
- Explain why the result does not establish a universal cure or replacement for clinical care.
Answer Sensky et al. (2000) randomly assigned 90 patients with persistent symptoms despite antipsychotic treatment to CBT or befriending while routine care continued. Both groups improved during treatment; the CBT group continued improving at the nine-month follow-up while the befriending group did not. This supports CBT's value for the studied group, but does not show a cure, prove it is best for everyone or justify replacing an individual's clinical care.
Try a topic test
Choose Easy, Normal or Difficult. Save your answers and open worked review after finishing.
Test this topic →From guided practice to a new situation
Write your answer and reasoning first. Use a hint only if you are stuck. The model solution is for self-checking; your written work is not automatically marked.
A classmate says, ‘The CBT group did better at follow-up, so this proves CBT works for every person and replaces medication.’ Use the trial design to correct the statement.
Give me a hint
Name the sample, comparison and follow-up before stating the limit.
Compare my reasoning
- The trial involved 90 patients with persistent symptoms and compared CBT with befriending; routine care continued.
- Both groups improved by the end of treatment, while the CBT group continued to improve at the nine-month follow-up.
- The result supports CBT for the studied group and conditions, but cannot establish a universal effect or justify changing anyone's treatment.
The trial supports a bounded conclusion: among the recruited patients, CBT was compared with befriending alongside routine care, and the CBT group continued improving at follow-up. It does not show that every person will benefit, that CBT is a cure or that anyone should replace prescribed care.
Look for these in your work
- Sample and comparison stated
- Follow-up finding accurate
- No universal or personal treatment claim
Evaluate one strength and one limitation of the Sensky et al. (2000) trial for investigating CBT.
Give me a hint
Consider allocation or blinded assessment for a strength, then sample or blinding limits.
Compare my reasoning
- Random allocation to CBT or befriending strengthens the comparison by reducing systematic pre-existing group differences on average.
- Outcome assessors were blind to treatment group, reducing one possible source of rating bias.
- Participants and therapists could not be blind, and the sample came from five UK clinical services; expectation effects and generalisation remain concerns.
Random allocation and blinded outcome assessment strengthen the comparison, but participants and therapists knew the intervention and the sample came from a specific UK clinical group. These features limit conclusions about treatment mechanisms and how broadly the finding applies.
Look for these in your work
- Design-specific strength
- Limitation linked to inference
- Scope of conclusion stated
A researcher plans a follow-up comparing CBT with befriending for a different clinical group. Propose two design features and one ethical safeguard that would make the comparison clearer.
Give me a hint
Use comparable allocation, outcome measurement and follow-up, then protect participants alongside routine care.
Compare my reasoning
- Randomly allocate consenting participants to clearly defined CBT or befriending while keeping routine clinical support available and documenting other treatments.
- Use the same validated outcome measures at baseline, after intervention and at a pre-specified follow-up; where feasible, keep assessors blind to group.
- Obtain informed consent, protect confidential health information, monitor distress and provide a route to clinical support; allow withdrawal without penalty.
A stronger comparison would use clearly defined interventions, random allocation, shared outcome measures and planned follow-up, while recording concurrent care. Consent, privacy, distress monitoring and access to clinical support protect participants. The design tests the new sample and cannot guarantee that results transfer to every person.
Look for these in your work
- Comparison and outcomes standardised
- Follow-up planned
- Consent, privacy and participant support included
Common mistakes
- Calling all typical or atypical medicines identical in effect or side effects
- Treating a treatment response as proof of a single cause
- Describing ECT as routine treatment for all schizophrenia
- Saying the trial's participants stopped all other care
- Ignoring that befriending participants also improved during treatment
- Calling the follow-up result proof that CBT works for every person
- Giving personal medication or treatment advice from a classroom lesson
What can you explain now?
What happened to the CBT and befriending groups at the nine-month follow-up in Sensky et al. (2000)?
Compare with the explanation
The CBT group continued to improve, while the befriending group did not continue its earlier improvement.
Both groups had improved by the end of treatment, so the finding should be interpreted as comparative evidence for this study group, not a universal cure.
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Make it stick
Give one feature and one finding of Sensky et al. (2000), then state one limit on generalising its conclusion.
If you needed the solution, close it and solve the problem again from a blank page. A correct answer is stronger when you can explain the reason for each step.