J Korean Neuropsychiatr Assoc.  2012 Nov;51(6):359-366.

The Application of the Cognitive Behavioral Therapy in Schizophrenia

Affiliations
  • 1Department of Psychiatry, Chook Ryoung Evangelical Hospital, Namyangju, Korea. abraxas2@hanmail.net

Abstract


OBJECTIVES
Cognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services.
METHODS
The important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy.
RESULTS
Cognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive.
CONCLUSION
Alongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system.

Keyword

Schizophrenia; Cognitive behavioral therapy; Drug resistant patient; Acute psychotic state; Early psychosis; Group cognitive behavioral therapy

MeSH Terms

Cognitive Therapy
Hallucinations
Humans
Mental Health
Prodromal Symptoms
Psychotherapy
Psychotic Disorders
Schizophrenia
Voice

Reference

1. Arlow JA, Brenner C. The psychopathology of the psychoses: a proposed revision. Int J Psychoanal. 1969. 50:5–14.
2. Gunderson JG, Frank AF, Katz HM, Vannicelli ML, Frosch JP, Knapp PH. Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment. Schizophr Bull. 1984. 10:564–598.
Article
3. Perris C. Cognitive Therapy with Schizophrenic Patients. 1989. London: Guilford Press.
4. Drury V, Birchwood M, Cochran R, Macmillan F. Cognitive therapy and recovery from acute psychosis: controlled trial, 1: impact on psychotic symptoms. Br J Psychiatry. 1996. 169:593–601.
Article
5. Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D, et al. Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. Br J Psychiatry Suppl. 2002. 43:s91–s97.
Article
6. Lecomte T, Leclerc C, Corbière M, Wykes T, Wallace CJ, Spidel A. Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. J Nerv Ment Dis. 2008. 196:866–875.
Article
7. National Collaborating Centre for Mental Health. Schizophrenia: Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. 2009.
8. American Psychatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia. 2004. 2nd ed. Arlington, VA: American Psychatric Association.
9. Black K, Peters L, Rui Q, Milliken H, Whitehorn D, Kopala LC. Duration of untreated psychosis predicts treatment outcome in an early psychosis program. Schizophr Res. 2001. 47:215–222.
Article
10. McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry. 2002. 59:921–928.
Article
11. Chung YC, Kim JH, Eun HB, Hwang IK. Effect of cognitive-behavioral therapy on the delusion in schizophrenic patients. J Korean Neuropsychiatr Assoc. 2001. 40:63–71.
12. Kim KR, Lee SY, Kang JI, Kim BR, Choi SH, Park JY, et al. Clinical efficacy of individual cognitive therapy in reducing psychiatric symptoms in people at ultra-high risk for psychosis. Early Interv Psychiatry. 2011. 5:174–178.
Article
13. Kingdon DG, Turkington D. Cognitive Therapy of Schizophrenia. 2005. New York: Guilford.
14. Gleeson JFM, McGorry PD. Psychological Interventions in Early Psychosis: A Treatment Handbook. 2004. West Sussex: John Wiley & Sons.
15. French P, Morrison AP. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis: A Treatment Approach. 2004. West Sussex: John Wiley & Sons.
16. Beck AT. Successful outpatient psychotherapy of a chronic schizophrenic with a delusion based on borrowed guilt. Psychiatry. 1952. 15:305–312.
Article
17. Tarrier N, Beckett R, Harwood S, Baker A, Yusupoff L, Ugarteburu I. A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. Br J Psychiatry. 1993. 162:524–532.
Article
18. Kuipers E, Garety P, Fowler D, Dunn G, Bebbington P, Freeman D, et al. London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. I: effects of the treatment phase. Br J Psychiatry. 1997. 171:319–327.
Article
19. Tarrier N, Yusupoff L, Kinney C, McCarthy E, Gledhill A, Haddock G, et al. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ. 1998. 317:303–307.
Article
20. Sensky T, Turkington D, Kingdon D, Scott JL, Scott J, Siddle R, et al. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry. 2000. 57:165–172.
Article
21. Tarrier N, Wittkowski A, Kinney C, McCarthy E, Morris J, Humphreys L. Durability of the effects of cognitive-behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up. Br J Psychiatry. 1999. 174:500–504.
Article
22. Tarrier N, Kinney C, McCarthy E, Humphreys L, Wittkowski A, Morris J. Two-year follow-up of cognitive--behavioral therapy and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia. J Consult Clin Psychol. 2000. 68:917–922.
Article
23. Turkington D, Sensky T, Scott J, Barnes TR, Nur U, Siddle R, et al. A randomized controlled trial of cognitive-behavior therapy for persistent symptoms in schizophrenia: a five-year follow-up. Schizophr Res. 2008. 98:1–7.
Article
24. Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis. Schizophr Res. 2001. 48:335–342.
Article
25. Zimmermann G, Favrod J, Trieu VH, Pomini V. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophr Res. 2005. 77:1–9.
Article
26. Lynch D, Laws KR, McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychol Med. 2010. 40:9–24.
Article
27. Wykes T, Steel C, Everitt B, Tarrier N. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull. 2008. 34:523–537.
Article
28. Drury V, Birchwood M, Cochrane R, Macmillan F. Cognitive therapy and recovery from acute psychosis: a controlled trial. II. Impact on recovery time. Br J Psychiatry. 1996. 169:602–607.
Article
29. Drury V, Birchwood M, Cochrane R. Cognitive therapy and recovery from acute psychosis: a controlled trial. 3. Five-year follow-up. Br J Psychiatry. 2000. 177:8–14.
Article
30. Tarrier N, Lewis S, Haddock G, Bentall R, Drake R, Kinderman P, et al. Cognitive-behavioural therapy in first-episode and early schizophrenia. 18-month follow-up of a randomised controlled trial. Br J Psychiatry. 2004. 184:231–239.
Article
31. Loebel AD, Lieberman JA, Alvir JM, Mayerhoff DI, Geisler SH, Szymanski SR. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry. 1992. 149:1183–1188.
32. Malla AK, Norman RM, Manchanda R, Ahmed MR, Scholten D, Harricharan R, et al. One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res. 2002. 54:231–242.
Article
33. Wyatt RJ. Early intervention with neuroleptics may decrease the long-term morbidity of schizophrenia. Schizophr Res. 1991. 5:201–202.
Article
34. Köhn D, Niedersteberg A, Wieneke A, Bechdolf A, Pukrop R, Ruhrmann S, et al. [Early course of illness in first episode schizophrenia with long duration of untreated illness - a comparative study]. Fortschr Neurol Psychiatr. 2004. 72:88–92.
35. Klosterkötter J, Hellmich M, Steinmeyer EM, Schultze-Lutter F. Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry. 2001. 58:158–164.
Article
36. Ruhrmann S, Schultze-Lutter F, Klosterkötter J. Intervention in the at-risk state to prevent transition to psychosis. Curr Opin Psychiatry. 2009. 22:177–183.
Article
37. Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry. 2004. 185:291–297.
Article
38. Addington J, Epstein I, Liu L, French P, Boydell KM, Zipursky RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res. 2011. 125:54–61.
Article
39. McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, Woods SW, et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry. 2006. 163:790–799.
Article
40. Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010. 67:146–154.
Article
41. An SK. Overview of cognitive therapy for people at risk state for psychosis. Korean J Schizophr Res. 2011. 14:13–19.
42. Preti A, Cella M. Randomized-controlled trials in people at ultra high risk of psychosis: a review of treatment effectiveness. Schizophr Res. 2010. 123:30–36.
Article
43. Gledhill A, Lobban F, Sellwood W. Group CBT for people with schizophrenia: a preliminary evaluation. Behav Cogn Psychother. 1998. 26:63–76.
Article
44. Wykes T, Parr AM, Landau S. Group treatment of auditory hallucinations. Exploratory study of effectiveness. Br J Psychiatry. 1999. 175:180–185.
45. Wykes T, Hayward P, Thomas N, Green N, Surguladze S, Fannon D, et al. What are the effects of group cognitive behaviour therapy for voices? A randomised control trial. Schizophr Res. 2005. 77:201–210.
Article
46. Barrowclough C, Haddock G, Lobban F, Jones S, Siddle R, Roberts C, et al. Group cognitive-behavioural therapy for schizophrenia. Randomised controlled trial. Br J Psychiatry. 2006. 189:527–532.
47. Penn DL, Meyer PS, Evans E, Wirth RJ, Cai K, Burchinal M. A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophr Res. 2009. 109:52–59.
Article
48. Craig TJ, Bromet EJ, Fennig S, Tanenberg-Karant M, Lavelle J, Galambos N. Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry. 2000. 157:60–66.
Article
49. Samarasekera N, Kingdon D, Siddle R, O'Carroll M, Scott JL, Sensky T, et al. Befriending patients with medication-resistant schizophrenia: can psychotic symptoms predict treatment response? Psychol Psychother. 2007. 80:97–106.
Article
50. Lee DE. The theory and therapeutic techniques of cognitive therapy for schizophrenia. Korean J Schizophr Res. 2011. 14:5–12.
51. Malik N, Kingdon D, Pelton J, Mehta R, Turkington D. Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months. J Clin Psychiatry. 2009. 70:201–207.
Article
52. Scott J, Paykel E, Morriss R, Bentall R, Kinderman P, Johnson T, et al. Cognitive-behavioural therapy for bipolar disorder. Br J Psychiatry. 2006. 188:488–489.
Article
53. Morrison AP, Hutton P, Wardle M, Spencer H, Barratt S, Brabban A, et al. Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial. Psychol Med. 2012. 42:1049–1056.
Article
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