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Brief cognitive–behavioural therapy for patients in the community with schizophrenia: Randomised controlled trial in Beijing, China

  • Zhi-Hua Guo (a1), Zhan-Jiang Li (a1), Yun Ma (a1), Jing Sun (a2), Jun-Hua Guo (a3), Wen-Xiu Li (a4), Zhi-Qiang Wang (a5), Hui-Li Xu (a6), Roger M. K. Ng (a7), Douglas Turkington (a8) and David Kingdon (a9)...
Abstract
Background

Brief cognitive–behavioural therapy (CBT) is an emerging treatment for schizophrenia in community settings; however, further trials are needed, especially in non-Western countries.

Aims

To test the effects of brief CBT for Chinese patients with schizophrenia in the community (trial registration: ChiCTR-TRC-13003709).

Method

A total of 220 patients with schizophrenia from four districts of Beijing were randomly assigned to either brief CBT plus treatment as usual (TAU) or TAU alone. Patients were assessed at baseline, post-treatment and at 6- and 12-month follow-ups by raters masked to group allocation.

Results

At the post-treatment assessment and the 12-month follow-up, patients who received brief CBT showed greater improvement in overall symptoms, general psychopathology, insight and social functioning. In total, 37.3% of those in the brief CBT plus TAU group experienced a clinically significant response, compared with only 19.1% of those in the TAU alone group (P = 0.003).

Conclusions

Brief CBT has a positive effect on Chinese patients with schizophrenia in the community.

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Copyright
Corresponding author
Zhan-Jiang Li, MD, PhD, Professor of Psychiatry & Clinical Psychology, 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: lizhj8@ccmu.edu.cn
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Henry, LP, Amminger, GP, Harris, MG, Yuen, HP, Harrigan, SM, Prosser, AL, et al. The EPPIC follow-up study of first-episode psychosis: longer-term clinical and functional outcome 7 years after index admission. J Clin Psychiatry 2010; 71: 716–28.
2 Chen, CH, Shen, YC, Zhang, WX, Li, SR, Huang, YQ, Wang, JR, et al. Epidemiological survey on schizophrenia in 7 areas of China [in Chinese]. Chin J Psychiatry 1998; 31: 72–4.
3 Ferrari, AJ, Saha, S, McGrath, JJ, Norman, R, Baxter, AJ, Vos, T, et al. Health states for schizophrenia and bipolar disorder within the Global Burden of Disease 2010 Study. Popul Health Metr 2012; 10: 1.
4 Olivares, JM, Sermon, J, Hemels, M, Schreiner, A. Definitions and drivers of relapse in patients with schizophrenia: a systematic literature review. Ann Gen Psychiatry 2013; 12: 32.
5 Ascher-Svanum, H, Faries, DE, Zhu, B, Ernst, FR, Swartz, MS, Swanson, JW. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry 2006; 67: 453–60.
6 Wykes, T, Steel, C, Everitt, B, Tarrier, N. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull 2008; 34: 523–37.
7 National Institute for Health and Care Excellence. Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care. National Collaborating Centre for Mental Health, 2009.
8 Kreyenbuhl, J, Buchanan, RW, Dickerson, FB, Dixon, LB. The schizophrenia patient outcomes research team (PORT): updated treatment recommendations 2009. Schizophr Bull 2010; 36: 94103.
9 Li, ZJ, Guo, ZH, Wang, N, Xu, ZY, Qu, Y, Wang, XQ, et al. Cognitive-behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychol Med 2015; 45: 1893–905.
10 Xiang, Y-T, Weng, Y-Z, Li, W-Y, Gao, L, Chen, G-L, Xie, L, et al. Efficacy of the Community Re-Entry Module for patients with schizophrenia in Beijing, China: outcome at 2-year follow-up. Br J Psychiatry 2007; 190: 4956.
11 Turkington, D, Kingdon, D, Turner, T. Effectiveness of a brief cognitive–behavioural therapy intervention in the treatment of schizophrenia. Br J Psychiatry 2002; 180: 523–7.
12 Turkington, D, Kingdon, D, Rathod, S, Hammond, K, Pelton, J, Mehta, R. Outcomes of an effectiveness trial of cognitive–behavioural intervention by mental health nurses in schizophrenia. Br J Psychiatry 2006; 189: 3640.
13 Waller, H, Garety, PA, Jolley, S, Fornells-Ambrojo, M, Kuipers, E, Onwumere, J, et al. Low intensity cognitive behavioural therapy for psychosis: a pilot study. J Behav Ther Exp Psychiatry 2013; 44: 98104.
14 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
15 Kay, SR, Fiszbein, A, Opler, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bul 1987; 13: 261–76.
16 Guo, ZH, Li, ZJ, Ma, Y, Zhou, YL, Chao, WM, Guo, JH, et al. A pilot study on the effect of brief cognitive behavioural therapy combined with routine treatment for schizophrenia in communities of Beijing [in Chinese]. Chin J Psychiatry 2015; 48: 331–8.
17 Chen, M, Wu, G, Wang, Z, Yan, J, Zhou, J, Ding, Y, et al. Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia. Shanghai Arch Psychiatry 2014; 26: 119–28.
18 David, AS. Insight and psychosis. Br J Psychiatry 1990; 156: 798808.
19 Si, TM, Yang, JZ, Shu, L, Wang, XL, Kong, QM, Zhou, M, et al. The reliability, validity of PANSS and its implications [in Chinese]. Chin Ment Health 2004; 18: 45–7.
20 Xu, ZY, Guo, ZH, Fu, ZY, Wang, N, Zhang, Y. Reliability and validity of the Chinese version of the schedule for assessment of insight [in Chinese]. Chin J Behav Med Brain Sci 2013; 22: 752–4.
21 Morosini, P, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R. 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 Psychiatr Scand 2000; 101: 323–9.
22 Tianmei, S, Liang, S, Yun'ai, S, Chenghua, T, Jun, Y, Jia, C, et al. The Chinese version of the Personal and Social Performance Scale (PSP): validity and reliability. Psychiatry Res 2011; 185: 275–9.
23 Beck, AT, Steer, RA, Ball, R, Ranieri, W. Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess 1996; 67: 588–97.
24 Wang, Z, Yuan, CM, Huang, J, Li, ZZ, Chen, Y, Zhang, HY, et al. Reliability and validity of the Chinese version of Beck Depression Inventory-II among depression patients [in Chinese]. Chin Ment Health 2011; 25: 476–80.
25 Cohen, J. A power primer. Psychol Bull 1992; 112: 155–9.
26 Pinson, L, Gray, GE. Psychopharmacology: number needed to treat: an underused measure of treatment effect. Psychiatr Serv 2003; 54: 145–6.
27 Lehman, AF, Lieberman, JA, Dixon, LB, McGlashan, TH, Miller, AL, Perkins, DO, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry 2004; 161 (suppl 2): 156.
28 Morrison, AP, Turkington, D, Pyle, M, Spencer, H, Brabban, A, Dunn, G, et al. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. Lancet 2014; 383: 1395–403.
29 Tarrier, N, Yusupoff, L, Kinney, C, McCarthy, E, Gledhill, A, Haddock, G, et al. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ 1998; 317: 303–7.
30 Zimmermann, G, Favrod, J, Trieu, V, Pomini, V. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005; 77: 19.
31 Freeman, D, Dunn, G, Startup, H, Pugh, K, Cordwell, J, Mander, H, et al. Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. Lancet Psychiatry 2015; 2: 305–13.
32 Hansen, L, Turkington, D, Kingdon, D, Smith, P. Brief rating instrument for assessment of negative symptoms: derived from the Comprehensive Psychopathological Rating Scale (CPRS). Int J Psychiatry Clin Pract 2003; 7: 113–6.
33 Rathod, S, Kingdon, D, Smith, P, Turkington, D. Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics—data on a previously published randomised controlled trial. Schizophr Res 2005; 74: 211–9.
34 Gerlinger, G, Hauser, M, De Hert, M, Lacluyse, K, Wampers, M, Correll, CU. Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry 2013; 12: 155–64.
35 Bedford, NJ, David, AS. Denial of illness in schizophrenia as a disturbance of self-reflection, self-perception and insight. Schizophr Res 2014; 152: 8996.
36 Iqbal, Z, Birchwood, M, Chadwick, P, Trower, P. Cognitive approach to depression and suicidal thinking in psychosis 2. Testing the validity of a social ranking model. Br J Psychiatry 2000; 177: 522–8.
37 Granholm, E, McQuaid, JR, McClure, FS, Link, PC, Perivoliotis, D, Gottlieb, JD, et al. Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. J Clin Psychiatry 2007; 68: 730–7.
38 Grant, PM, Huh, GA, Perivoliotis, D, Stolar, NM, Beck, AT. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry 2012; 69: 121–7.
39 Lecomte, T. Psychosis patients refusing antipsychotic medicine could benefit from CBT in terms of both symptom reduction and social functioning. Evid Based Ment Health 2015; 18: 18.
40 Tarrier, N, Lewis, S, Haddock, G, Bentall, R, Drake, R, Kinderman, P, et al. Cognitive–behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial. Br J Psychiatry 2004; 184: 231–9.
41 Blackburn, IM, James, IA, Milne, DL, Baker, C, Standart, S, Garland, A, et al. The revised cognitive therapy scale (CTS-R): psychometric properties. Behav Cogn Psychother 2001; 29: 431–46.
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Brief cognitive–behavioural therapy for patients in the community with schizophrenia: Randomised controlled trial in Beijing, China

  • Zhi-Hua Guo (a1), Zhan-Jiang Li (a1), Yun Ma (a1), Jing Sun (a2), Jun-Hua Guo (a3), Wen-Xiu Li (a4), Zhi-Qiang Wang (a5), Hui-Li Xu (a6), Roger M. K. Ng (a7), Douglas Turkington (a8) and David Kingdon (a9)...
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eLetters

Written response to Zhi-Hua Guo and colleagues regarding their recent publication.

Emily Rose Kruger, Assistant Psychologist, CAMHS
16 March 2017

Dear Zhi-Hua Guo and colleagues,

I would firstly like to thank you for producing such an interesting piece of work, of which I found captivating and highly well written due to my interest in CBT.

In terms of your results, it is clear to see that those suffering with schizophrenia showed more positive psychological outcomes after receiving a form of short CBT. I am curious as to whether there were some other factors which could have added to this ‘positive effect’, of which was not measured. For example, those who have higher levels of motivation or mental toughness may respond more positively and effectively to CBT.

Moreover, I understand that follow-up procedures occurred at 6 and 12 month intervals, showing the success of the CBT. However, could future studies in this domain perhaps examine whether this ‘effect’ continues for longer than 1 year, as surely this is what professionals, and clients themselves, would prefer.

Nevertheless, these are just comments which were sparked by such a compelling read and I thank you for your contribution in this field of work.



Yours Sincerely,

Emily Kruger

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Conflict of interest: None Declared

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