What's really wrong with cognitive behavioral therapy for psychosis?

For persons with medication-refractory psychotic experiences such as auditory hallucinations, a psychological therapy referred to as cognitive behavioral therapy for psychosis (CBTp) has emerged as the standard recommended treatment in clinical practice guidelines (e.g., Kreyenbuhl et al., 2010; National Institute for Health and Clinical Excellence [NICE], 2014). However, the past few years have seen impassioned debate regarding the endorsement of CBTp as evidence-based practice, with some arguing that evidence in its favor has been “oversold” (McKenna and Kingdon, 2014). As a follow up to their earlier controversial review (Lynch et al., 2010), which claimed no evidence that CBTp was effective in “well-conducted” trials, a recent meta-analysis by Jauhar et al. (2014) drew the only slightly less pessimistic conclusion that CBTp's therapeutic effect was only in the small range. Coinciding with the continuing recommendation of CBTp for routine provision in the 2014 NICE guidelines, this has led to debates published in several journals, and a flurry of further meta-analyses analysing different permutations of trial characteristics and measures. These meta-analyses have formed the more optimistic conclusions that CBTp shows good effects for hallucinations (van der Gaag et al., 2014), for overall psychotic symptoms in people with persisting symptoms (Burns et al., 2014), and in direct contrasts with other interventions (Turner et al., 2014).