Effectiveness of individual therapy and group therapy in the treatment of schizophrenia

Abstract

Background There is no simple, single treatment for schizophrenia and present approaches are based on clinical research and experience. Pharmacotherapy is the most common treatment for schizophrenia; however, unwanted side-effects are often problematic, and medications do not provide important coping skills. These skills are provided through forms of psychotherapy. Psychotherapy has been examined from a range of perspectives, including the effectiveness of group and individual treatments on behaviours and symptoms of schizophrenia. This review reports on the effectiveness of forms of group and individual therapy. Objectives The objective of this review was to present the best available information on the use of group therapy and individual therapy in the treatment of schizophrenia. This review summarises the findings of all relevant studies relating to these interventions. This review attempted to answer the question: which is more effective in improving symptoms in patients with schizophrenia, group or individual therapy? Inclusion criteria The review included adult patients with schizophrenia. Interventions of interest were forms of group and individual therapy aimed at lessening the symptoms of schizophrenia. For the purposes of this review, individual therapy was regarded as a one-to-one interaction between a patient and a therapist, and group therapy excluded family therapy. Studies that examined symptom reduction, including measures of mental state, quality of life and social function, were included in this review. This review attempted to determine the efficacy of group and individual therapy in the treatment of schizophrenia. Therefore, randomised or pseudo-randomised controlled trials that address the use or comparison of these treatment modalities were included. High-quality systematic reviews of evidence of effectiveness were also included. Results Based on the search terms used, 28 references relating to the use of some form of group or individual therapy, in the treatment of chronic schizophrenia, were identified. Of these, nine were excluded for not meeting the stated inclusion criteria and 19 were included in the analysis (17 trials and two systematic reviews). From these studies numerous treatment types were compared for the management of chronic schizophrenia. Meta-analysis was not possible given the level of heterogeneity in trial methods and measurement scales. Recommendations The following recommendations are made: Individual cognitive behavioural therapy (ICBT) can be effective in improving overall mental state and global functioning (level I). Relapse and readmission rates are not improved by the use of ICBT (level I). ICBT using a psychodynamic or psychotherapy approach is recommended for outpatient care (level I). ICBT can be recommended to promote a 25% improvement in insight (number needed to treat = 10) (level II). Group psychotherapy is not effective at improving global functioning when given for short periods of time (level II). Interactive behavioural training is not effective at improving social functioning (level II). Longer-term group psychotherapy or modular skills training can be effective at improving overall psychological symptoms (level II). Modular skills training is effective at improving living skills and medication compliance (level II). Group psycho-educational training is not effective for improving medication compliance (level II). Coping skills training has a longer lasting effect on improving goal attainment than problem skills group training in patients with schizophrenia (level II). Intensive group cognitive behaviour therapy and supportive counselling effectively reduce the number of psychiatric symptoms and positive psychiatric symptoms in patients with a short duration of illness and less severe symptoms in the longer term (2 years) (level II). The use of group psychotherapy can be effective at decreasing social anxiety and improving social interaction (level II). Group psychotherapy is ineffective at producing lasting improvement in polydipsia among subjects with schizophrenia (level II).