Cognitive-Behavioral Therapy in Veterans With Schizophrenia

Not Applicable

Completed

Interventions: Behavioral: Cognitive Behavioral Therapy for Psychosis (CBTp)
Behavioral: Supportive Therapy (ST)

Brief Summary: This is a study comparing the benefits of two types of individual psychotherapy (cognitive-behavioral therapy for psychosis and supportive therapy) in symptomatic Veteran outpatients diagnosed with schizophrenia or schizoaffective disorder. Treatment lasted approximately 6 months, with outcome data on symptoms, functioning, and distress levels collected at baseline, post-treatment, and 6 months post -treatment follow-up.

Detailed Description: This is a randomized controlled trial comparing 6 months of participation in one of two active treatments, cognitive-behavioral therapy for psychosis or supportive therapy in symptomatic Veterans diagnosed with schizophrenia or schizoaffective disorder who are still symptomatic. Assessments of clinical status and social functioning were obtained at baseline, end of treatment, and 6 month follow-up. We hypothesized that participation in the cognitive-behavioral therapy would lead to greater reductions in symptoms and distress about symptoms, and more improvements in social functioning.

Recruitment & Eligibility

Inclusion Criteria

outpatients with schizophrenia or schizoaffective disorder in proximity to the West Los Angeles VAMC
at least one month since last hospitalization
stable antipsychotic medication with persisting psychotic symptoms with at least minimal distress
competent to sign informed consent.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Cognitive Behavioral Therapy for Psychosis (CBTp)	Cognitive Behavioral Therapy for Psychosis (CBTp)	approximately 6 months of weekly individual manualized cognitive-behavioral psychotherapy for psychosis in which participants set personal goals, identify problematic/ illness-related beliefs and experiences that may interfere with achieving those goals, evaluate the data supporting those beliefs, and then modify the beliefs or behavior as warranted by the data to make progress on those goals.
Supportive Therapy (ST)	Supportive Therapy (ST)	approximately 6 months of weekly manualized supportive psychotherapy to promote a strong alliance between the therapist and the participant in order to provide a safe place to discuss issues pertaining to the participants' lives and concerns

Primary Outcome Measures

Name	Time	Method
Changes in Positive Schizophrenia Symptoms	Pre-treatment to follow-up, approximately 6 months post end-of-treatment	Mean positive symptoms Interview rating on the Brief Psychiatric Rating Scale (Ventura, Lukoff. Nuechterlein. Liberman, Green, \& Shaner, 1993), with range of 1-7 and higher scores indicating greater symptoms Ventura, J. Lukoff D, Nuechterlein KH, Liberman RP, Green M, Shaner A: Appendix 1: Brief Psychiatric Rating Scale (BPRS) Expanded Version (4.0) scales, anchor points and administration manual. International Journal of Methods in Psychiatric Research 1993; 3:227-243
Changes in Global Social Functioning	Pre-treatment to follow-up, approximately 6 months post end-of-treatment	Interview rating of overall adaptive functioning rated on a 1-7 scale on the Social Adjust Scale II (Schooler N, Hogarty G, Weissman M:, 1979) with low scores indicating better functioning Schooler N, Hogarty G,\& Weissman M, (1979). Social Adjustment Scale (SAS) II, in Resource Materials for Community Mental Health Program Evaluators. Edited by Hargreaves W, Attkisson C, Sorenson J. Rockville MD, US Department of Health, Education, and Welfare, 1979, pp 290-303)

Secondary Outcome Measures

Name	Time	Method
Changes in Distress From Schizophrenia Symptoms	Pre-treatment to follow-up, approximately 6 months post end-of-treatment	Interview rating of overall preoccupation and distress from hallucinations and delusions rated on the psychotic symptom rating scales (PSYRATS; Haddock, McCarron, Tarrier, \& Faragher,; 1999) total score, with a range of 0-85 and low scores indicating less preoccupation and distress Haddock, G., McCarron, J., Tarrier, N., \& Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological medicine, 29(04), 879-889.