March 01, 2004

Cognitive Behavioral Therapy for Schizophrenia?

COGNITIVE-BEHAVIOURAL THERAPY REVISITED - The British Journal of Psychiatry that became availabe on the Internet this week covered two recent research reports on efforts to test whether talk therapy classed as "Cognitive Behavioral Therapy" was effective in treatment of schizophrenia. Both of the tests DID NOT show any effectiveness in schizophrenia. We'll be doing more research on this area because I've heard for many years that the "ideal schizophrenia treatment program" would be one with both good medications and good therapy of sorts. This seems to counter the "therapy" aspect - but perhaps there are other therapies (other than CBT) that may be very effective for schizophrenia. We'll report on what we find in the future. In this month's issue, the journal states that:

"The evidence from an 18-month follow-up of a randomised controlled trial of CBT shows no benefit of the CBT or of supportive counselling over routine treatment on outcome measures such as relapse or re-hospitalisation. Also, CBT was not superior to supportive counselling on symptom measures at 18-months. Tarrier et al (pp. 231�239) suggest that the duration of psychological therapy may have been too brief, at an average of 8 hours over 5 weeks, which was well below the target and recommended therapy time of 15�20 hours.

This study used highly trained therapists, Huibers et al (pp. 240�246) used general practitioners to deliver a CBT package aimed at treating unexplained severe fatigue in 151 patients off work on sick leave. After the intervention, delivered in 5�7 sessions over 4 months, there were no differences in fatigue severity, absenteeism and clinical recovery between the treated and an untreated comparison group."

The research paper's authors suggest two main conclusions; 1. that effective trials in secondary care do not necessarily translate successfully into primary care and 2. t may be difficult for CBT to be delivered effectively by non-specialists. We'll be watching for more research in the area and will report both on the positive and negative information we find.


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