Befriending versus CBT for Schizophrenia: A Convergent and Divergent Fidelity Check

Abstract

Befriending (BF) has received attention as a beneficial part of mental health care. For example, when compared with cognitive-behavioural therapy (CBT) for schizophrenia, BF was found to be as effective as CBT in terms of initial symptom improvement (Sensky et al., 2000). Why was the BF apparently so effective? Was the BF really a discrete and powerful intervention? Or was it simply an unrecognized aspect of regular CBT? We addressed these questions by first observing BF's convergence with "social support" (a plausibly discrete treatment) and, second, by examining its divergence from CBT, drawing on archival data. For the convergence prediction we correlated the speech content of therapists' in 10 BF sessions from the Sensky et al. study with previously published social support data from stylists working with people with severe mental health problems in a psychiatric hospital (Milne and Netherwood, 1997). For the second prediction the same 10 BF sessions were compared with a sample of 10 CBT sessions, also from the Sensky et al. study. The results indicated that BF was indeed significantly correlated (converged) with social support (r = 0.7; p < .05), and also that it did differ (diverged) significantly from CBT (p < .05). As a treatment fidelity check, therefore, these findings indicate tentatively that the two treatments in the Sensky et al. (2000) study were appropriately implemented. As an analysis of effective interventions for schizophrenia, it cautiously suggests that "social support" merits serious attention, and is perhaps no mere placebo.

Using attachment theory to inform the design and delivery of mental health services: A systematic review of the literature

“…Berry and Drake () recommend that staff should be encouraged to engage in one‐to‐one activities with patients to facilitate the development of secure staff–patient relationships. The importance of social relationships to recovery is also highlighted by research showing the potential benefits of befriending interventions in people with a diagnosis of schizophrenia (Milne, Wharton, James, & Turkington, ).…”

Learning through Cognitive Milieu Therapy among Inpatients with Dual Diagnosis: A Qualitative Study of Interdisciplinary Collaboration

“…Common factors, such as instillation of hope, trust, and mutual goals of the therapy developed by the patients and the staff together, also are important. These qualities are also called "befriending" and seem to be important as a form of social support in order to keep up an active engagement of patients in mental health care (Milne, Wharton, James, & Turkington, 2006). Kingdon and Turkington (2005) argue that there is no evidence showing that befriending alone has a lasting effect, but that it may be useful in relational work in CBT.…”

“…However, Sensky and coworkers (2000) found befriending to be equally useful as CBT for patients with schizophrenia. Milne et al (2006) outline that this should be focused on in future studies as part of an optimal social therapy form of CBT. Qualitative studies may be useful in addressing this.…”

“…A holding environment, good interpersonal relationships, and being met on equal terms in a predictable and structured framework provide an essential foundation that contributes to a patient being motivated for treatment. These qualities are also called "befriending" and seem to be important as a form of social support in order to keep up an active engagement of patients in mental health care (Milne, Wharton, James, & Turkington, 2006). These features engender feelings of recognition, cooperation, and personal value in patients (Borge & Fagermoen, 2008;Borge & Hummelvoll, 2008;Scaturo, 2010;Stickley & Freshwater, 2009).…”

Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost?: a randomised controlled trial.

“…An analysis of session content indicated that the befriending was distinct from CBT, and a conclusion was drawn that social support is "no mere placebo". 34 During protocol development for the Befriending and Costs of Caring (BECCA) project, a literature search was undertaken for befriending schemes for family carers of people with dementia. No quantitative research trials were found for the use of befriending volunteers to support carers.…”