Group Cognitive Behavior Therapy or Social Skills Training for Individuals With a Recent Onset of Psychosis?

Department of Psychology, Université de Montréal, Quebec, Canada.
The Journal of nervous and mental disease (Impact Factor: 1.69). 01/2009; 196(12):866-75. DOI: 10.1097/NMD.0b013e31818ee231
Source: PubMed


This study aimed at determining the effectiveness of group cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness-social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures (baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in improvements on positive and negative symptoms compared with the wait-list control group, with the CBT group having significant effects over time on overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising intervention for individuals with recent onset of psychosis and their mental health professionals.

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    • "If more than one paper reported results from the same trial, we combined the results of these papers to provide the most complete data on post-treatment outcomes of negative symptoms. For comparison reasons, if a trial involved two control conditions (Tarrier et al. 1999; Garety et al. 2008; Lecomte et al. 2008), we chose to compare the CBT arm with the condition arm most resembling treatment as usual (TAU). In addition, we separated out trials specifically designed to reduce negative symptoms from those in which negative symptoms were examined as a secondary outcome measure. "
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    ABSTRACT: Background: There is an increasing interest in cognitive-behavioural therapy (CBT) interventions targeting negative symptoms in schizophrenia. To date, CBT trials primarily focused on positive symptoms and investigated change in negative symptoms only as a secondary outcome. To enhance insight into factors contributing to improvement of negative symptoms, and to identify subgroups of patients that may benefit most from CBT directed at ameliorating negative symptoms, we reviewed all available evidence on these outcomes. Method: A systematic search of the literature was conducted in PsychInfo, PubMed and the Cochrane register to identify randomized controlled trials reporting on the impact of CBT interventions on negative symptoms in schizophrenia. Random-effects meta-analyses were performed on end-of-treatment, short-term and long-term changes in negative symptoms. Results: A total of 35 publications covering 30 trials in 2312 patients, published between 1993 and 2013, were included. Our results showed studies' pooled effect on symptom alleviation to be small [Hedges' g = 0.093, 95% confidence interval (CI) -0.028 to 0.214, p = 0.130] and heterogeneous (Q = 73.067, degrees of freedom = 29, p < 0.001, τ 2 = 0.081, I 2 = 60.31) in studies with negative symptoms as a secondary outcome. Similar results were found for studies focused on negative symptom reduction (Hedges' g = 0.157, 95% CI -0.10 to 0.409, p = 0.225). Meta-regression revealed that stronger treatment effects were associated with earlier year of publication, lower study quality and with CBT provided individually (as compared with group-based). Conclusions: The co-occurring beneficial effect of conventional CBT on negative symptoms found in older studies was not supported by more recent studies. It is now necessary to further disentangle effective treatment ingredients of older studies in order to guide the development of future CBT interventions aimed at negative symptom reduction.
    Full-text · Article · Feb 2015 · Psychological Medicine
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    • "Huh, Perivoliotis, Stolar, & Beck, 2012; Gumley et al., 2003; Lecomte et al., 2008; Lysaker, Davis, Bryson, & Bell, 2009; Pilling et al., 2002). Of note, concurrent with a wealth of interest in CBT, interest has also increased in using a modified form of psychoanalytic therapy for people with schizophrenia. "
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    ABSTRACT: Empirical study of the long-term course of schizophrenia reveals that recovery is often possible and involves different experiences for different people who have the same psychiatric condition. While, for some, recovery may mean symptom remission or the achievement of psychosocial milestones, for others, recovery involves subjective changes in their experience of identity and agency in the world. We suggest that the recognition that recovery may involve the recapturing a sense of identity and agency points to the need for the development of integrative psychotherapy that can bring together a range of interventions under an internally consistent theoretical network, rather than merely a multitude of highly specific or isolated approaches. In this introduction to the special issue, we explore the rationale for the need for integrative approaches and possible theoretical basis that might enable an integrative approach to make full use of emerging empirical work from a range of perspectives. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
    Full-text · Article · Dec 2012 · Journal of Psychotherapy Integration
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    • "Such individual therapy approaches may be more effective later rather than earlier in the course of recovery (i.e., when clients are more stable) (C. Jackson et al., 2009; Lewis et al., 2002; Nick Tarrier et al., 2004), and it remains unclear whether group treatment confers greater benefits than individual treatments (Lecomte et al., 2008; Saksa, Cohen, Srihari, & Woods, 2009). Overall, individual therapy appears to have promise as a front line intervention for first episode psychosis (Haddock & Lewis, 2005; Harvey, Lepage, & Malla, 2007; Penn, Waldheter, Perkins, Mueser, & Lieberman, 2005). "
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    ABSTRACT: The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP+TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation.
    Full-text · Article · Feb 2011 · Schizophrenia Research
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