A randomized comparison of group cognitive‐behavioural therapy and group psychoeducation in patients with schizophrenia

Bechdolf, Andreas; Knost, Bärbel; Kuntermann, C.; Schiller, Sabine; Klosterkötter, Joachim; Hambrecht, Martin; Pukrop, Ralf

doi:10.1111/j.1600-0447.2004.00300.x

Cited by 110 publications

(118 citation statements)

References 34 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…Overall, despite the absence of exclusion criteria, the sample in our study was comparable to samples from previous CBTp treatment trials in terms of their baseline PANSS scores (e.g. Rector et al, 2003;Bechdolf et al, 2004;Valmaggia et al, 2005), age, gender and length of disorder (Lincoln et al, 2008). Also, the drop-out rates and pre-post effect sizes for positive symptoms were in the range of those found in the literature (Lincoln et al, 2008).…”

Section: Discussionsupporting

confidence: 48%

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

Lincoln

Rief

Westermann

et al. 2014

Psychiatry Research

View full text Add to dashboard Cite

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis, Psychiatry Research, http://dx.doi.org/10.1016/j. psychres. 2014.02.012 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at one-year follow-up. The predictor x group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp + the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and one-year follow-up after controlling for pretreatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier.

show abstract

Section: Discussionsupporting

confidence: 48%

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

Lincoln

Rief

Westermann

et al. 2014

Psychiatry Research

View full text Add to dashboard Cite

show abstract

“…Dividing studies into those carried out on acute patients (n=1), mixed or unspecified patients (n=6) and chronic patients (n=2) did not reveal differences [effect size +0.10, x0.17 and x0.04 respectively, QB(2)=1.82, p=0.40]. The overall effect size was increased only slightly by excluding the single study that used a group therapy form of CBT (Bechdolf et al 2004) (effect size for eight studies=x0.11, 95 % CI x0.29 to +0.06, p=0.19).…”

Section: Effectiveness On Symptomsmentioning

confidence: 96%

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

2009

View full text Add to dashboard Cite

Background. Although cognitive behavioural therapy (CBT) is claimed to be effective in schizophrenia, major depression and bipolar disorder, there have been negative findings in well-conducted studies and meta-analyses have not fully considered the potential influence of blindness or the use of control interventions.Method. We pooled data from published trials of CBT in schizophrenia, major depression and bipolar disorder that used controls for non-specific effects of intervention. Trials of effectiveness against relapse were also pooled, including those that compared CBT to treatment as usual (TAU). Blinding was examined as a moderating factor.Results. CBT was not effective in reducing symptoms in schizophrenia or in preventing relapse. CBT was effective in reducing symptoms in major depression, although the effect size was small, and in reducing relapse. CBT was ineffective in reducing relapse in bipolar disorder.Conclusions. CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates. It is effective in major depression but the size of the effect is small in treatment studies. On present evidence CBT is not an effective treatment strategy for prevention of relapse in bipolar disorder. Key words : Bipolar disorder, cognitive therapy, depression, schizophrenia. IntroductionCognitive behavioural therapy (CBT) has been widely adopted by psychiatry in recent years, but its increase in use in the severe disorders of schizophrenia, major depression and bipolar disorder is particularly noteworthy. This is because it challenges what has, until recently, been a dominance of biological approaches to these disorders. Thus, although contemporary accounts of schizophrenia (e.g. Picchioni & Murray, 2007) emphasize biological factors in its aetiology and consider neuroleptic drugs to be the mainstay of treatment, official UK treatment guidelines from the National Institute for Clinical Excellence (NICE) also state that psychological interventions are indispensable and that CBT should be offered to all patients (NICE, 2003(NICE, , 2009. Psychological factors may loom larger in the aetiology of major affective disorder, but when it comes to treatment, the emphasis in the literature, particularly in bipolar disorder, has once again been firmly on pharmacotherapy. Attitudes may be changing here too, however. References to the effectiveness of CBT are pervasive in the UK depression treatment guideline (NICE, 2004) ; a government initiative is under way in the UK to provide CBT for depression and anxiety in 250 dedicated therapy centres (Layard, 2006) ; and CBT is being advocated for relapse prevention in bipolar disorder (e.g. Scott & Colom, 2005 ;Basco & Rush, 2007).Nevertheless, a cursory look at the literature reveals well-conducted trials where CBT has had negative findings in all three disorders. For example, large-scale trials of CBT in schizophrenia have failed to find significant advantages over befriending (Sensky et al. 2000) or supportive counselling (L...

show abstract

“…Globalement, on peut considérer que le profil démographique et clinique de nos patients est similaire à celui communément décrit dans différentes études conduites avec des patients chroniques présentant un trouble schizophrénique. Cela est en particulier le cas des patients enrôlés dans les études portant sur l'entraînement aux habiletés sociales (Marder et al, 1996 ;Liberman et al, 1998), sur les retombées de la thérapie cognitive (Bechdolf et al, 2004), sur les effets de la psychoéducation (Buchkremer et al, 1997) ou encore dans diverses méta-analyses focalisées sur l'efficacité des traitements psychosociaux (Merinder et al, 2000 ;Pilling et al, 2002).…”

Section: Discussionunclassified

“…Approximativement un tiers des patients se désintéresse de celles-ci. Cette proportion est comparable à celle d'une étude conduite avec l'IPT (Vallina et al, 1999) ou d'autres approches thérapeutiques proposées à ces patients (Marder et al, 1996 ;Merinder et al, 2000 ;O'Donnell et al, 2003 ;Bechdolf et al, 2004). En outre, il faut rappeler que 31 % des patients du groupe « ACCEPTE » sortent prématurément du programme.…”

Section: Discussionunclassified

“…Un taux de « drop-outs » analogue est retrouvé dans diverses études de réhabilitation cognitivocomportementale (Marder et al, 1996 ;Vallina et al, 1999) ou méta-analyses portant sur l'efficacité de la thérapie cognitive (Jones et al, 2000). Néanmoins, ce résultat contraste avec ceux d'autres auteurs qui rapportent des taux de « drop-outs » nettement inférieurs : 13 % à 20 % (Liberman et al, 1998 ;Merinder et al, 2000 ;Bechdolf et al, 2004).…”

Section: Discussionunclassified

See 1 more Smart Citation

Le programme de réhabilitation cognitive et comportementale IPT (Integrated Psychological Treatment) dans un contexte psychiatrique ambulatoire : étude clinique

Zanello¹,

Merlo

2005

smq

View full text Add to dashboard Cite

Une des approches actuelles de la réhabilitation offerte aux patients avec un trouble schizophrénique privilégie la combinaison de stratégies cognitives et psychosociales. Paradigme de ce courant, le programme IPT (Integrated Psychological Treatment) a fait l’objet de plusieurs recherches contrôlées et son efficacité ne semble plus devoir être prouvée. Néanmoins, son utilisation et son efficacité dans la pratique clinique courante sont encore des questions ouvertes et peu explorées. Cet article s’intéresse à ces questions et prend comme assises notre expérience avec l’IPT dans un contexte ambulatoire de psychiatrie adulte. Les résultats montrent que seule une minorité de patients participe à l’IPT dans son intégralité. De plus, les patients qui récusent ou ceux qui agréent le projet de participer aux activités de réhabilitation ont un profil analogue sur les plans démographique, clinique, symptomatique et cognitif. Par ailleurs, nous avons constaté que ces deux groupes de patients présentent une évolution similaire deux ans après l’évaluation initiale au niveau du taux de réadmission, du nombre d’hospitalisations, de la durée des séjours et du nombre de suicides. Ce constat suggère que dans un milieu psychiatrique riche, l’apport spécifique des diverses stratégies de l’IPT se perd vraisemblablement dans la synergie avec d’autres types d’interventions. En outre, il soulève la question de définir un plan de réhabilitation plus individualisé et conforme aux projets propres à chaque patient.Among the actual rehabilitation programs offered to patients with schizophrenic disorders, the IPT (Integrated Psychological Treatment) is one paradigm which combines cognitive and psychosocial strategies. A solid body of evidence, derived from controlled studies, indicates that IPT improves cognitive and social functioning and reduces symptoms severity. Nevertheless, little is known about its efficacy in routine clinical conditions. In this article, the authors address this issue. Our clinical experience with IPT in an ambulatory psychiatric service is presented. The results show that only few patients find useful to participate to all IPT strategies. Patients who refuse or accept to be enrolled in this rehabilitation program share the same demographic, clinical., symptoms and cognitive characteristics. After two years, the outcome of these two groups is similar when we consider the rate of readmissions, the number of hospitalisations, the length of stay and the number of suicides. These observations suggest that IPT strategies in clinical routine are probably less efficient than in well controlled studies. They also raise the question to define an individualised rehabilitation program that fits particular patients’ needs.Uno de los enfoques actuales de la rehabilitación, que se ofrece a los pacientes con un trastorno de esquizofrenia, privilegia la combinación de estrategias cognitivas y psicosociales. Paradigma de esta corriente, el programa IPT (Integrated Psychological Treatment) ha sido objeto de varios estudios controlados ...

show abstract

A randomized comparison of group cognitive‐behavioural therapy and group psychoeducation in patients with schizophrenia

Abstract: The brief group CBT intervention showed some superiority to the PE programme, which could be of considerable clinical and economical importance.

Cited by 110 publications

References 34 publications

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

Le programme de réhabilitation cognitive et comportementale IPT (Integrated Psychological Treatment) dans un contexte psychiatrique ambulatoire : étude clinique

Contact Info

Product

Resources

About