Category: Schizophrenia / Psychotic Disorders
Keywords: Schizophrenia | Psychosis / Psychotic Disorders | Randomized Controlled Trial
Presentation Type: Symposium
While cognitive-behavioral therapy for psychosis (CBTp) has been well-studied in other countries, there have been few published US randomized controlled trials (RCTs). Furthermore, the findings are somewhat contradictory, likely because of the significant variation in intervention length, targets, and components, trial rigor, and sample characteristics. We conducted an RCT of CBTp in 88 US Veterans diagnosed with schizophrenia or schizoaffective disorder. Participants, who averaged 49.6 years old and had been ill for a mean 24.1 years, had a more long-term illness course than those in many other CBTp trials. At baseline, despite being prescribed antipsychotic medication, participants reported at least one positive psychotic symptom rated a 4 or more on the Brief Psychiatric Rating Scale (BPRS), and exhibited at least mild distress, reflected on a score of at least 3 on the BPRS anxiety or depression items.
Participants were randomized to receive 6 months of manualized CBTp or supportive therapy (ST). The CBTp (Kingdon and Turkington, 2004) emphasized developing a shared understanding of the psychosis development, normalization of psychotic symptoms, gentle challenging of psychotic symptoms, homework, and improving functioning through work on personal goals. Measures of symptoms (BPRS), distress from symptoms (Psychotic Symptom Rating Scale; PSYRATS), and adaptive functioning (Social Adjustment Scale; SAS) were administered pre-treatment, post-treatment, and at 3-month follow-up.
Participants attended an average of 14.51 therapy sessions (no group differences). Contrary to our hypotheses of CBTp superiority, participants in both groups improved significantly from pre to post treatment on the BPRS total and psychosis factors, and on PSYCHRATS total symptom distress. However, the CBTp group experienced significantly greater functional improvement (SAS overall item) at the 3 month follow-up. These results suggest that the therapeutic relationship, whether shaped by CBTp or ST, may have had a beneficial impact on symptoms and distress in this impaired sample, but that only the CBTp may lead to improvements in community functioning.
VA Greater Los Angeles/UCLA
Saturday, November 18
3:30 PM – 5:00 PM
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