Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older People With Schizophrenia

Granholm, Eric; McQuaid, John R.; McClure, Fauzia Simjee; Link, Peter C.; Perivoliotis, Dimitri; Gottlieb, Jennifer D.; Patterson, Thomas L.; Jeste, Dilip V.

doi:10.4088/jcp.v68n0510

Cited by 108 publications

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“…We previously reported that participants in CBSST showed greater skills acquisition and superior self-reported functioning relative to participants in TAU at end of treatment (Granholm et al 2005) and these gains were maintained at 1-year follow-up (Granholm et al 2007). The present study found that neuropsychological impairment was a nonspecific predictor of skills acquisition and functional outcome in CBSST.…”

Section: Discussionmentioning

confidence: 91%

“…A composite score of five ILSS domains (appearance & clothing, personal hygiene, health maintenance, transportation, leisure and community) assessed selfreported basic and social functioning activities performed in the past month. The ILSS has been found to be reliable and sensitive to differences between healthy controls and older people with schizophrenia (Perivoliotis et al 2004), and was sensitive to treatment effects in our prior CBSST trial (Granholm et al 2005;2007).…”

Section: Functional Outcome Measuresmentioning

confidence: 86%

“…Additional details of study methodology, participant characteristics, and specifics of the interventions can be found elsewhere (Granholm et al 2002;Granholm et al 2004;Granholm et al 2005;McQuaid et al 2000). et al 2004), and was sensitive to treatment effects in our prior CBSST trial (Granholm et al 2005;2007). …”

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confidence: 87%

“…Only a few other studies have examined psychotherapy interventions for the growing population of older people with schizophrenia (Bartels et al 2004;Pratt et al 2006;Patterson et al 2006). In a randomized controlled trial comparing treatment as usual (TAU) with TAU plus group CBSST (Granholm et al 2005), we previously found significantly greater skill acquisition and functioning in CBSST relative to TAU at the end of treatment, and these benefits were maintained at 12-month posttreatment follow-up (Granholm et al 2007). …”

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confidence: 99%

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Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Granholm

McQuaid

Link

et al. 2008

Schizophrenia Research

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Cognitive Behavioral Social Skills Training (CBSST) is a 24-session weekly group therapy intervention to improve functioning in people with schizophrenia. In our prior randomized clinical trial comparing treatment as usual (TAU) with TAU plus group CBSST (Granholm et al. 2005), participants with schizophrenia in CBSST showed significantly better functional outcome than participants in TAU. The present study was a secondary analysis of neuropsychological predictors of functional outcome in our prior CBSST trial. We examined (1) whether neuropsychological impairment at baseline moderated functional outcome in CBSST relative to TAU, and (2) whether improvement in neuropsychological abilities mediated improvement in functional outcome in CBSST. Attention, verbal learning/memory, speed of processing, and executive functions were assessed at baseline, end of treatment, and 12-month follow-up. Greater severity of neuropsychological impairment at baseline predicted poorer functional outcome for both treatment groups (nonspecific predictor), but the interaction between severity of neuropsychological impairment and treatment group was not significant (no moderation). Effect sizes for the difference between treatment groups on functional outcome measures at 12-month follow-up were similar for participants with relatively mild (d=.44-.64) and severe (d=.29-.60) neuropsychological impairment. Results also did not support the hypothesis that improvement in neuropsychological abilities mediated improvement in functioning in CBSST. Adding CBSST to standard pharmacologic care, therefore, improved functioning relative to standard care alone, even for participants with severe neuropsychological impairment, and this improvement in functioning was not related to improvement in neuropsychological abilities in CBSST. KeywordsSchizophrenia; cognitive behavior therapy; social skills training; neuropsychological impairment; functioning Please address all correspondence to: Eric Granholm, Ph.D., VA San Diego Healthcare System (116B), 3350 La Jolla Village Drive, San Diego, CA 92161, Phone: (858) 552-8585 x 7768, FAX: (858) 642-6416, Email: egranholm@ucsd.edu. Publisher's Disclaimer: 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 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. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThere is considerable evidence that neuropsychological impairment is associated with poor functioning in people with schizophrenia (Bowen et al. 1994;Green et al. 2000;Kern et al. 1992;Lysaker et al. 1995;McKee et al. 1997;Penn et al. 1995). Neuropsychological impairment is also a strong predictor ...

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Section: Discussionmentioning

confidence: 91%

Section: Functional Outcome Measuresmentioning

confidence: 86%

mentioning

confidence: 87%

mentioning

confidence: 99%

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Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Granholm

McQuaid

Link

et al. 2008

Schizophrenia Research

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“…We previously reported that middle-aged and older people with schizophrenia who received group cognitive-behavioral social skills training (CBSST) had significantly greater self-reported everyday functioning and coping skills knowledge than those who received treatment as usual (TAU) [9]. Improvements in everyday functioning and coping skills knowledge were maintained in the CBSST group compared with the TAU group at 12-month posttreatment follow-up [10].…”

Section: Introductionmentioning

confidence: 93%

Insight and treatment outcome with cognitive-behavioral social skills training for older people

Emmerson

Granholm²,

Link³

et al. 2009

JRRD

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Abstract-Poor insight (awareness of having a mental illness that requires treatment) is common in schizophrenia and typically predicts poor outcome, yet greater insight has been linked to negative outcomes, including hopelessness. This study focused on two questions: (1) Does insight moderate the effects of cognitive-behavioral social skills training (CBSST) on functional outcomes in schizophrenia? (2) Does a specific type of insight (e.g., awareness of illness, need for treatment) predict benefit from CBSST? We examined insight as a predictor of everyday functioning in a randomized controlled trial of CBSST versus treatment as usual (TAU) for middle-aged and older people with schizophrenia (n = 62). We used linear regression models to examine moderators of the relationship between baseline insight and everyday functioning measured 12 months following completion of the 6-month intervention. Insight, especially insight into the need for treatment, moderated the relationship between treatment group and everyday functioning (Independent Living Skills Survey), such that CBSST offset the negative effect of insight on functioning observed with TAU (wherein greater insight was related to poorer everyday functioning). Post hoc analyses showed that reduction of insight-linked hopelessness may have accounted for the positive effect of CBSST on functioning relative to TAU. Clinical

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Effect of Antipsychotic Medication Alone vs Combined With Psychosocial Intervention on Outcomes of Early-Stage Schizophrenia

Guo¹,

Zhai²,

Liu³

et al. 2010

Arch Gen Psychiatry

126

107

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Context Antipsychotic drugs are limited in their ability to improve the overall outcome of schizophrenia. Adding psychosocial treatment may produce greater improvement in functional outcome than does medication treatment alone. Objective To evaluate the effectiveness of antipsychotic medication alone versus combined with psychosocial intervention on outcomes of early stage schizophrenia. Design, Setting, and Participants Randomized controlled trial of a clinical sample of 1268 patients with early stage schizophrenia, conducted at 10 clinical sites in China from 2005–2007. Intervention Patients were randomly assigned to antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention, consisting of psycho-education, family intervention, skills training and cognitive-behavioral therapy, administered over 48 group sessions. Main Outcome Measures The rate of treatment discontinuation or change due to any cause, relapse or remission, and assessments of insight, treatment adherence, quality of life and social functioning. Results The rates of treatment discontinuation or change due to any cause were 32.8% in the combined treatment group and 46.8% in the medication alone group. Comparisons with medication treatment alone showed lower risk for any cause discontinuation with combined treatment (hazard ratios [HR], 0.62; 95% confidence interval [CI], 0.52–0.74; p<0.001); and lower risk for relapse with combined treatment (HR, 0.57; 95%CI, 0.44–0.74; p<0.001). The combined treatment group exhibited greater improvement in insight (p<0.001), social functioning (p=0.002), activities of daily living (p<0.001), and in 4 domains of quality of life as measured by Medical Outcome Study Short-Form 36-item questionnaire (all p-values<0.02). Furthermore, a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education (p=0.001). Conclusions Compared to those receiving medications only, early stage schizophrenia patients receiving medications and psychosocial intervention had a lower rate of treatment discontinuation or change, lower risk of relapse, and improved insight, quality of life and social functioning.

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Randomized Controlled Trial of Cognitive Behavioral Social Skills Training for Older People With Schizophrenia

Cited by 108 publications

References 0 publications

Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Neuropsychological predictors of functional outcome in Cognitive Behavioral Social Skills Training for older people with schizophrenia

Insight and treatment outcome with cognitive-behavioral social skills training for older people

Effect of Antipsychotic Medication Alone vs Combined With Psychosocial Intervention on Outcomes of Early-Stage Schizophrenia

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