Behavioural and Cognitive Psychotherapy, 2006, 34, 277–291 Printed in the United Kingdom doi:10.1017/S1352465806002815 The Credibility and Acceptability of Befriending as a Control Therapy in a Randomized Controlled Trial of Cognitive Behaviour Therapy for Acute First Episode Psychosis Sarah Bendall, Henry J. Jackson, Eoin Killackey, Kelly Allott, Tracy Johnson, Susan Harrigan, John Gleeson and Patrick D. McGorry University of Melbourne, Australia Abstract. There is increasing evidence that cognitive behavioural therapy (CBT) is efficacious in treating psychosis. However, very little attention has been paid to the nature of the control treatments used in studies of this. Befriending has been used as a control treatment in several randomized control trials (RCTs) of CBT for psychosis as it is simple to learn and administer. The aim of the present study was to examine whether Befriending controlled for important non- specific aspects of therapy when compared to CBT in a RCT for acute first episode psychosis (FEP). These non-specific factors included time in, expectancy created by, and acceptability of therapy. Expectations and enjoyment of therapy were measured by questionnaire. Time in therapy and the number of drop-outs were also recorded. Results showed that Befriending was comparable to CBT on measures of expectancy, enjoyment of therapy and drop-out rate, but significantly different with regard to time in therapy. This suggests that Befriending is a credible and acceptable control therapy for FEP with modification to increase time in therapy sessions. Methodological issues are raised, and suggestions for future research are made regarding control treatments. Keywords: CBT, first episode psychosis, control, Befriending, psychosis, non-specific factors. Introduction Several RCTs of CBT for psychotic disorders have found that CBT in combination with standard treatment (including medication) produces better outcomes on a variety of measures than standard treatment alone (Kuipers et al., 1997; Startup, Jackson and Bendix, 2004; Tarrier et al., 1998). However, it is necessary to ensure that these results are due to the specific effects of CBT rather than being due to people simply receiving increased amounts of treatment. Therefore, CBT should be compared with an appropriate control (Chambless and Hollon, 1998). RCTs of CBT for psychosis have utilised a variety of control treatments and have consistently found that CBT outperformed those control treatments (Drury, Birchwood, Cochrane and MacMillan, 1996; Sensky et al., 2000; Tarrier et al., 2004, 1998; Turkington and Kingdon, 2000). Reprint requests and requests for the Befriending manual to Sarah Bendall, ORYGEN Research Centre, 35 Poplar Road, Parkville, Victoria 3052, Australia. E-mail: sbendall@unimelb.edu.au © 2006 British Association for Behavioural and Cognitive Psychotherapies