An update of psychological treatments for schizophrenia was presented at the 2016 EPA congress. Comprehensive schizophrenia care is best – two therapies are better than one to boost outcomes. Psychological treatments are effective - they make a real difference in patients’ lives and should be used early. These were the messages of the update on the growing field of psychological treatments for schizophrenia presented by Til Wykes, Professor of Clinical Psychology and Rehabilitation at King's College London.
While there is some agreement on the psychological treatment guidelines across the globe, there are also differences. Psychoeducation, social skills training and cognitive remediation are not recommended worldwide, whereas cognitive behavioral therapy for psychosis (CBTp) is generally supported.
CBTp aims to ease distress by reducing positive symptoms. The therapist meets with the patient for up to 30 sessions over 6 to 9 months. They join forces to question the beliefs that limit the patient from achieving their goals. The patient re-evaluates their experiences and identifies new ways of responding to them. Relapse prevention deals with the issues of reasoning style, self-concept, social isolation, appraisals of psychosis and emotional processes.
CBTp has demonstrated efficacy in treating positive symptoms. Patients value CBTp in addition to medication.
‘Now I have the illness - the illness doesn’t have me’ - Quote from a patient who benefited from CBTp.
What’s ahead for cognitive therapies?
Auditory hallucinations can be tackled with avatar therapy. The patient creates a virtual character with a face and voice that is similar to the one in their head. This allows the therapist to speak to the patient through the avatar. The key aspects are to increase power and control over the avatar, and improve self esteem.
Mobile-based interventions are on the rise. But with thousands of apps available, and only a handful with pre-post or control evaluation, these may be over-promised, over-sold and underperforming tools.
An exciting finding is that combining CBTp with other therapies – including assertive outreach, skills training and supported employment - can boost outcomes. Treatment can be tailored to specific groups of patients, such as those with low function, to improve results.
The ongoing challenge is to disseminate this science so that these tools are successfully applied in normal clinical care. The patient’s goals and the critical targets that limit recovery should guide the choice of psychological treatment.