Researchers from the Perelman School of Medicine at the University of Pennsylvania found that cognitive therapy improved daily functioning and quality of life among the lowest-functioning, most impaired cases of schizophrenia.
It is estimated that between 2 and 3 million American adults have schizophrenia. Unfortunately, despite medical treatments, about one-third to one-half of patients with schizophrenia continue to experience residual symptoms and/or cannot tolerate medications.
“Mental health professionals often give up on the lowest-functioning cases of schizophrenia and may say that they are not capable of improving,” said Paul Grant, Ph.D., lead author of the study.
Cognitive therapy was developed by Beck and Albert Ellis in the 1970s and seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses. Patients are aided in developing skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors
In the current randomized, single-blind, controlled trial, 60 adults with schizophrenia from Philadelphia received cognitive therapy plus standard treatment, or standard treatment alone.
Standard treatment included antipsychotic medication, at least, as well as psychosocial services provided by local community mental health centers.
Researchers adapted the cognitive program to focus on the patients’ interests, assets and strengths. The intervention was intentionally designed to promote recovery by helping patients identify and achieve concrete goals for improving quality of life and reintegration into society.
Treatment targeted specific defeatist beliefs (“if I partially fail it is as bad as being a complete failure”) that earlier research has identified as blocks to patients engaging in constructive activity.
After 18 months of therapy, patients in the cognitive therapy group were encouraged to set goals related to their everyday functioning. Researchers observed that as they became motivated to engage in tasks they moved out of their withdrawn state.
This increase in activity and motivation put the patients more in touch with reality and reduced hallucinations, delusions, and disorganized speech. The cycle continued as engagement in activity led to better functional outcomes and motivation, which facilitated continued improvement of symptoms.
Researchers believe these patients have more potential than their care providers and family members may have thought possible.
According to investigators, the next stage is to train community therapists to deliver the recovery-oriented cognitive therapy in community mental health agencies.
“Our results suggest that cognitive therapy can improve quality of life, reduce symptoms, and promote recovery in these patients. This intervention can help these patients improve to the point where they may be able to move up to the next level in psychosocial functioning – i.e. going from being unemployed to volunteering part-time; not being in school to enrolling in night classes; not socializing to having a weekly social contact and making a friend or two.”
In the United States, nearly $63 billion is spent annually on overall direct treatment costs and indirect costs incurred due to lost employment and productivity, for an average of between $26,000 and $31,000 per patient, which is five times greater than the per-patient cost of depression.
“Our study suggests that cognitive therapy might have utility to help reduce public health costs for the most expensive per-patient psychiatric population while simultaneously improving patients’ quality of life,” said Aaron T. Beck, M.D., senior author of the study.
The study appears in the journal Archives of General Psychiatry.