Carl Sherman, Contributing Writer

[Clinical Psychiatry News 27(9):1,2 1999. © 1999 International Medical News Group.

HAMBURG, GERMANY -- Cognitive behavioral therapy may have a good deal to offer schizophrenic patients whose positive symptoms have been refractory to medication alone, Dr. David Kingdon said at the 11th World Congress of Psychiatry.

In a recent study, a CBT protocol that included rational discussion of delusional content and the subjective nature of hallucinations was associated with a 50% reduction in symptoms persisting well beyond the conclusion of therapy, said Dr. Kingdon of the Nottingham Healthcare Trust, England.

Three or four randomized controlled trials using the Beckian model of cognitive therapy -- a type of CBT with strong emphasis on cognitive aspects -- have previously demonstrated improvements in psychosis, particularly for persistent positive symptoms.

The study that Dr. Kingdon reported involved 90 patients whose symptoms had failed to respond adequately to pharmacotherapy. The symptoms were predominantly positive but in some cases negative as well.

Forty-six patients were given CBT, and 44 received "befriending" therapy, a control condition in which patients met regularly with a therapist who focused on "neutral, nonthreatening topics" in an empathic, supportive, nonconfrontational way but refrained from active therapeutic interventions.

In the CBT sessions, patients were encouraged to discuss the content of their delusions -- where they came from, why they were important to them -- and led to consider alternative explanations. The subjective nature of hallucinations was explored rationally, and negative symptoms addressed with such standard CBT techniques as goal setting, scheduling of activities, and the use of diaries.

Nine months after initiation of therapy, symptoms were halved in both the CBT and control group. "We didn't expect 'befriending' to be so successful," Dr. Kingdon said.

But at follow-up 9 months later, a significant difference emerged: the symptoms of patients who had received CBT continued to decline, while those of the "befriending therapy" group returned to previous levels.

Patients expressed satisfaction with both types of therapy but reported that they felt "their difficulties had been taken seriously" significantly more often with CBT, and also that they had been helped in finding ways to cope, Dr. Kingdon said.

A member of the audience observed that the sessions were spread out rather thinly -- a mean 18.5 sessions over the 9-month treatment period. Dr. Kingdon replied that a more intensive schedule had been tried, with as many as twice-weekly sessions, but the number of sessions was generally cut back when patients became emotionally aroused by the material.