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Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China

  • Z.-J. Li (a1), Z.-H. Guo (a1), N. Wang (a1), Z.-Y. Xu (a1), Y. Qu (a2), X.-Q. Wang (a3), J. Sun (a4), L.-Q. Yan (a5), R. M. K. Ng (a6), D. Turkington (a7) and D. Kingdon (a8)...

Abstract

Background

Meta-analyses support the efficacy of cognitive–behavioural therapy (CBT) for schizophrenia in western cultures. This study aimed to compare the efficacy of CBT and supportive therapy (ST) for patients with schizophrenia in China.

Method

A multicentre randomized controlled, single-blinded, parallel-group trial enrolled a sample of 192 patients with schizophrenia. All patients were offered 15 sessions of either CBT or ST over 24 weeks and followed up for an additional 60 weeks. All measures used were standardized instruments with good reliability and validity. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptoms of schizophrenia. The Schedule for Assessing Insight (SAI) was used to assess patients’ insight and the Personal and Social Performance Scale (PSP) was used to assess their social functioning.

Results

Effect-size analysis showed that patients made rapid improvements in all symptoms, insight and social functioning as measured by the PANSS, SAI and PSP at 12 and 24 weeks and maintained these improvements over the course of the study to 84 weeks. Patients in the CBT group showed significantly greater and more durable improvement in PANSS total score (p = 0.045, between-group d = 0.48), positive symptoms (p = 0.018, between-group d = 0.42) and social functioning (p = 0.037, between-group d = 0.64), with significant differences emerging after completion of therapy.

Conclusions

Both CBT and ST combined with medication had benefits on psychopathology, insight and social functioning of patients with schizophrenia. CBT was significantly more effective than ST on overall, positive symptoms and social functioning of patients with schizophrenia in the long term.

Copyright

Corresponding author

* Address for correspondence: Z. J. Li, Ph.D., M.D., Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Hutong, Deshengmen Wai, Xicheng District, Beijing 100088, People's Republic of China. (Email : lizhj8@ccmu.edu.cn)

References

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Alphs, L, Bossie, CA, Sliwa, JK, Fu, DJ, Ma, YW, Hulihan, J (2013). Paliperidone palmitate and risperidone long-acting injectable in subjects with schizophrenia recently treated with oral risperidone or other oral antipsychotics. Neuropsychiatric Disease and Treatment 9, 341350.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association: Washington, DC.
Apiquian, R, Ulloa, RE, Herrera-Estrella, M, Moreno-Gómez, A, Erosa, S, Contreras, V, Nicolini, H (2009). Validity of the Spanish version of the Personal and Social Performance scale in schizophrenia. Schizophrenia Research 112, 181186.
Brissos, S, Palhavã, F, Marques, JG, Mexia, S, Carmo, AL, Carvalho, M, Dias, C, Franco, JD, Mendes, R, Zuzarte, P, Carita, AI, Molodynski, A, Figueira, ML (2012). The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 47, 10771086.
Burns, T, Patrick, D (2007). Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatrica Scandinavica 116, 403418.
Citrome, L, Meng, X, Hochfeld, M (2011). Efficacy of iloperidone in schizophrenia: a PANSS five-factor analysis. Schizophrenia Research 131, 7581.
David, AS (1990). Insight and psychosis. British Journal of Psychiatry: The Journal of Mental Science 156, 798808.
First, MB, Gibbon, M (1997). User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I): Clinician Version. American Psychiatric Publishing Incorporated: Washington, DC.
Freeman, D, Garety, P, Fowler, D, Kuipers, E, Dunn, G, Bebbington, P, Hadley, C (1998). The London–East Anglia randomized controlled trial of cognitive–behaviour therapy for psychosis IV: Self-esteem and persecutory delusions. British Journal of Clinical Psychology 37, 415430.
Grant, PM, Huh, GA, Perivoliotis, D, Stolar, NM, Beck, AT (2012). Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry 69, 121127.
Jerrell, JM, Hrisko, S (2013). A comparison of the PANSS Pentagonal and Van der Gaag 5-factor models for assessing change over time. Psychiatry Research 207, 134139.
Jiang, JF, Wei, JY, Bia, MJ, Xu, YF, Gu, JY (2008). Effect of cognitive behavioral intervention on recovery of social function of patients with schizophrenic. Morden Nursing 14, 701702 (in Chinese).
Kay, S, Fiszbein, A, Opler, L (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Kazantzis, N, Whittington, C, Dattilio, F (2010). Meta-analysis of homework, effects in cognitive and behavioral therapy: a replication and extension. Clinical Psychology: Science and Practice 17, 144156.
Kingdon, DG, Turkington, D (2004). Cognitive Therapy of Schizophrenia. Guilford Press: New York.
Kreyenbuhl, J, Buchanan, RW, Dickerson, FB, Dixon, LB, Dixon, LB (2010). The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophrenia Bulletin 36, 94103.
Kuipers, E, Garety, P, Fowler, D, Freeman, D, Dunn, G, Bebbington, P (2006). Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms. Schizophrenia Bulletin 32 (Suppl. 1), S24S31.
Lysaker, PH, Lancaster, RS, Nees, MA, Davis, LW (2004). Attributional style and symptoms as predictors of social function in schizophrenia. Journal of Rehabilitation Research and Development 41, 225232.
Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323329.
Morrison, AK (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont) 6, 32.
Morrison, AP, Hutton, P, Wardle, M, Spencer, H, Barratt, S, Brabban, A, Callcott, P, Christodoulides, T, Dudley, R, French, P (2011). Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial. Psychological Medicine 42, 1049.
Naeem, F, Kingdon, D (2011). Cognitive Therapy for Psychosis in Beijing, Cognitive Behaviour Therapy in Non Western Cultures. Nova Science Publishers: New York.
National Institute for Clinical Excellence (ed.) (2003). Guidelines for Psychological Treatment in Schizophrenia. Gaskell Press: London.
National Institute for Health and Care Excellence (2014). Psychosis and Schizophrenia in Adults: Treatment and Management. Centre for Clinical Practice at NICE: London.
National Institute for Health and Clinical Excellence (2009). Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care. National Collaborating Centre for Mental Health: London.
Ng, R (2006). Cultural Adaptation of Cognitive Therapy in Hong Kong Chinese, International Handbook of Cultural Psychiatry. Taylor & Francis: London.
Penn, DL, Meyer, PS, Evans, E, Wirth, RJ, Cai, K, Burchinal, M (2009). A randomized controlled trial of group cognitive–behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophrenia Research 109, 5259.
Penn, DL, Mueser, KT, Tarrier, N, Gloege, A, Cather, C, Serrano, D, Otto, MW (2004). Supportive therapy for schizophrenia. Schizophrenia Bulletin 30, 101112.
Rathod, S, Kingdon, D, Weiden, P, Turkington, D (2008). Cognitive–behavioral therapy for medication-resistant schizophrenia: a review. Journal of Psychiatric Practice 14, 2233.
Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, O'Carroll, M, Barnes, TRE (2000). A randomized controlled trial of cognitive–behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry 57, 165172.
Si, T, Shu, L, Su, Y, Tian, C, Yan, J, Cheng, J, Li, X, Liu, Q, Ma, Y, Zhang, W, Zhang, H (2011). The Chinese version of the Personal and Social Performance Scale (PSP): validity and reliability. Psychiatry Research 185, 275279.
Si, T, Yang, J, Shu, L, Wang, X, Kong, Q, Zhou, M, Li, X, Liu, C (2004). The reliability, validity of PANSS and its implication. Chinese Journal of Mental Health 18, 4547.
Sim, K, Su, A, Fujii, S, Yang, S, Chong, MY, Ungvari, GS, Si, T, Chung, EK, Tsang, HY, Chan, YH (2004). Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. British Journal of Clinical Pharmacology 58, 178183.
Tarrier, N, Lewis, S, Haddock, G, Bentall, RP, Drake, R, Kinderman, P, Kingdon, D, Siddle, R, Everitt, J, Leadley, K (2004). Cognitive–behavioural therapy in first-episode and early schizophrenia 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry 184, 231239.
Tarrier, N, Yusupoff, L, Kinney, C, McCarthy, E, Gledhill, A, Haddock, G, Morris, J (1998). Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. British Medical Journal 317, 303307.
Turner, DT, Gaag, M, Karyotaki, E, Cuijpers, P (2014). Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. American Journal of Psychiatry 171, 523538.
Velligan, DI, Lam, Y, Glahn, DC, Barrett, JA, Maples, NJ, Ereshefsky, L, Miller, AL (2006). Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophrenia Bulletin 32, 724742.
Wang, CH, Li, Y, Zhao, Z, Pan, M, Feng, JG, Sun, FG, Du, BG (2004). Controlled study on long -term effect of cognitive behavior intervention on first episode schizophrenia. Chinese Mental Health Journal 17, 200202.
Warman, DM, Beck, AT (2003). Cognitive behavioral therapy for schizophrenia: an overview of treatment. Cognitive and Behavioral Practice 10, 248254.
Winston, A, Rosenthal, RN, Pinsker, H (2004). Introduction to Supportive Psychotherapy. American Psychiatric Publishing Incorporated: New York.
World Health Organization (2011). Schizophrenia (http://www.who.int/mental_health/management/schizophrenia/en/). Accessed 19 June 2014.
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523537.
Xu, Z, Guo, ZH, Fu, ZY, Wang, N, Zhang, Y (2013). Reliability and validity of the Chinese version of the Schedule for Assessment of Insight. Chinese Journal of Behaviour Medicine and Brain Science 22, 752754.
Zuo, XC, Liu, SK, Yi, ZY, Xie, ZH, Li, HD (2006). Steady-state pharmacokinetic properties of aripiprazole 10 mg PO q12h in Han Chinese adults with schizophrenia: a prospective, open-label, pilot study. Current Therapeutic Research, Clinical and Experimental 67, 258269.

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