Psychotherapy Of Schizophrenia Research Articles

The Psychotherapy of Schizophrenia: A Review of the Evidence for Psychodynamic and Nonpsychodynamic Treatments.

Following the discovery of chlorpromazine's effectiveness as a treatment for schizophrenia in the 1950s, a gradual shift away from psychotherapeutic and toward biological methods of investigation has ensued. Nevertheless, psychological approaches to schizophrenia have a long history and continue to represent an important component of schizophrenia treatment. In the past 2 decades, there has been renewed interest in psychotherapy for schizophrenia among some clinicians and researchers. This article examines the current evidence for both psychodynamic and nonpsychodynamic (cognitive-behavioral, cognitive enhancement, and psychoeducational) therapies for schizophrenic illness. There is evidence to support the use of both types of therapies though these orientations generally differ in their views on the role of psychological factors in the etiology of schizophrenia. It is argued that a pluralistic or biopsychosocial model of schizophrenia is necessary to account for the complexity of the disease and to provide the most effective treatment.

WORKING WITH ODD REALITIES IN SUPERVISION: THE PSYCHOTIC PATIENT

Working with the psychotic patient is one of the most difficult tasks in psychotherapy, especially for beginner therapists. The paper presents some of the major difficulties in the psychotherapy of schizophrenia, structured according to the integrative-strategic approach, together with potential interventions in supervision.

Psychotherapy of schizophrenia and its borderline states E. Kretschmer (Zeitschr. F. D. Ges. Neur. U. Psych. Bd. 121)

Schizophrenia is a hereditary, endogenous disease. The unfounded fatalism associated with the concept of the endogenous, the constitutional has long paralyzed our therapeutic thinking. And in schizophrenia "we often saw incurable defects where there were only bizarre psychogenic arabesques of deceptive schizophrenia of symptoms against the background of a relatively unsharp process." For a psychiatrist, as a practical therapist, and from the point of view of an endogenous understanding of schizophrenia, it is important to be interested in not what is endogenously destroyed, but what is recoverable and in what form. In psychotherapy for schizophrenia, its features depend on the characteristics of the period and degree of the disease.

I Am Schizophrenic, Believe It or Not! A Dialogue about the Importance of Recognition

The main aim of our article is to discuss the importance of recognition in the psychotherapeutic process. To achieve recognition, patient and clinician should be able to build a space where the patient can find an "ecological niche" in which he can find an "adaptive equilibrium" between the burdensome demands of his psychopathological condition and the external, imposing demands of society. The clinician's recognition is to a patient the condition of possibility to survive the "oceanic" social currents without integrating too much into them, and in so doing losing all his "non-adaptive" traits, his "pathological" freedom and unique and valuable way to interpret and henceforth live in the world. A schizophrenic person and his psychiatrist discuss the patient's condition and his way of dealing with it. A dialogue between a "view-from-within" and a sympathetic "view-from-without" whose purpose is to build a circle of reciprocal recognition that allows the patient to come out of isolation and try to construct a fulfilling, even though schizophrenic, life. The concluding remarks will not be a definitive and "closed" examination of the material brought forth by the dialogue, but the opening of a series of questions for further research on this very important and promising theme in the psychotherapy of schizophrenia.

The effect of medical and psychotherapeutic treatment models for schizophrenia on stigma and recovery expectations

It is common practice to inform patients about causes and treatment models when starting psychiatric treatment or psychotherapy for schizophrenia. However, previous research indicates that focusing on etiological models increases stigmatizing beliefs. This raises the question of whether contemporary, medical or cognitive behavioral therapy (CBT)-based treatment models share this negative side effect. This experiment tested whether providing information about medical vs. CBT-based vs. combined treatment models affects stigmatizing attitudes towards schizophrenia and the expected efficacy of these treatments. Participants received acase vignette of aperson with schizophrenia including either: (1)no treatment details, or adescription of treatment with (2)medication, (3)CBT, or (4)medication and CBT. Next, stigmatizing attitudes (stereotypes, affective reactions, and desired social distance) were assessed and participants rated the perceived effectiveness of different treatment methods. No treatment model showed an effect on stigmatizing attitudes. Medical and CBT treatment information (alone or in combination) had apositive effect on subjective efficacy ratings for the respective treatment. There appear to be no negative side effects of (biogenetic) models when presented in acontext emphasizing recovery. Moreover, medication and CBT treatment information showed additive positive effects on the rating of treatment strategies. Acombined treatment model integrating various evidence-based methods appears to be most useful in clinical practice.

Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation

Historical and newly emerging models of schizophrenia suggest it is a disorder characterized by the fragmentation of the experience of the self and the world, leading to the interruption of how a unique life is unfolding in the world. It has been proposed that psychotherapy might therefore promote recovery by facilitating the development of a greater ability to integrate information about the self and others. In this paper we explore how the supervision of a metacognitively-oriented psychotherapy can assist therapists to experience and conceptualize fragmentation within sessions, join patients in the gradual process of making sense of their psychiatric problems and life challenges, and ultimately envision and achieve recovery. Common challenges and responses within supervision are described and discussed.

Psychotherapy in schizophrenia: a retrospective controlled study

ABSTRACT Introduction Although pharmacological interventions have been the mainstay of treatment for schizophrenia, there has been a growing recognition of the importance of psychotherapy. Aims To investigate whether a novel psychotherapeutic approach, dialog therapy (DT), has an effect beyond standard psychiatric treatment (ST) in schizophrenia. Methods Twenty-four patients diagnosed with schizophrenia and treated with DT and 24 patients matched on age, sex, and diagnosis receiving ST were included in the study. Results At follow-up after a mean of 4 years and 1 month, the DT group had significantly higher scores on the GAF functions (GAF-F) and GAF symptoms (GAF-S) subscales compared to the ST group. Effect sizes (Cohen’s d) were very large, 238 for GAF-S and 241 for GAF-F. The number and doses of psychoactive drugs were significantly lower in the DT group compared to the ST group at follow-up, despite a shorter time in psychotherapy in the DT group. Conclusions This study provides preliminary evidence that dialog therapy may lead to improvements in symptoms and functioning compared to standard psychiatric treatment.

Self Psychology and Psychosis: the Development of the Self during Intensive Psychotherapy of Schizophrenia and Other Psychoses. by David Garfield and Ira Steinman

Self Psychology and Psychosis: the Development of the Self during Intensive Psychotherapy of Schizophrenia and Other Psychoses. by David Garfield and Ira Steinman

Interpersonal stance and dialogue in psychotherapy for schizophrenia: A supervisory approach

Emerging integrative psychotherapy approaches for schizophrenia have received increased attention and support, but little has been published exploring concepts and challenges pertinent to the supervision and training of clinicians working within an integrative psychotherapy framework with persons with schizophrenia. In this article, one general concept related to intersubjectivity, referred to as the development of an open interpersonal psychotherapist stance, is explored within the context of supervision. General considerations for supervision are offered regarding the development of an open interpersonal stance, and strategies for addressing four prototypical non-open stances in which dialogue may be disrupted are delineated.

Bilingualism and schizophrenia.

Although a bilingual advantage has been described for neurodegenerative disease in general, it is not known whether such an advantage could accrue to individuals suffering from schizophrenia, since language networks are known to be disrupted in this condition. The aim of this minireview was to scan the existing literature to determine: (1) whether individuals with schizophrenia are able to learn a second language as adults; (2) whether clinical assessment, both for the purpose of accurate diagnosis and for the prediction of treatment response, should be carried out in both languages in bilinguals with schizophrenia; (3) whether psychotherapy in schizophrenia is affected by bilingualism; and (4) whether speaking a second language improves outcome in schizophrenia. The literature to date is too sparse to make definitive statements, but: (1) individuals with schizophrenia appear to be capable of learning a new languages as adults; and (2) it is possible that teaching a foreign language may serve as a form of cognitive rehabilitation for this condition. This literature review recommends research into the effects of bilingualism on the outcome of schizophrenia. Included in this review is a retrospective pilot study conducted in Canada, which suggests that employment opportunities for patients with schizophrenia are improved when they speak more than one language. This is important to note because employment is generally problematic in the context of schizophrenia while, at the same time, the ability to obtain work contributes significantly to quality of life.

Group Psychotherapy in Schizophrenia with Obesity and Eating Disorders: A Pilot Study

CME Educational Objectives 1. Develop individualized treatment methods for patients with metabolic illness and schizophrenia. 2. Anticipate the importance of body image, body weight and self-esteem in patients with stabilized schizophrenia. 3. Incorporate psychotherapy in treatment regimens. Despite an abundance of data on metabolic illnesses in patients with schizophrenia, their management is relatively less studied. In the few treatment studies, the goal is even less clear. Are we aiming to reduce weight? Why? Or are we aiming to reduce morbidities associated with obesity and, ultimately, cardiovascular mortality? If it is the latter, then weight is just one surrogate marker. We still do not know what weight is a surrogate of in patients with schizophrenia.

Self-disorders and Schizophrenia: A Phenomenological Reappraisal of Poor Insight and Noncompliance

Poor insight into illness is considered the primary cause of treatment noncompliance in schizophrenia. In this article, we critically discuss the predominant conceptual accounts of poor insight, which consider it as an ineffective self-reflection, caused either by psychological defenses or impaired metacognition. We argue that these accounts are at odds with the phenomenology of schizophrenia, and we propose a novel account of poor insight. We suggest that the reason why schizophrenia patients have no or only partial insight and consequently do not comply with treatment is rooted in the nature of their anomalous self-experiences (ie, self- disorders) and the related articulation of their psychotic symptoms. We argue that self-disorders destabilize the patients’ experiential framework, thereby weakening their basic sense of reality (natural attitude) and enabling another sense of reality (solipsistic attitude) to emerge and coexist. This coexistence of attitudes, which Bleuler termed “double bookkeeping,” is, in our view, central to understanding what poor insight in schizophrenia really is. We suggest that our phenomenologically informed account of poor insight may have important implications for early intervention, psychoeducation, and psychotherapy for schizophrenia.

Scorn, Disillusionment and Adoration in the Psychotherapy of Schizophrenia

Scorn, Disillusionment and Adoration in the Psychotherapy of SchizophreniaHarold F. SearlesHarold F. SearlesSearch for more papers by this authorPublished Online:April 2013https://doi.org/10.1521/prev.2013.100.2.337PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Volume 100Issue 2Apr 2013 Information© 2013 N.P.A.P.PDF download

Estudio Bibliométrico Sobre Intervenciones Psicológicas para la Esquizofrenia

Schizophrenia is a psychiatric illness that has been approached since the eighteenth century by Kraepelin andBleuler, but continues to cause confusion with respect to its course and treatment. The objective of this studywas to reveal, through research realized since 2000 on psychotherapy for schizophrenia, the therapy that withcurrent evidence improves the efficacy for the integral function of these patients. This investigation was basedon a bibliometric methodology that analyzed a total of 71 items abstracted from the following databases: Scopus,PubMed, Medline, ScienceDirect, EbscoHost, Redalyc and Proquest. The outcomes of the study demonstrated that cognitive behavioral therapy was used in 30 of the 71 articlesanalyzed. Related therapies, such as cognitive and cognitive specifically aimed at the management of social skills,added another 19 of these articles. These therapies were recognized for promoting an essential treatment forthe patient, for their proper interdisciplinary management, and for the importance that they give to theimplementation of a continuous monitoring after the process is completed.

Psychotherapy for Schizophrenia: A Review of Modalities and Their Evidence Base

We reviewed the techniques and evidence base of four psychotherapeutic adjuncts to the pharmacological treatment of schizophrenia: Personal therapy, cognitive behavioral therapy, cognitive enhancement therapy, and psychodynamic psychotherapy. While there is a significant evidence base for the first three of these modalities, there is a paucity of research on psychodynamic treatments for schizophrenia. We review the history of psychodynamic treatment for schizophrenia and the ways in which it informs current treatment. In light of the limited efficacy of antipsychotic medications in the treatment of schizophrenic persons, there is increasing interest in the role of social and psychological approaches.

AS17-02 - Psychoeducation and psychotherapy of schizophrenia patients

Although medication is the most important part of treatment, psychotherapy can also play an important role in helping schizophrenics manage anxiety and deal with interpersonal relationships, and treatment for the disorder usually consists of a combination of medication, therapy, and various types of rehabilitation. Family therapy has worked well for many patients, educating both patients and their families about the nature of schizophrenia and helping them in their cooperative effort to cope with the disorder. Psychoeducational intervention, also at its first level (information group), has shown the capacity of increasing the adherence to pharmacological treatment. On the other hand, the second level (support group, psychoeducational family intervention) is able to reduce both the familial EE level and the rate of relapse in chronic schizophrenic patients. The stress-vulnerability model conceives of the symptoms of schizophrenia as resulting from the actions of environmental stresses on the vulnerable individual. Psychotherapies are ideally suited to address a number of stress and vulnerability factors. There now exists a body of literature, including a number of methodologically sound randomized controlled trials covering four types of psychotherapy of schizophrenia which can be implemented in the general clinical setting: family interventions; cognitive behavioural psychotherapy; social skills training; and psychoeducation. Data on effectiveness from these trials can be used to guide clinical practice.

Pharmacokinetics and metabolism update for some recent antipsychotics

Introduction: The search for drugs that reduce psychotic symptoms, with minimal adverse effects, has led to the development of new agents that act somewhat differently from their older antipsychotic counterparts. These agents, which include aripiprazole, lurasidone and perospirone, act by targeting both D2 and 5-HT1A receptors, in addition to other characteristic receptors.Areas covered: This article covers the pharmacokinetics and metabolism of aripiprazole, perospirone, lurasidone and cariprazine. The review also describes the effects of physiological and pathological variables on these drugs as well as potential drug interactions. The author provides the reader with knowledge of the fundamental pharmacokinetic characteristics and metabolic pathways of these new antipsychotics, emphasizing the clinically important common features and differences compared to other older agents.Expert opinion: Aripiprazole, perospirone, lurasidone and cariprazine share some of the pharmacokinetic characteristics of older, lipophilic antipsychotics and, like these, each has some distinct pharmacokinetic features that are clinically beneficial and some that are not. We await the results of future practical effectiveness trials of these new antipsychotics and their follow-on derivatives to learn more about their benefit/risk profile compared with established antipsychotics. It is hoped that some of these newer antipsychotics will not only increase the range of pharmacotherapeutic options, but decisively improve the expectations of psychotherapy for schizophrenia.

Metacognition as a predictor of therapeutic alliance over 26 weeks of psychotherapy in schizophrenia

Research to identify client factors that impact treatment outcome has found that deficits in metacognitive abilities and weaker therapeutic alliance are both associated with poorer treatment outcomes for schizophrenia. However, it is unknown if metacognition and therapeutic alliance are related in any way, in particular, if metacognitive abilities predict therapeutic alliance. This study explored whether differing capacities for mastery, a domain of metacognition that involves the ability to use knowledge about mental states to respond to psychological challenges, predicted client perceptions of therapeutic alliance assessed by the Working Alliance Inventory — Short Form (WAI-S). Participants were 63 adults with schizophrenia or schizoaffective disorder enrolled in a 6-month program of cognitive behavioral or supportive therapy, placed into a high, intermediate or minimal mastery group as measured by the Metacognitive Assessment Scale (MAS). Repeated measures ANOVA found group effects for the total WAI-S score, with the high and intermediate mastery groups having better alliance scores than the minimal mastery group. The group effects approached significance when neurocognition was controlled for. Results suggest that greater capacity for mastery predict stronger therapeutic alliance, but do not predict its development over time.

Addressing metacognitive capacity for self reflection in the psychotherapy for schizophrenia: A conceptual model of the key tasks and processes

Recognition that recovery from schizophrenia may involve a deepening of the experience of being in the world has led to the possibility that psychotherapy may play a key role in treatment by enhancing metacognition, or the capacity to think about thinking. While the potential of psychotherapy to enhance metacognition in non-psychotic disorders has been discussed in depth, little has been written about how psychotherapy may systematically address metacognition in schizophrenia. Accordingly, the current paper formulates a model of how psychotherapy might address one specific element of metacognition, namely self-reflectivity. Procedures are outlined for assessing clients' capacity for self-reflectivity within narrative contexts during psychotherapy. Targeted interventions are identified which are tailored to clients' capacities in the moment and which assist clients to think about their own thinking at the level of which they are capable. This may lead clients over time to develop a greater ability to engage in acts of increasingly complex self-reflectivity. Individual psychotherapy can be modified and utilized to assist persons with schizophrenia to move towards recovery by assisting them to develop the capacity for self-reflectivity. This may lead to clients having a fuller experience of themselves as a being in the world with a richer and more coherent personal narrative.

Autism and Perplexity: A Qualitative and Theoretical Study of Basic Subjective Experiences in Schizophrenia

Background: Autistic traits and perplexity are considered core features of schizophrenia in phenomenological psychiatry. They express a fundamental disturbance of the self-world relation (including disturbances of self and intersubjectivity). The aim of our study was to examine this disturbance by exploring in detail how autism and perplexity are experienced subjectively. Methods: It is a qualitative single-case study. In order to fully examine our patient’s experiences within the context of his experiential world and not only as isolated or decontextualized symptoms, we applied a heideggerian framework, i.e. Heidegger’s exhaustive account of the self-world relation (care). Results: Through the framework of care, we discovered a profound disturbance of the self-world relation in our patient, characterized by subtle experiences of estrangement, anxiety and exposure. We found these experiences to be enduring, pervasive and generative for the development of other symptoms. Conclusions: We argue that these experiences can be seen as experiential correlates of schizotypy and of vulnerability to schizophrenia, and furthermore that an understanding of these experiences can play a role in diagnostic and differential diagnostic procedures, e.g. in early detection or in the search for high-risk individuals, as well as in the psychotherapy of schizophrenia.