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A Trial of Two Cognitive-Behavioural Methods of Treating Drug-Resistant Residual Psychotic Symptoms in Schizophrenic Patients: I. Outcome

Published online by Cambridge University Press:  02 January 2018

Nicholas Tarrier ,
Richard Beckett ,
Sue Harwood ,
Amanda Baker ,
Lawrence Yusupoff  and
Itziar Ugarteburu
Nicholas Tarrier*
Affiliation:
Department of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University Hospital of South Manchester, West Didsbury, Manchester M20 8LR
Richard Beckett
Affiliation:
Department of Psychology, Fairmile Hospital, Wallingford, 0X10 9HH
Sue Harwood
Affiliation:
Department of Psychology, Prestwich Hospital, Manchester M25 7BL
Amanda Baker
Affiliation:
National Drug and Alcohol Research Centre, University of New South Wales, NSW 2033, Australia
Lawrence Yusupoff
Affiliation:
Department of Psychology, Hope Hospital, Manchester
Itziar Ugarteburu
Affiliation:
Department of Psychology, Prestwich Hospital, Manchester M25 7BL
*
∗Correspondence
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Abstract

Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counterdemand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in pyschotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 162 , Issue 4 , April 1993 , pp. 524 - 532
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Alford, G. S., Fleece, L. & Rothblum, E. (1982) Hallucinatory–delusional verbalisations: modification in a chronic schizophrenic by self-control and cognitive restructuring. Behaviour Modification, 6, 421–435.CrossRefGoogle Scholar
Barlow, D. H. (1981) On the relation of clinical research to clinical practice: current issues, new directions. Journal of Consulting and Clinical Psychology, 49, 147–155.Google Scholar
Belcher, T. L. (1988) Behavioural reduction of overt hallucinatory behaviour in chronic schizophrenics. Journal of Behaviour Therapy Experimental Psychiatry, 19, 69–71.Google Scholar
Birchwood, M. (1986) Control of auditory hallucinations through occlusion of monoaural auditory input. British Journal of Psychiatry, 149, 104–107.CrossRefGoogle Scholar
Birchwood, M., Smith, J., Cochrane, R., et al (1990) The social functioning scale: the development and validation of a scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853–859.Google Scholar
Brier, A. & Strauss, H. S. (1983) Self–control in psychotic disorders. Archives of General Psychiatry, 40, 1141–1145.CrossRefGoogle Scholar
Bulow, H., Oei, T. P. S. & Pinkney, B. (1979) Effects of contingent social reinforcement with delusional chronic schizophrenic men. Psychological Reports, 44, 659–666.CrossRefGoogle ScholarPubMed
Carr, V. (1988) Patients techniques for coping with schizophrenia: an exploratory study. British Journal of Medical Psychology, 61, 339–352.Google Scholar
Cohen, C. I. & Berk, B. S. (1985) Personal coping styles of schizophrenic out–patients. Hospital and Community Psychiatry, 36, 407–410.Google Scholar
Curson, D. A., Barnes, T. R. E., Bamber, R. W., et al (1985) Long term depot maintenance of chronic schizophrenic outpatients. British Journal of Psychiatry, 146, 464–480.CrossRefGoogle Scholar
Curson, D. A., Patel, M., Liddle, P. F., et al (1988) Psychiatric morbidity of a long stay hospital population with chronic schizophrenia and implications for future community care. British Medical Journal, 297, 819–822.Google Scholar
Davis, J. R., Wallace, C. J., Liberman, R. P., et al (1976) The use of brief isolation to suppress delusional and hallucinatory speech. Journal of Behaviour Therapy and Experimental Psychiatry, 7, 269–275.Google Scholar
D'Zurilla, T. J. & Goldfried, M. (1971) Problem solving and behaviour modification. Journal of Abnormal Psychology, 78, 107–126.Google Scholar
Emmelkamp, P. M. G. & Foa, E. B. (1983) Failures as a challenge. In Failures in Behaviour Therapy (eds Foa, E. B. & Emmelkamp, P. M. G.). New York: Wiley.Google Scholar
Falloon, I. R. H. (1986) Cognitive and behavioural interventions in the self–control of schizophrenia. In Psychosocial Treatment of Schizophrenia (eds Strauss, J., Bäker, W. & Brenner, H. D.), pp 180–190. Bern: Hans Huber.Google Scholar
Falloon, I. R. H. & Talbot, R. E. (1981) Persistent auditory hallucinations: coping mechanisms and implications for management. Psychological Medicine, 11, 329–339.CrossRefGoogle ScholarPubMed
Falloon, I. R. H., Boyd, J. L. & McGill, C. (1984) Family Care of Schizophrenia. New York: Guilford.Google Scholar
Fonagy, P. & Slade, P. (1982) Punishment vs negative reinforcement in the aversive conditioning of auditory hallucinations. Behaviour Research and Therapy, 20, 483–492.Google Scholar
Fowler, D. & Morley, S. (1989) The cognitive–behavioural treatment of hallucinations and delusions: a preliminary study. Behavioural Psychotherapy, 17, 267–282.Google Scholar
Hall, J. (1989) Chronic psychiatric handicaps. In Cognitive Behaviour Therapy for Psychiatric Problems (eds Hawton, K., Salkovskis, P. M., Kirk, J., et al ), pp. 315–338. Oxford: Oxford Medical Publications. CrossRefGoogle Scholar
Harrow, M. & Silverstein, M. L. (1977) Psychotic symptoms in schizophrenia after the acute phase. Schizophrenia Bulletin, 3, 608–616.Google Scholar
Hawton, K. & Kirk, J. (1989) Problem solving. In Cognitive Behaviour Therapy for Psychiatric Problems (eds Hawton, K., Salkovskis, P., Kirk, J., et al ), pp. 406–426. Oxford: Oxford Medical Publications.CrossRefGoogle Scholar
Heinrichs, D. W. (1988) The treatment of delusions in schizophrenic patients. In Delusional Beliefs (eds Oltmanns, T. F. & Maher, B. A.), pp. 275–294. New York: Wiley.Google Scholar
Hemsley, D. (1986) Psychological treatment of schizophrenia. In A Handbook of Clinical Psychology (eds Lindsay, S. & Powell, G.). London: Gower. Google Scholar
Hole, R. W., Rush, A. J. & Beck, A. T. (1979) A cognitive investigation of schizophrenic delusions. Psychiatry, 42, 312–319.Google Scholar
Hugdahl, K. & Ost, L. (1981) On the difference between statistical and clinical significance. Behavioral Assessment, 3, 289–295.Google Scholar
Jacobson, N. S., Follette, W. C. & Revenstorf, D. (1984) Psychotherapy outcome research: methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15, 336–350.Google Scholar
Jansson, L. & Ost, L. (1982) Behavioural treatments for agoraphobics: an evaluation review. Clinical Psychology Review, 2, 311–336.CrossRefGoogle Scholar
Kanas, N. & Barr, M. A. (1984) Self–control of psychotic productions in schizophrenia. Archives of General Psychiatry, 41, 919–920.Google Scholar
Kazdin, A. E. & Wilson, G. T. (1978) Evaluation of Behaviour Therapy: Issues, Evidence and Research Strategies. Cambridge: Ballinger.Google Scholar
Krawiecka, M., Goldberg, D. & Vaughan, M. (1977) A standardised psychiatric assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica, 55, 299–308.Google Scholar
Lamontagne, Y., Audet, N. & Elie, R. (1983) Thought stopping for delusions and hallucinations: a pilot study. Behavioural Psychotherapy, 11, 177–184.CrossRefGoogle Scholar
Liberman, R. P., Teigan, J., Patterson, R., et al (1973) Reducing delusional speech in chronic paranoid schizophrenics. Journal of Applied Behaviour Analysis, 6, 57–64.Google Scholar
Lukoff, D., Nuechterlein, K. H. & Ventura, J. (1986) Manual for expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin, 12, 594–602.Google Scholar
Meichenbaum, D. & Cameron, R. (1973) Training schizophrenics to talk to themselves: a means of developing attentional control. Behavior Therapy, 4, 525–534.Google Scholar
Milton, F., Patwa, V. K. & Hafner, J. (1978) Confrontation vs belief modification in persistently deluded patients. British Journal of Medical Psychology, 51, 127–130.Google Scholar
Morley, S. (1987) Modification of auditory hallucinations: experimental studies of headphones and earplugs. Behavioural Psychotherapy, 15, 240–251.Google Scholar
Nydegger, R. V. (1972) The elimination of hallucinatory and delusional behaviours by verbal conditioning and assertive training: a case study. Journal of Behaviour Therapy and Experimental Psychiatry, 3, 225–227.Google Scholar
Schneider, S. J. & Pope, A. T. (1982) Neuroleptic–like electroencephalographic changes in schizophrenics through biofeedback. Biofeedback and Self–Regulation, 7, 479–490.Google Scholar
Slade, P. D. (1972) The effects of systematic desensitisation on auditory hallucinations. Behaviour Research and Therapy, 10, 85–91.Google Scholar
Slade, P. D. (1973) The psychological investigation and treatment of auditory hallucinations: a second case report. British Journal of Medical Psychology, 46, 293–296.CrossRefGoogle ScholarPubMed
Slade, P. D. & Bentall, R. P. (1988) Sensory Deception: Towards Scientific Analysis of Hallucinations. London: Croom Helm.Google Scholar
Silverstein, M. L. & Harrow, M. (1978) First rank symptoms in the post acute schizophrenic: a follow–up study. American Journal of Psychiatry, 135, 1481–1486.Google Scholar
Smith, J. & Birchwood, M. (1990) Relatives and patients as partners in the management of schizophrenia: the development of a service model. British Journal of Psychiatry, 156, 654–660.Google Scholar
Steinmark, S. W. & Borkovec, T. D. (1974) Active and placebo treatment effects on moderate insomniac under counter demand and positive demand instruction. Journal of Abnormal Psychology, 83, 157–163.Google Scholar
Tarrier, N. (1987) An investigation of residual psychotic symptoms in discharged schizophrenic patients. British Journal of Clinical Psychology, 26, 141–143.CrossRefGoogle ScholarPubMed
Tarrier, N. (1991) Some aspects of family interventions in schizophrenia. I: Adherence with family intervention programmes. British Journal of Psychiatry, 159, 475–480.Google Scholar
Tarrier, N. (1992a) Psychological treatment of schizophrenic symptoms. In Schizophrenia: An Overview and Practical Handbook (ed. Kavanagh, D.). London: Chapman & Hall. Google Scholar
Tarrier, N. (1992b) Management and modification of residual psychotic symptoms. In Innovations in the Psychological Management of Schizophrenia (eds Birchwood, M. & Tarrier, N.). Chichester: Wiley.Google Scholar
Tarrier, N. & Main, C. (1986) Applied Relaxation Training (ART) with patients suffering from generalised anxiety and panic attacks: the efficacy of a learnt coping strategy on subjective reports. British Journal of Psychiatry, 149, 330–336.Google Scholar
Tarrier, N., Harwood, S., Yusopoff, L., et al (1990) Coping Strategy Enhancement (CSE): a method of treating residual schizophrenic symptoms. Behavioural Psychotherapy, 18, 283–293.Google Scholar
Tarrier, N., Sharpe, L., Beckett, R., et al (1993) A trial of two cognitive–behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: II. Treatment specific changes in coping and problem solving skills. Social Psychiatry and Psychiatric Epidemiology (in press).Google Scholar
Tress, K. H., Bellenis, C., Brownlow, J. M., et al (1987) The Present State Examination Change rating scale. British Journal of Psychiatry, 150, 201–207.CrossRefGoogle ScholarPubMed
Turner, S., Herson, M. & Bellack, A. (1977) Effects of social disruption, stimulus interference and aversive conditioning on auditory hallucinations. Behaviour Modification, 1, 249–258.Google Scholar
Watts, F. N., Powell, G. E. & Austin, S. V. (1973) The modification of abnormal beliefs. British Journal of Medical Psychology, 46, 359–363.Google Scholar
Weingaertner, A. H. (1971) Self–administered aversive stimulation with hallucinating hospitalised schizophenics. Journal of Consulting and Clinical Psychology, 36, 422–429.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego Programme. Cambridge, Cambridge University Press. Google Scholar
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