Effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia – a multi-centre randomised controlled trial

Stefan Priebe,Ulrich Reininghaus,Richard Bentall,Frank Röhricht,Sandra Eldridge,Mark Savill,Christoph Lauber,Paul Mccrone,Til Wykes

doi:10.1186/1471-244x-13-26

Abstract

BackgroundNegative symptoms of schizophrenia are frequently associated with poor long term outcomes. Established interventions have little, if any, positive effects on negative symptoms. Arts Therapies such as Body Psychotherapy (BPT) have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control.Methods/DesignIn a randomised controlled trial, 256 schizophrenic outpatients with negative symptoms will be randomly allocated either to BPT or Pilates groups. In both conditions, patients will be offered two 90 minutes sessions per week in groups of about 8 patients over a period of 10 weeks. Outcomes are assessed at the end of treatment and at six months follow-up. The primary outcome is severity of negative symptoms, as measured by the Positive and Negative Symptom Scale (PANSS), whilst a range of secondary outcome measures include general psychopathology, social contacts, and quality of life. We will also assess the cost-effectiveness of the intervention.DiscussionThe study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat. If the trial is successful, it will add a new and effective option in the treatment of negative symptoms. Group BPT is manualised, might be attractive to many patients because of its unusual approach, and could potentially be rolled out to services at relatively little additional cost.Trial registrationCurrent Controlled Trials ISRCTN84216587

Highlights

Negative symptoms of schizophrenia are frequently associated with poor long term outcomes
The study aims to evaluate the effectiveness of a promising form of group therapy which may help alleviate negative symptoms that are associated with unfavourable long-term outcomes and have so far been difficult to treat
This study suggests that physical activity groups can be used as an active control, fulfilling the requirement laid down by National Institute for Clinical Excellence (NICE) for a ‘sham condition,’ but with physical activity groups being found to have a significant effect on negative symptoms this study may under-report any effect of the intervention compared to the usual treatment patients are likely to receive

Summary

Introduction

Negative symptoms of schizophrenia are frequently associated with poor long term outcomes. Arts Therapies such as Body Psychotherapy (BPT) have been suggested to reduce negative symptoms, but the existing evidence is limited. In a small exploratory trial a manualised form of group BPT led to significantly lower negative symptom levels both at the end of treatment and at 4 months follow-up as compared to supportive counseling. We designed a large multi-site trial to assess the effectiveness of a manualised BPT intervention in reducing negative symptoms, compared to an active control. NICE suggested that arts therapies are effective in reducing negative symptoms as compared to any other control. “an adequately powered trial should be conducted to investigate the clinical and cost-effectiveness of arts therapies as compared to an active control in people with schizophrenia” [1] (p200)

Objectives

Methods

Findings

Conclusion