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Deficits in processing social information in schizophrenia have long been thought to lead to patients' delusional interpretations of other people as well as negative symptoms such as avolition and avoidance of interactions (e.g., JW Psychiatry Jan 23 2012 and Jan 18 2008). In this 18-month study, researchers examined the effect of a modified form of cognitive therapy (CT) on global functioning, positive symptoms, and negative symptoms.
The 60 participants had chronic schizophrenia (mean age, 38; mean duration of illness, 16 years) and considerable impairment of memory, attention, and executive function. They were randomized to standard community treatment alone or with weekly CT (mean sessions, 50). CT adhered to the recovery model and focused on enhancing motivation to set meaningful goals; removing impediments to achieving those goals; correcting negative expectations; practicing adaptive behaviors; and addressing cognitive deficits and specific delusions, hallucinations, and disorders of thought.
Treatment with psychotropic medications did not differ between groups. Compared with controls, CT patients had statistically and clinically significantly more improvement in global functioning, avolition/apathy, and positive symptoms; effect sizes for between-group differences were moderate to large (0.56, 0.66, and 0.46, respectively).
Grant PM et al. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry 2012 Feb; 69:121.
Comment
The investigators hypothesize that combating self-defeating and negative beliefs that inhibit the accomplishment of reasonable goals enabled patients to become less withdrawn and more in touch with reality, which then decreased their psychotic explanations of the world and promoted more adaptive behavior and better functioning — in contrast to the effects of antipsychotics in some studies. Hallucinations, delusions, and cognitive impairment in these chronically ill patients did not prevent them from making use of formal cognitive therapy. This approach could be added to other psychosocial therapies for severely impaired patients.