Schizophrenia Helped by CBT

February 10, 2014  David Murray   6 comments

Research published in The Lancet, the world’s leading medical journal, reveals that Cognitive Behavior Therapy [CBT] could be an effective treatment when schizophrenics refuse antipsychotic drugs:

  • CBT is an officially recommended treatment, but is available to less than 10% of patients in the UK with schizophrenia.
  • About four-in-10 patients benefit from taking antipsychotic medication.
  • But the drugs cause side-effects such as type 2 diabetes and weight gain.
  • Up to half of patients with schizophrenia end up not taking the drugs.
  • CBT reduced symptoms, and improved person and social function
  • CBT worked in 46% of patients, approximately the same as for antipsychotics.
  • Most patients were agreeable to trying cognitive therapy.
  • Drugs and CBT combined were the best treatment.

The authors are at pains to point out that those presently taking meds should not stop taking them. The research conclusions are primarily aimed at helping those who will not take meds, are irregular in taking them, or who suffer too bad side-effects from them.

See summary of research here.

For a simple explanation of CBT, see Six Steps to Better Thoughts, Feelings, and Actions.

  • http://www.goodmoodbadmood.com Charles Hodges MD

    Hello David, It does not look like anyone is going to say too much about this study so I will. As the authors note, no one will recommend CBT to treat schizophrenia alone. The article is an interesting parallel to depression, medical treatment and biblical counseling. The idea of treating schizophrenia with only CBT talk therapy would seem to most an outrageous idea.
    What did catch my eye was a comment article to the right of the abstract. The comment article makes an interesting point about the study.

    “First, the study did not have a placebo intervention. The potential effect of this limitation should not be underestimated because placebo effects can be large in schizophrenia trials,12 and have contributed to failed studies of new drug treatments for schizophrenia.13 The absence of placebo might be important in this trial because, although the assessors were masked to group allocation, patients were not, and the outcome measures rely on patient self-report. Although these measures are standard in schizophrenia trials, the risk of reporting biases might be large for cognitive therapy, because it explicitly focuses on the patient and therapist forming a close collaborative relationship.”

    As with any intervention in the life of a struggler the relationship itself may be the key. Just having someone to talk to without regard to what they might discuss may have a profound effect on their outcome whether they are
    schizophrenic or depressed.

    Maybe that is the most important thing we have to offer either the schizophrenic or the depressed individual; a human being with whom to talk.

    The for the comment article is as follow:
    Cognitive therapy: at last an alternative to antipsychotics?
    Oliver Howes
    The Lancet – 6 February 2014
    DOI: 10.1016/S0140-6736(13)62569-6

    • http://headhearthand.org/blog/ David Murray

      Hi Charles. I think there’s a place for finding flaws in research. Maybe I’m naive, but I suppose I try to find and highlight the positive and the helpful. I doubt the Lancet would have published this if there wasn’t something a bit more substantial than “friendships help schizophrenics.”

      • http://www.goodmoodbadmood.com Charles Hodges

        Hello David,

        You should be less trusting…:-)
        Medical Journals such as the Lancet are not always good sources for unbiased research. The Bias has to do with advertising the majority of which comes from Pharmaceutical companies. It is a complicated problem that began in the 1950s when JAMA and other journals decided to restrict advertising to medical companies instead of cruise lines and cadillacs. They should have stuck with Cadillacs. We can talk about it some time if you wish.

        A good journal with much less bias is the peer reviewed PLOSmedicine.org. Public Libary of Science. It is free. Articles are free, They take no money from any company that makes anything medical.

        I put in a search for Pharmaceutical Sponsorship on Editorial Policy and got a bunch of articles. You can do the same if you wish. I will include one at the bottom of this comment. PLOSmedicine is a good source for less biased medical information.

        Charles

        Ghost Management: How Much of the Medical Literature Is Shaped Behind the Scenes by the Pharmaceutical Industry?
        Sergio Sismondo
        Published: September 25, 2007
        •DOI: 10.1371/journal.pmed.0040286
        •Featured in PLOS Collections

        • http://headhearthand.org/blog/ David Murray

          Thanks Charles. I’ll look that journal up. My wife is a medical doctor, so we’ve been familiar with the influence of Big Pharma for a long time, (although it’s nowhere near as bad in the UK as in the USA).

          It’s been a great combination for pastoral ministry having Shona with her medical knowledge and practice, including time in psychiatry, fill out and broaden my more theological/biblical perspective.

      • http://www.goodmoodbadmood.com Charles Hodges

        Hello Heath and David!

        I think I interact positively with the disciplines of psychiatry/psychology on multiple occasions in my blog. Please go look at the following dates 1/1, 1/15, 1/30, 2/6. These are response to published articles that talk about subjects that fall in to the psychology/psychiatric field.

        And, what I say is positive!

        Hello David, I thought I would put this here because you would see it. It applies to your earlier statement and your comment at ACBC website.

        Charlie

  • http://www.companionapproach.com Dan

    Interesting article.

    CBT has the potential to help a lot of people with all types of mental illness.

    We’ve just launched a CBT app (www.companionapproach.com) more for people who suffer from stress and anxiety. But would be great to do a version for those who have bear the brunt of schizophrenia.

    Dan