Article 4: cognitive-behavioural therapy for sz Flashcards
Who were the participants in the study and how were they selected?
The participants in this study were referred from three care centres in the UK. They were clients of the catchment area. They were recruited by asking referrals from community teams and in-patient units. They had to meet specific inclusion criteria. First the participants eligible for the study must have a least one positive symptom of psychosis that is medication-resistant. It had to be unremitting for a period of at least 6 months. What they meant by medication resistant is that the symptom had to have been unresponsive to a previous trial of appropriate medication for its treatment for at least 6 months. For the patients who were prescribe clozapine, they needed to have been stable on this treatment for at least 12 months. The exclusion criteria was those who had drug, alcohol problems or organic problems. The final sample consisted of middle-aged mostly men with a long history of illness and an average IQ score.
How were the treatment and control groups assigned?
152 people were recruited and after being screened for eligibility, 47 had no positives symptoms, 10 were not stable, 26 were out of the catchment area and 9 did not agree to participate, therefore only 60 remained and were randomly assigned to either the treatment group (n = 28) or the control group (n = 32). This was a Randomized Controlled Study Design.
What treatment did the control group receive?
The treatment group received CBT and standard routine care, the control group received only standard routine care with clozapine to manage symptoms.
What were the main goals of the CBT intervention used in this study?
What were the main goals of the CBT intervention used in this study?
First of all CBT had to be followed for up to 9 months, weekly and then every two weeks. Sessions were up to an hour. The goals of CBT were:
(1) to reduce distress and inference from positive psychotic symptoms,
(2) reduce emotional disturbance (e.g anxiety, depression, hopelessness) and to modify dysfunctional schemas (e.g reducing negative or dysfunction views of themselves)
(3) to promote active participation of the patient in the regulation of their relapse risks and social disability.
Describe two strategies used to treat hallucinations and delusions.
The strategy for working with delusions is to work within the delusion system in order for the client to reduce their distress. The therapists would review the evidence for their client’s belief, which they called “reality-testing”. This technique has the purpose to test out the actual consequences that can occur, rather than the ones that are feared when not obeying a hallucination’s command. The second technique was to evaluate the meaning attributed to the hallucinations. There was also a coping strategy to combat hallucinations which was to read out loud.
What changes were observed in the Brief Psychiatric Rating Scale (BPRS) measure? Which specific symptoms measures showed changes? What was the rate of clinical improvement? How satisfied were people with the treatment?
- Reduction in the BPRS over time for the CBT compared to controls
- Specific changes delusional conviction; distress and frequency of hallucinations
- 25% in treatment group; 8% in control
- 80% were satisfied
What conclusions did the researchers draw about the effectiveness of the treatment? Name one limitation they identified in their study.
What conclusions did the researchers draw about the effectiveness of the treatment?
The researchers concluded based on their findings that CBT improves overall symptomalogy of SZ, and that talking about your psychotic symptoms and their meanings with a therapists helps improve outcome. Since the drop-out rates were low and satisfaction was high, these are good indicatives that the treatment is effective. Similar effects were found in randomized controlled trials of clozapine. This is also very indicative of the treatments effect.
Additional note: The reason why the latter finding is indicative that the treatment is effective is because for a therapy to have the same effect as a drug is very importance since we know medication has terrible side effects
Name one limitation they identified in their study.
Even though the changes observed in the treatment group were significant and reliable on a clinical level, only 50% of these participants responded to treatment (i.e treatment responders).
