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Judith S. Beck, Ph.D.

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Hope for Patients With Severe Schizophrenia

Posted: 10/19/11 01:17 PM ET

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 People with severe schizophrenia are usually withdrawn, isolated and unable to engage in basic day-to-day functioning.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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04:00 PM on 10/27/2011
A ten point jump in the global functioning scale is not particularly dramatic. While I believe wholeheartedly in CBT an important point to wonder is what gains will the client sustain AFTER therapy has ceased? Will there be regression and how quickly might it occur? Also, in this day and age the gov't. (federal, state AND local) is drastically reducing the amount of dollars available for care. I am not a fan of medications at all but is it possible the research is overstating the effectiveness of its results??
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ZENNEPHI
05:45 PM on 10/25/2011
Having been a part of the Proactive Mental Health Programme for the better of the
last 25 years, I can attest to the "Trials and Tribulations" of discovering the Key
innate ingredients in Nueroleptic Pharmacologies.
In my [Schiz-Affects/Bi-Pole] Mindset, Bio-Feed {Zen-tec} or "Self-Talk"; has issued
me remedial care in honeing in on Required tasks and requirements of a Well-Regimented
Day. I manage a Home Vocational Occupation, with few "lapses" in Promental Health
Accuities. I shun "Self Isolation" and have studiously aimed for the privledge of returning
something to the Communal/Community I reside in.
I maintain "Full Post Cognitive Recollection Skills" in the {Kraft} of Home Journal Parelells.
Now that I have survived the "Brain-Jello" era of 1st Generation physcotroupics, and side-
effect Meds for the side effect Medications; I render myself with steadfastness as a Con-
sumer Leaison to fellow Consumers of Drug {rx} and Substance Empowerment and
referall. Subsequently "Bridging" with the National Allience of the Mentally ill. [NAMI]
..."Join us Monday Class, When We'll Discuss on How Dr Frued Did Enough COKE to
Kill a Small Horse..." NAMASTE
10:50 PM on 11/01/2011
Keep on, keepin' on, there, Zennephi. Namaste.
photo
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DJ Jaffe
Founder, Mental Illness Policy Org.
12:01 AM on 10/24/2011
The author fails to state that the CBT therapy was in addition to "standard treatment" (presumably neuroleptics) and not in lieu of them. That is important because some are proposing talk therapy as alternative to standard treatments. I wish the author had mentioned this important fact.
DJ Jaffe
http://mentalillnesspolicy.org
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Norge
Rolf K. Artist, worker of metal, writer of poems
08:46 AM on 10/20/2011
I have worked in the area for some years and with folks with serious negative symptoms of which affected their motivation factors etc.
I am very glad for new research coming continuously which can be helpfull for the many millions so affected by the serious life quality reduction illness.
The past 30 years has seen a revolution in new thinking and methods for helping this group of people and much has been accomplished in different countries of the world.

By finally doing away with the hollywood produced versions of the illness has helped enormously
to reduce the social stigma of such a serious illness. And it really is a cureable illness and more and more will eventually become well.

http://www.bcss.org

Rolf Krogsæther
01:34 AM on 10/20/2011
My experience with the mental health field is that psychotherapy is an even bigger waste of money that psychiatry, which is itself pointless. (And no, I am not a Scientologist. I am merely a survivor of the US mental health industry.)

My experience with mental health has also taught me that the members of the field will try to manipulate the data of any study to justify their paychecks and/or prescribe their drug of choice.

Mental health has absolutely nothing to do with "helping" others. It only "helps" for so long as it can define and identify the problem-- there is absolutely no input from the patient, who is after all quite mad-- and then it offers preconceived solutions for the preconceived problem. Helping others only helps them collect a nice middle class paycheck.

Sorry, but color me unimpressed.
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miamorphos
07:54 AM on 10/22/2011
This is an interesting post. I can imagine it's very difficult to deal with a client or patient who is determined at the onset that "mental health has absolutely nothing to do with helping others" and the people in the field are all there for purely financial motives.

A good therapist would try to see if they could break through that defensiveness. Is there literally no instance in the history of Western psychiatry or psychology in which a doctor or therapist was happy to see a patient improve? Has there literally never been a patient who improved? If the patient, or you rather, could be brought to look at the onesidedness of the negative attitude, it's possible that you will maybe see that there are some distorted thoughts occurring that make the negative outcome inescapable.

If you are functioning and able to maintain a fairly steady course in life, you probably don't need therapy or "medication." (I'm not a Scientologist, but I am inherently mistrustful of knocking people out with sedatives and tranquillizers or ramping them up with amphetamines.) You're probably better off focused on maintaining a household and getting income and managing spending -- in short, "normal" life. I think that if you can function without it, you ought to stay far, far away from therapy or psychiatry. Your attitude will guarantee that these professionals cannot help you.