Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-18T18:55:09.444Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China

Published online by Cambridge University Press:  23 December 2014

Z.-J. Li ,
Z.-H. Guo ,
N. Wang ,
Z.-Y. Xu ,
Y. Qu ,
X.-Q. Wang ,
J. Sun ,
L.-Q. Yan ,
R. M. K. Ng  and
D. Turkington
...Show all authors
Z.-J. Li*
Affiliation:
Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
Z.-H. Guo
Affiliation:
Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
N. Wang
Affiliation:
Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
Z.-Y. Xu
Affiliation:
Department of Clinical Psychology, Beijing Key Lab of Mental Disorders, Beijing Anding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing, People's Republic of China
Y. Qu
Affiliation:
Beijing Huilongguan Hospital, Beijing, People's Republic of China
X.-Q. Wang
Affiliation:
Institute of Mental Health, Peking University (The Sixth Hospital, Peking University), Beijing, People's Republic of China
J. Sun
Affiliation:
Griffith Health Institute and School of Medicine, Griffith University, QLD 4222, Australia
L.-Q. Yan
Affiliation:
The Third Hospital of Chaoyang District, Beijing, People's Republic of China
R. M. K. Ng
Affiliation:
Department of Psychiatry, Kowloon Hospital, Hong Kong, People's Republic of China
D. Turkington
Affiliation:
University of Newcastle-on-Tyne, Newcastle, UK
D. Kingdon
Affiliation:
University of Southampton, Southampton, UK
*
* Address for correspondence: Z. J. Li, Ph.D., M.D., Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Hutong, Deshengmen Wai, Xicheng District, Beijing 100088, People's Republic of China. (Email : [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Meta-analyses support the efficacy of cognitive–behavioural therapy (CBT) for schizophrenia in western cultures. This study aimed to compare the efficacy of CBT and supportive therapy (ST) for patients with schizophrenia in China.

Method

A multicentre randomized controlled, single-blinded, parallel-group trial enrolled a sample of 192 patients with schizophrenia. All patients were offered 15 sessions of either CBT or ST over 24 weeks and followed up for an additional 60 weeks. All measures used were standardized instruments with good reliability and validity. The Positive and Negative Syndrome Scale (PANSS) was used to assess symptoms of schizophrenia. The Schedule for Assessing Insight (SAI) was used to assess patients’ insight and the Personal and Social Performance Scale (PSP) was used to assess their social functioning.

Results

Effect-size analysis showed that patients made rapid improvements in all symptoms, insight and social functioning as measured by the PANSS, SAI and PSP at 12 and 24 weeks and maintained these improvements over the course of the study to 84 weeks. Patients in the CBT group showed significantly greater and more durable improvement in PANSS total score (p = 0.045, between-group d = 0.48), positive symptoms (p = 0.018, between-group d = 0.42) and social functioning (p = 0.037, between-group d = 0.64), with significant differences emerging after completion of therapy.

Conclusions

Both CBT and ST combined with medication had benefits on psychopathology, insight and social functioning of patients with schizophrenia. CBT was significantly more effective than ST on overall, positive symptoms and social functioning of patients with schizophrenia in the long term.

Keywords

Cognitive–behavioural therapyrandomized controlled trialsschizophreniasupportive therapy
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 9 , July 2015 , pp. 1893 - 1905
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alphs, L, Bossie, CA, Sliwa, JK, Fu, DJ, Ma, YW, Hulihan, J (2013). Paliperidone palmitate and risperidone long-acting injectable in subjects with schizophrenia recently treated with oral risperidone or other oral antipsychotics. Neuropsychiatric Disease and Treatment 9, 341–350.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association: Washington, DC.Google Scholar
Apiquian, R, Ulloa, RE, Herrera-Estrella, M, Moreno-Gómez, A, Erosa, S, Contreras, V, Nicolini, H (2009). Validity of the Spanish version of the Personal and Social Performance scale in schizophrenia. Schizophrenia Research 112, 181–186.Google Scholar
Brissos, S, Palhavã, F, Marques, JG, Mexia, S, Carmo, AL, Carvalho, M, Dias, C, Franco, JD, Mendes, R, Zuzarte, P, Carita, AI, Molodynski, A, Figueira, ML (2012). The Portuguese version of the Personal and Social Performance Scale (PSP): reliability, validity, and relationship with cognitive measures in hospitalized and community schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology 47, 1077–1086.Google Scholar
Burns, T, Patrick, D (2007). Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatrica Scandinavica 116, 403–418.Google Scholar
Citrome, L, Meng, X, Hochfeld, M (2011). Efficacy of iloperidone in schizophrenia: a PANSS five-factor analysis. Schizophrenia Research 131, 75–81.Google Scholar
David, AS (1990). Insight and psychosis. British Journal of Psychiatry: The Journal of Mental Science 156, 798–808.Google Scholar
First, MB, Gibbon, M (1997). User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I): Clinician Version. American Psychiatric Publishing Incorporated: Washington, DC.Google Scholar
Freeman, D, Garety, P, Fowler, D, Kuipers, E, Dunn, G, Bebbington, P, Hadley, C (1998). The London–East Anglia randomized controlled trial of cognitive–behaviour therapy for psychosis IV: Self-esteem and persecutory delusions. British Journal of Clinical Psychology 37, 415–430.Google Scholar
Grant, PM, Huh, GA, Perivoliotis, D, Stolar, NM, Beck, AT (2012). Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry 69, 121–127.Google Scholar
Jerrell, JM, Hrisko, S (2013). A comparison of the PANSS Pentagonal and Van der Gaag 5-factor models for assessing change over time. Psychiatry Research 207, 134–139.Google Scholar
Jiang, JF, Wei, JY, Bia, MJ, Xu, YF, Gu, JY (2008). Effect of cognitive behavioral intervention on recovery of social function of patients with schizophrenic. Morden Nursing 14, 701–702 (in Chinese).Google Scholar
Kay, S, Fiszbein, A, Opler, L (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Kazantzis, N, Whittington, C, Dattilio, F (2010). Meta-analysis of homework, effects in cognitive and behavioral therapy: a replication and extension. Clinical Psychology: Science and Practice 17, 144–156.Google Scholar
Kingdon, DG, Turkington, D (2004). Cognitive Therapy of Schizophrenia. Guilford Press: New York.Google Scholar
Kreyenbuhl, J, Buchanan, RW, Dickerson, FB, Dixon, LB, Dixon, LB (2010). The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophrenia Bulletin 36, 94–103.Google Scholar
Kuipers, E, Garety, P, Fowler, D, Freeman, D, Dunn, G, Bebbington, P (2006). Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms. Schizophrenia Bulletin 32 (Suppl. 1), S24–S31.Google Scholar
Lysaker, PH, Lancaster, RS, Nees, MA, Davis, LW (2004). Attributional style and symptoms as predictors of social function in schizophrenia. Journal of Rehabilitation Research and Development 41, 225–232.Google Scholar
Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323–329.Google Scholar
Morrison, AK (2009). Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont) 6, 32.Google Scholar
Morrison, AP, Hutton, P, Wardle, M, Spencer, H, Barratt, S, Brabban, A, Callcott, P, Christodoulides, T, Dudley, R, French, P (2011). Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial. Psychological Medicine 42, 1049.Google Scholar
Naeem, F, Kingdon, D (2011). Cognitive Therapy for Psychosis in Beijing, Cognitive Behaviour Therapy in Non Western Cultures. Nova Science Publishers: New York.Google Scholar
National Institute for Clinical Excellence (ed.) (2003). Guidelines for Psychological Treatment in Schizophrenia. Gaskell Press: London.Google Scholar
National Institute for Health and Care Excellence (2014). Psychosis and Schizophrenia in Adults: Treatment and Management. Centre for Clinical Practice at NICE: London.Google Scholar
National Institute for Health and Clinical Excellence (2009). Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care. National Collaborating Centre for Mental Health: London.Google Scholar
Ng, R (2006). Cultural Adaptation of Cognitive Therapy in Hong Kong Chinese, International Handbook of Cultural Psychiatry. Taylor & Francis: London.Google Scholar
Penn, DL, Meyer, PS, Evans, E, Wirth, RJ, Cai, K, Burchinal, M (2009). A randomized controlled trial of group cognitive–behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophrenia Research 109, 52–59.Google Scholar
Penn, DL, Mueser, KT, Tarrier, N, Gloege, A, Cather, C, Serrano, D, Otto, MW (2004). Supportive therapy for schizophrenia. Schizophrenia Bulletin 30, 101–112.Google Scholar
Rathod, S, Kingdon, D, Weiden, P, Turkington, D (2008). Cognitive–behavioral therapy for medication-resistant schizophrenia: a review. Journal of Psychiatric Practice 14, 22–33.Google Scholar
Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, O'Carroll, M, Barnes, TRE (2000). A randomized controlled trial of cognitive–behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry 57, 165–172.Google Scholar
Si, T, Shu, L, Su, Y, Tian, C, Yan, J, Cheng, J, Li, X, Liu, Q, Ma, Y, Zhang, W, Zhang, H (2011). The Chinese version of the Personal and Social Performance Scale (PSP): validity and reliability. Psychiatry Research 185, 275–279.Google Scholar
Si, T, Yang, J, Shu, L, Wang, X, Kong, Q, Zhou, M, Li, X, Liu, C (2004). The reliability, validity of PANSS and its implication. Chinese Journal of Mental Health 18, 45–47.Google Scholar
Sim, K, Su, A, Fujii, S, Yang, S, Chong, MY, Ungvari, GS, Si, T, Chung, EK, Tsang, HY, Chan, YH (2004). Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. British Journal of Clinical Pharmacology 58, 178–183.Google Scholar
Tarrier, N, Lewis, S, Haddock, G, Bentall, RP, Drake, R, Kinderman, P, Kingdon, D, Siddle, R, Everitt, J, Leadley, K (2004). Cognitive–behavioural therapy in first-episode and early schizophrenia 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry 184, 231–239.Google Scholar
Tarrier, N, Yusupoff, L, Kinney, C, McCarthy, E, Gledhill, A, Haddock, G, Morris, J (1998). Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. British Medical Journal 317, 303–307.Google Scholar
Turner, DT, Gaag, M, Karyotaki, E, Cuijpers, P (2014). Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. American Journal of Psychiatry 171, 523–538.Google Scholar
Velligan, DI, Lam, Y, Glahn, DC, Barrett, JA, Maples, NJ, Ereshefsky, L, Miller, AL (2006). Defining and assessing adherence to oral antipsychotics: a review of the literature. Schizophrenia Bulletin 32, 724–742.Google Scholar
Wang, CH, Li, Y, Zhao, Z, Pan, M, Feng, JG, Sun, FG, Du, BG (2004). Controlled study on long -term effect of cognitive behavior intervention on first episode schizophrenia. Chinese Mental Health Journal 17, 200–202.Google Scholar
Warman, DM, Beck, AT (2003). Cognitive behavioral therapy for schizophrenia: an overview of treatment. Cognitive and Behavioral Practice 10, 248–254.Google Scholar
Winston, A, Rosenthal, RN, Pinsker, H (2004). Introduction to Supportive Psychotherapy. American Psychiatric Publishing Incorporated: New York.Google Scholar
World Health Organization (2011). Schizophrenia (http://www.who.int/mental_health/management/schizophrenia/en/). Accessed 19 June 2014.Google Scholar
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523–537.Google Scholar
Xu, Z, Guo, ZH, Fu, ZY, Wang, N, Zhang, Y (2013). Reliability and validity of the Chinese version of the Schedule for Assessment of Insight. Chinese Journal of Behaviour Medicine and Brain Science 22, 752–754.Google Scholar
Zuo, XC, Liu, SK, Yi, ZY, Xie, ZH, Li, HD (2006). Steady-state pharmacokinetic properties of aripiprazole 10 mg PO q12h in Han Chinese adults with schizophrenia: a prospective, open-label, pilot study. Current Therapeutic Research, Clinical and Experimental 67, 258–269.CrossRefGoogle Scholar