Results were encouraging. Despite the chronicity of illness, six of eight patients were judged to have benefited from the CBT intervention. In the case of Mr. A, the improvement was dramatic. Fifteen years ago he had committed a double homicide while in an acute psychotic state, but he had little prospect of discharge because he lacked insight into his disorder. He believed that a cult group had cast a spell on him, which led to the murders. He showed no interest in exercising off-ward privileges and thought frequently of suicide. As a result of the CBT intervention, Mr. A came to doubt his cult delusion and to acknowledge that mental illness may have played a role in the murders. He was able to express feelings of guilt, remorse, and worthlessness.