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June 29, 2006
Evidence-Based Psychotherapy for Schizophrenia
Read more... Schizophrenia Research Journal Articles
Typically treatment for schizophrenia focuses on the use of antipsychotic medications, and case management, accompanied by little to no psychotherapy. Previous reviews on psychotherapy have shown promising results for a multitude of psychiatric illnesses. A 1994 meta-analysis of over 320 studies, spanning from 1895 to 1992, found that only an estimated 1/3 of patients suffering from schizophrenia have a favorable outcome with medication alone (Harvard Medical School, Hegarty 1994). (though a skeptical person would say that there were no effective treatments for schizophrenia prior to Chlorpromazine in the 1950s, so why have the study authors included such old data in their meta-analysis?). More recent studies suggest that approximately 50% of people will find any one medication helpful - but which medication works for any one person, and for how long, is an open issue.
Whatever the issues with that particular study, research does support the idea that some form of psychotherapy may be beneficial. The purpose of this article is to summarize different forms of psychotherapy used for treating schizophrenia, and their ability to effectively eliminate or decrease symptoms.
Cognitive Behavioral Therapy (CBT):
CBT, usually one-on-one therapy based, has the strongest evidence supporting its ability to alleviate symptoms in schizophrenia. CBT is conducted in an environment where the patient feels safe, the therapist avoids challenging delusions, and instead helps implement natural coping strategies. The main goal is not to “cure” the patient, but to help them develop rational thoughts and perspectives about their delusions and hallucinations . This is in hopes of giving the patient the tools to help themselves maintain reality in their illness.
But there are many variations of CBT for schizophrenia, and the differences between these variations have not been thoroughly studied. Therefore which variation or style is best suited for treatment is unknown at this time.
Reviews and meta-analyses on CBT and schizophrenia have shown significant improvements in positive symptoms, and overall symptoms. But no significant improvements were found with negative symptoms, depression, or social functioning. But the lack of improvement for all areas does not conclude CBT to be unsuccessful. Many studies showed that the improvements that do occur are long standing and remain after completion of treatment.
CBT is not suited for all patients and drop out rates for these programs are very high in acute sufferers. The best candidates for CBT are those with long-standing suffering and resistance to medications or typical treatments.
Personal Therapy (PT):
PT utilizes many of the same elements as CBT. Its one-on-one sessions, customized to the individuals disorder and symptoms. The main focus of PT is affective dysregulation, and the ability to adapt to stressors of the illness. PT differs from CBT in its utilization of phases. These phases correspond with the patients’ recovery, and to advance is dependant on the degree to which the patient improves. Because of this, PT is a long-term treatment plan, spanning several years.
One study compared PT with family therapy, and supportive psychotherapy on patients recently released from hospitals. The therapies were administered over a 3 year time period. Though no significant differences were shown in the patients’ relapse rates (returning to hospitals), significant improvement was found in psycho social functioning for those treated with PT.
Compliance therapy is administered during the acute phase of schizophrenia for a short period of time (4-6 sessions in hospital, and a few more after discharge). The main goal is medication adherence, getting the patient to take their medication following discharge from a hospital setting. Studies examining the ability of Compliance Therapy to effectively accomplish this goal have shown inconsistent results. One study found it to be more effective than traditional counseling, while another found no significant difference at all.
Acceptance and Commitment Therapy (ACT):
ACT varies from CBT in its approach to alleviating symptoms. ACT focuses on the patients association to their thoughts. ACT attempts to eliminate stress associated with delusions or hallucinations by asking the patient to simply take note of them. Because they are no longer attempting to suppress, control, or judge these delusions and hallucinations, and instead just be aware of them, they are eliminating a major stressor. In schizophrenia stress can not only be a result of symptoms, but also a trigger for more/new symptoms.
Very little research has been done on ACT and schizophrenia, but the two pilot studies conducted concluded lower rates for relapse into hospitals, and decreased stress associated with hallucinations.
There is no standard of supportive therapy, but is frequently administered to those suffering from schizophrenia. Supportive therapy counsels the patient while they deal with life issues raised by their disorder with reassurance, clarifications, and general assistance. When compared to CBT, supportive therapy provided results.
Reviewing the literature on treatment of schizophrenia with psychotherapy provides one clear conclusion; no single method can address all the issues and needs of the patients. A combination of “illness education, cognitive remediation, and social skills training” accompanied with medication would provide the best treatment.
Dr. Faith Dickerson, and Dr. Anthony Lehman highlight “emotional support in dealing with a disabling illness, enhancement of coping strategies to promote functional recovery, and alteration of underlying pathophysiology and processes of illness” as the three elements future psychotherapy interventions for schizophrenia should focus on.
More Information on CBT and Schizophrenia:
Posted by Michelle Roberts at June 29, 2006 05:07 PM
More Information on Schizophrenia Research Journal Articles