Hope for Patients With Severe Schizophrenia

For many decades, mental health professionals believed that talk therapy was completely ineffective for schizophrenia. A groundbreaking new study, however, was just published.
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Many people regard the symptoms of psychiatric illness of schizophrenia as bizarre: hearing voices and seeing people or objects that don't exist (auditory or visual hallucinations), having extremely strong ideas that have no basis in reality (delusions), incoherent speech and disorganized behavior, for example. People with severe schizophrenia are usually withdrawn, isolated and unable to engage in basic day-to-day functioning.

For many decades, mental health professionals believed that talk therapy was completely ineffective for schizophrenia. A groundbreaking new study, however, was just published in the Archives of General Psychiatry. The researchers at the University of Pennsylvania involved with this study have provided new hope for severe schizophrenia, which until now has been widely regarded as almost completely resistant to talk therapy. Even pharmacological treatment has led, at best, to only mild reductions in hallucinations and delusions. Moreover, up to one-half of patients experience residual symptoms or are unable to tolerate the adverse effects of medication.

Previous research on schizophrenia and cognitive therapy (often termed cognitive behavior therapy) has primarily focused on symptom reduction in acute cases of psychosis. In the current study, Paul Grant, Ph.D., Aaron Beck, M.D. and colleagues charted new territory; they focused their research on improving the global functioning of patients with chronic cases of severe schizophrenia. Grant et al. found that people with severe schizophrenia have the same goals as people with other psychiatric disorders. They want to have good relationships, they want to be productive and they want to be independent. The researchers used recovery-oriented, cognitive therapy treatment methods to help them move, in small steps, toward these goals.

Treatment consisted of weekly, goal-directed therapy sessions focused on engaging the patient, establishing a therapeutic rapport and stimulating interest and motivation in achieving long-term, measurable goals, which they broke down into intermediate and short-term goals. Therapists in the study highlighted the patients' interests, assets and strengths. Once patients became engaged in treatment, therapists were able to help correct their self-defeating beliefs such as "Taking even a small risk is foolish because the loss will be a disaster." The results are far-reaching.

Patients were able to reach a whole new level of functioning (demonstrated by an increase of 10 points on an instrument called the Global Assessment Scale). They also showed significant improvements in motivation and reductions in positive symptoms (hallucinations, delusions, disorganization). These findings suggest that recovery-based cognitive therapy (cognitive behavior therapy) treatment for schizophrenia may help to reduce public health costs for this psychiatric population while simultaneously improving patients' quality of life.

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