The American Psychiatric Association practice guidelines for schizophrenia: Scientific base and relevance for behavior therapy

Abstract

The American Psychiatric Association's practice guidelines for schizophrenia provide a general blueprint for treating people with the illness. They are primarily oriented toward psychiatrists and pharmacological management. However, the guidelines also discuss the importance of psychosocial treatments, including behavioral therapy techniques. We provide an overview of the treatment guidelines and their empirical base. The pharmacological recommendations are generally consonant with the literature, albeit they have become somewhat dated due to the rapid progress in studies of the effects of new generation antipsychotics. We next review recommendations concerning social skills training, cognitive therapy and rehabilitation, behavioral family therapy, and vocational rehabilitation. Overall, the guidelines are quite positive about the potential benefit of these interventions, but they are appropriately conservative in interpreting the literature. There are promising data to support the efficacy of each of these approaches, but effectiveness data are lacking and questions remain about their actual impact on community functioning. Schizophrenia has not received sufficient attention from behavior therapists since the early successes achieved by operant programs. The optimistic stance taken by the guidelines should, if anything, encourage students to pursue careers working with this very needy population.