University of Minnesota
Journal of Cognitive Psychotherapy: An International Journal, 12, (1) 13-25, 1998 Abstract
Cognitive-behavioural treatment (CBT) has rarely been applied as the primary treatment for the multiple, severe and persistent problems that characterize schizophrenia. This case study describes the process of CBT in the long-term outpatient care of a young woman with schizophrenia. The study highlights the adaptation of cognitive-behavioural strategies to the unique needs of schizophrenia and presents data regarding clinical outcomes in this case. Measures of psychosocial functioning, severity of symptoms, attainment of treatment goals and hospitalisation data were used to assess change over the 3- year treatment period and at 1-year follow-up. Results indicate considerable improvement in all outcome variables and maintenance of treatment gains. These findings suggest the potential usefulness of cognitive-behavioural interventions in the treatment of schizophrenia. Introduction
Cognitive-behavioural treatment (CBT) has been widely used and its effectiveness established with numerous patient populations and problems (Beck, 1993). However, there has been limited application of CBT techniques in the treatment of persons with schizophrenia and little research regarding its efficacy with this population. This neglect may be due to the dominance of pharmacological treatment and the decline of psychotherapy, the severity of the disorder, or the inadequacies of previous attempts to understand and manage schizophrenia from a cognitive behavioural framework (Birchwood & Preston, 1991; Goggin, 1993) There is a growing commitment to the design of psychotherapeutic treatments that are grounded in knowledge of the psychopathology of specific diagnostic groups and tailored to the unique needs of the population (Hogarty et al., 1995; Liberman, 1993). This paper will highlight current clinical findings and critical issues regarding schizophrenia that must be considered in order to develop an effective "disorder relevant" cognitive-behavioural treatment of schizophrenia. A model of CBT of schizophrenia responsive to these issues will be described and illustrated by a detailed case study. Schizophrenia: Current Research and Critical Issues
Schizophrenia is defined by positive symptoms (hallucinations and delusions), disorganised speech and behavior, negative symptoms (affective flattening, abolition, etc.) and significant impairment of psychosocial functioning. While it has been considered a uniformly chronic and progressively debilitating disorder, recent long-term outcome studies suggest the course and outcome of schizophrenia is quite varied and that outcomes can be significantly influenced by medications and psychosocial interventions (Carpenter & Strauss, 1991; McGlashan, 1988). Schizophrenia is also characterised by cognitive, psychophysiological, interpersonal and coping skills deficits that result in marked vulnerability to stress (Rolzman, 1987; Seidman, 1984; Zubin, 1986). Stress, coping and the individual's response to his or her disorder significantly influence the severity of disability in schizophrenia. Relapse is frequent and there are identifiable prodromal symptoms and stages of decompensation that involve problems in affective regulation and management of stress (Herz, 1985, 1989). Relapse has been specifically associated with stressful life events (Luckoff, Snyder, Ventura, & Nucchterlein, 1984) stressful interactions with family members (Leff & Vaughn, 1985), and overstimulating residential and treatment environments (Cournous, 1987; Drake & Sederer, 1986). Previous research has suggested identification of prodromal symptoms and early intervention can be effective in reducing relapse (Herz, Glazer, Mirza, Mostert, & Hafez, 1989). There are also discrete phases in the process of recovery that need to be...