Cognitive Behaviour Therapy For Schizophrenia Research Articles

Visual P300 as a neurophysiological correlate of symptomatic improvement by a virtual reality-based computer AT system in patients with auditory verbal hallucinations: A Pilot study

Previous comparative trials showed that virtual reality (VR) therapies achieved larger effects than gold-standard cognitive-behavioral therapy (CBT) on overall auditory verbal hallucinations (AVHs). However, no trial has examined the corresponding underlying electrophysiological mechanisms. We performed a pilot randomized comparative trial evaluating the efficacy of a virtual reality–based computer AT system (CATS) over CBT for schizophrenia (SCZ) patients with treatment-resistant AVHs and explored these potential electrophysiological changes via the visual P300 component. Patients (CATS, n = 32; CBT, n = 33) completed the clinical assessments pre- and post-interventions and at 12-week follow-up. The visual P300 were measured before and after both therapies. The analysis of changes in psychiatric symptoms used linear mixed-effects models, and the P300 response in temporal and time-frequency domains was analyzed with repeated-measures analysis of variance. There was no interaction effect between change in clinical symptoms and treatment group. However, several statistically significant within-group improvements were found for CATS and CBT over time. AVH improved significantly after both treatments, as measured with the Psychotic Symptom Rating Scales-Auditory Hallucinations (PSYRATS-AH) sub-scores. Especially for the CATS group, omnipotence beliefs, anxiety symptoms, self-esteem, and quality of life also remained improved at the 12-week follow-up. Moreover, P300 amplitude had a significant interaction effect and correlation with AVH response. Overall, our analysis did not demonstrate general clinical superiority of CATS over CBT, but CATS improved refractory AVH in SCZ patients, likely by increasing P300 amplitude. These findings support the continued development of CATS for persistent AVH and suggest further trials to clarify the neurological effects of CATS.

Effectiveness of Cognitive Behavioural Therapy for Suicide in Schizophrenia: A Systematic Review

Background: Suicide is probably one of the worst potential complications for people with schizophrenia. Even though the use of antipsychotic medication is essential in reducing suicidal behaviour, the use of psychological treatments seems to be in the same way necessary. Cognitive Behavioural Therapy (CBT) is an evidence-based form of psychotherapy that is constantly trying to synchronise with the latest recommendations from the research. The goal of the present work is to systematically review the scientific evidence from published studies testing the effectiveness of CBT designed to deal with suicide in patients with schizophrenia. Methods: We searched using multiple terms related to suicide prevention based on CBT in schizophrenia. Two databases (Medline and SCOPUS) were scrutinised for the electronic search, and different reference lists from previous reviews were also hand-checked. Results: We identified 5 randomised and controlled trials of CBT that included suicide-related cognitions or behaviours as a primary outcome measure. CBT focusing on suicidal cognitions and behaviours was found to be effective in reducing suicidal ideation. As the number of studies fulfilling the inclusion criteria is small, and the assessment of outcomes is heterogeneous, we did not perform a meta-analysis and present results in a narrative way. Conclusion: Research on CBT focused on suicide prevention in patients with schizophrenia is promising, but current evidence is notoriously insufficient. Although those therapies seemed to be efficacious in the prevention of suicide, scarcity of randomised clinical trials specifically focusing on suicide is probably the most important issue to be faced. Given the current evidence, clinicians should be familiar with CBT techniques focusing on suicidal cognitions. However, suicide prevention and treatment in those with schizophrenia is complex, and many other factors such as possible earlier use of clozapine, optimizing adherence to medication, and other psychosocial aspects should be addressed. A combination of different strategies appears to be mandatory.

Global research on cognitive behavioural therapy for schizophrenia from 2000 to 2019: a bibliometric analysis via CiteSpace

BackgroundCognitive behavioural therapy (CBT) is considered to be an effective treatment for schizophrenia. In recent years, researchers have published clinical research results on CBT for schizophrenia. However, there is currently...

COGNITIVE BEHAVIORAL THERAPY FOR SCHIZOPHRENIA

Schizophrenia is a heterogeneous disorder that affects behavioral, affective, and cognitive domains and consists of positive and negative psychotic symptoms. Antipsychotic therapy is the first-line treatment for schizophrenia. However, treatment adherence levels are low. Even if there is good treatment compliance, residual symptoms and treatment resistance can be seen. As a result, recent schizophrenia treatment guidelines suggest Cognitive Behavioral Therapy (CBT) as adjunctive to antipsychotic therapy. CBT is known effective, especially on positive symptoms. This paper aims to review CBT practices and their effectiveness in schizophrenia.

Cognitive Behavioural Therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis

BackgroundThe effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention.MethodWe meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants).ResultsThe pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19).ConclusionsCBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention.

Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings

INTRODUCAO: A terapia cognitivo-comportamental (TCC) tem sido recomendada em diversas guidelines internacionais como a intervencao psicoterapeutica padrao de ouro para pacientes com esquizofrenia. Esta revisao tem como objetivo fornecer uma visao global sobre os avancos recentes da TCC na esquizofrenia. METODOS: Para esta revisao narrativa foi realizada uma busca eletronica na PubMed/MEDLINE, Web of Science e Cochrane Database utilizando as palavras-chave: schizophrenia, psychosis, cognitive-behavioral therapy, CBT e psychotherapy. RESULTADOS: Varias revisoes sistematicas suportam a eficacia da TCC na reducao a curto e longo prazo dos sintomas positivos e negativos da esquizofrenia. Na ultima decada, a TCC tem sido aplicada a individuos com alto risco de psicose, sendo tambem exploradas abordagens inovadoras na sua utilizacao (curta duracao, web-based, autogestao). Redes neurais responsaveis por funcoes cognitivas de nivel superior tem sido associadas a respostas positivas apos TCC para esquizofrenia. Existe ainda evidencia preliminar que a TCC promove a ativacao de zonas pre-frontais responsaveis pela modulacao top-down face a ameacas sociais. CONCLUSAO: Na ultima decada, a TCC para esquizofrenia tem explorado novos desfechos, intervindo em populacoes agudas e pre-clinicas e utilizado metodos alternativos para alcancar mais pacientes e reduzir custos O perfil neurocognitivo dos pacientes aparenta ter um papel critico na resposta ao tratamento, pelo que combinar a TCC com reabilitacao cognitiva podera potenciar os seus efeitos terapeuticos. Apesar da TCC ser uma pratica recomendada para a esquizofrenia, estudos futuros usando protocolos inovadores e explorando preditores e desfechos relacionados com o cerebro poderao possibilitar que esta intervencao seja mais eficaz, personalizavel e alcance o maximo numero de pacientes possivel.

La terapia cognitivo conductual y los síntomas negativos en la esquizofrenia

Resumen Introducción. La esquizofrenia constituye un problema sanitario y social de grandes dimensiones que afecta no sólo al paciente sino a su entorno familiar y social. Dentro de las aproximaciones psicoterapéuticas dirigidas a pacientes con esquizofrenia, las terapias cognitivo conductuales (TCC) son las que cuentan con mayor evidencia de efectividad para diferentes propósitos y etapas del trastorno. Objetivo. Analizar las técnicas y efectos específicos sobre síntomas negativos de las principales TCC para pacientes con esquizofrenia: Psicoeducación, Entrenamiento en Habilidades Sociales, Rehabilitación Cognitiva, TCC para Síntomas Positivos y TCC orientada a la Recuperación (TCC-R). Método. Se llevó a cabo una búsqueda y análisis de literatura científica en PSYCLIT, MEDLINE, EBSCO-HOST y PROQUEST publicada entre 1990 y 2014 en revistas indexadas en inglés y español, utilizando como palabras clave los nombres de las diferentes TCC para la esquizofrenia que se cruzaron en todos los casos con el diagnóstico. Se recopiló también la literatura relevante citada en estos artículos, sobre todo en las revisiones de literatura antecedentes. Resultados. A pesar de los avances que han presentado las TCC en la recuperación de pacientes con diagnóstico de esquizofrenia, los problemas generados por la sintomatología negativa no han sido resueltos por completo. Discusión y conclusión. La TCC-R se considera un estilo terapéutico prometedor para alcanzar los objetivos de recuperación de los pacientes con bajo funcionamiento psicosocial y predominio de sintomatología negativa.

Cognitive behaviour therapy for schizophrenia in a community mental health team

Cognitive behaviour therapy for schizophrenia in a community mental health team

Has cognitive behavioural therapy for psychosis been oversold?

After the discovery of chlorpromazine in 1952 and the subsequent rise of biological psychiatry, the mainstream view of schizophrenia became that it was amenable only to drug treatment. But everything...

Cognitive-behavioural therapy for schizophrenia in a forensic mental health setting

Purpose – The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice recommended in primary and secondary care. In secure forensic mental health services the evidence is less established. The purpose of this paper is to evaluate the effectiveness of group CBT for schizophrenia in a high secure hospital. Design/methodology/approach – In all, 27 male forensic patients completed a manualised CBT group and were compared on primary and secondary outcomes to patients receiving treatment as usual (TAU). Primary outcomes were positive and negative symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and the Psychotic Symptom Rating Scales (PSYRATS). A secondary outcome was interpersonal functioning as measured by the Inventory of Interpersonal Problems (IIP-64). Findings – CBT participants showed improvement on negative symptoms; affective flattening, alogia, anhedonia and avolition; in comparison to participants in TAU. CBT participants also showed reductions in delusions and hallucinations on the SAPS but not the PSYRATS. TAU participants improved on positive symptoms as measured by the PSYRATS. CBT participants showed reductions in overall interpersonal problems, and most notably in being socially inhibited and self-sacrificing. No iatrogenic effects of treatment were found; improvements in depression anxiety and stress were reported by group completers, which contrasted to experiences of the TAU group. Research limitations/implications – Absence of random allocation to CBP or TAU groups retains the risk of recruitment bias. Findings are preliminary given the sample size. Multiple outcome assessments increase risk of a type I error. Practical implications – CBT for schizophrenia can be effective with clients in secure forensic mental health settings. Improvements in negative symptoms and interpersonal functioning appear to be particular gains. Self-report measures might be subject to specific demand characteristics in such settings. Originality/value – The evaluation includes a comparator group in a high secure setting, which is typically absent in reported evidence for this population (Blackburn, 2004). The study also investigated changes in interpersonal functioning, which has previously been noted as an important but absent outcome in CBT for psychosis (Haddock et al., 2009). Iatrogenic outcomes were also considered in the evaluation to ensure no adverse effects were experienced from treatment.

Beliefs of Australian health professionals about the helpfulness of interventions for mental disorders: Differences between professions and change over time

To assess the beliefs of general practitioners (GPs), psychiatrists and clinical psychologists about the helpfulness of different interventions for mental disorders, and to examine change in beliefs over time. A questionnaire was mailed to 6848 GPs, psychiatrists and clinical psychologists registered with Medicare Australia. The questionnaire was based around one of six vignettes describing a person with a mental disorder: depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia and post-traumatic stress disorder. The depression and early schizophrenia vignettes were identical to those used in a similar survey of health professionals conducted in 1996. A range of interventions were rated for their likely helpfulness for each disorder, and consensus was defined as at least 66% of each profession rating an intervention as helpful. Responses were received from 1536 health professionals. A broader array of interventions were endorsed for depression than in 1996, including GPs, psychiatrists, psychologists, becoming more physically active, reading about people with similar problems and how they have dealt with them, psychotherapy, and cognitive behaviour therapy. For the schizophrenia vignettes, GPs, psychiatrists and antipsychotics were thought to be helpful by a majority of professionals. A variety of professionals, psychological treatments and lifestyle activities were endorsed for the anxiety disorders. Differences between professions were noted in beliefs about the helpfulness of antidepressants and counsellors for anxiety disorders and depression, as well as cognitive behaviour therapy for schizophrenia. Consensus across professions was reached on the helpfulness of a variety of interventions for each mental disorder, although there were some notable differences in beliefs. The study gives an updated overview of treatment beliefs for mental disorders by Australian health professionals, which can be used as a benchmark with which to compare the beliefs of the Australian public.

Cognitive behaviour therapy for schizophrenia.

Schizophrenia is one of the major and potentially severe mental illnesses. Even with best practices, there are limitations to the effectiveness of treatments that include medications for this disorder. Relapse rates are high and often those with the illness remain symptomatic and functionally impaired. All the evidence suggests that individuals with schizophrenia do best with a combination of pharmacological and psychosocial intervention. One psychosocial treatment that has received much attention is cognitive behaviour therapy (CBT). This brief review will address what we know about the use and effectiveness of CBT at all phases of schizophrenia and its strengths, weaknesses and its future.

Emotion Regulation and Schizophrenia

Psychosocial treatments for schizophrenia have evolved over the past 20 years to target cognitive biases behind psychotic thought disorders. For many individuals, psychotic symptoms can be modified through specific cognitive and behavior strategies. Recent research suggests that individuals with schizophrenia may lack the ability to regulate their emotions and that emotion dysregulation is present at experiential, processing, and expressive levels, exacerbating the distress and social dysfunction experienced. Recent findings regarding emotional dysregulation among individuals with schizophrenia are presented and the role of emotional experience in the etiology and the development of the illness is discussed. In agreement with the published literature, we argue for the priority of emotion regulation strategies such as reappraisal, exposure, acceptance, detachment, and mindfulness in cognitive behavior therapy for schizophrenia.

Cognitive Behavior Therapy for Schizophrenia and Psychosis: Current Status and Future Directions

Cognitive behavior therapy (CBT) is an empirically based psychological treatment, which has a strong evidence base in a range of psychological disorders and, more recently, has also been applied to more serious disorders such as schizophrenia and psychoses (CBTp). This review outlines the background to this development and the theoretical bases to CBTp. There is good evidence from a considerable number of clinical trials that CBTp has a consistent clinical benefit when used in addition to standard care. There is, however, some variation in the outcomes of these clinical trials which may be due, in part, to the variation in methodological rigor of the trials. There is evidence that smaller, albeit still significant, effect sizes are found in methodologically more robust clinical trials. This is consistent with results found in other branches of medicine and healthcare. The different clinical strategies and outcomes found with various phases of the illness are outlined. There are considerable clinical and research challenges posed by issues of: 1) risk; 2) treating serious comorbidity; and, 3) treating conditions that limit recovery. These clinical problems are being addressed by a second wave of clinical developments. Lastly, the perennial problem of dissemination and translation of research into clinical practice is discussed.

Therapeutic Alliance in Cognitive Behavior Therapy for Schizophrenia: Association with History of Sexual Assault

History of sexual assault in schizophrenia has been suggested as a risk factor for psychosis and a graver course of illness. One possibility is that a history of this type of trauma affects responses to treatment by forming a barrier to a therapeutic alliance. To explore this possibility, we compared monthly ratings of therapeutic alliance for clients with schizophrenia with (n = 9) and without (n = 31) a history of sexual assault across 6 months of cognitive behavior therapy. Ratings were collected from clients and therapists and compared using a repeated measures analysis of variance controlling for level of positive symptoms. Results revealed that clients with a sexual trauma history produced lower overall rating of therapeutic alliance than clients without such a history. Therapist ratings of therapeutic alliance between both groups were not significantly different. Results suggest treatment may need to consider trauma histories as a barrier to therapeutic alliance.

Cognitive behavioural therapy for schizophrenia

Around 0.7% of the population have schizophrenia.1 This serious psychotic disorder affects psychological and social functioning, and diagnosis can lead to stigma.2 Pharmacological interventions are a key element in management,3...

The evolution of cognitive behavior therapy for schizophrenia: current practice and recent developments.

Cognitive behavior therapy (CBT) evolved from behavioral theory and developed to focus more on cognitive models that incorporated reappraisal of thinking errors and schema change strategies. This article will describe the key elements of CBT for schizophrenia and the current evidence of its efficacy and effectiveness. We conclude with a description of recent concepts that extend the theoretical basis of practice and expand the range of CBT strategies for use in schizophrenia. Mindfulness, meta-cognitive approaches, compassionate mind training, and method of levels are postulated as useful adjuncts for CBT with psychotic patients.

Predictors of Outcome in Brief Cognitive Behavior Therapy for Schizophrenia

Antipsychotic medications, while effective, often leave patients with ongoing positive and negative symptoms of schizophrenia. Guidelines recommend using cognitive behavior therapy (CBT) with this group. Clearly, mental health professionals require training and supervision to deliver CBT-based interventions. This study tested which antipsychotic-resistant patients were most likely to respond to brief CBT delivered by psychiatric nurses. Staff were trained over 10 consecutive days with ongoing weekly supervision. Training for carers in the basic principles of CBT was also provided. This article represents the secondary analyses of completer data from a previously published randomized controlled trial (Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry. 2002;180:523-527) (n = 354) to determine whether a number of a priori variables were predictive of a good outcome with CBT and treatment as usual. Logistic regression was employed to determine whether any of these variables were able to predict a 25% or greater improvement in overall symptoms and insight. In the CBT group only, female gender was found to strongly predict a reduction in overall symptoms (P = .004, odds ratio [OR] = 2.39, 95% confidence interval [CI] = 1.33, 4.30) and increase in insight (P = .04, OR = 1.84, 95% CI = 1.03, 3.29). In addition, for individuals with delusions, a lower level of conviction in these beliefs was associated with a good response to brief CBT (P = .02, OR = 0.70, 95% CI = 0.51, 0.95). Women with schizophrenia and patients with a low level of conviction in their delusions are most likely to respond to brief CBT and should be offered this routinely alongside antipsychotic medications and other psychosocial interventions.

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

Although cognitive behavioural therapy (CBT) is claimed to be effective in schizophrenia, major depression and bipolar disorder, there have been negative findings in well-conducted studies and meta-analyses have not fully considered the potential influence of blindness or the use of control interventions. We pooled data from published trials of CBT in schizophrenia, major depression and bipolar disorder that used controls for non-specific effects of intervention. Trials of effectiveness against relapse were also pooled, including those that compared CBT to treatment as usual (TAU). Blinding was examined as a moderating factor. CBT was not effective in reducing symptoms in schizophrenia or in preventing relapse. CBT was effective in reducing symptoms in major depression, although the effect size was small, and in reducing relapse. CBT was ineffective in reducing relapse in bipolar disorder. CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates. It is effective in major depression but the size of the effect is small in treatment studies. On present evidence CBT is not an effective treatment strategy for prevention of relapse in bipolar disorder.

CBT Modification Promising in Treating Schizophrenia

CBT Modification Promising in Treating Schizophrenia