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9 - Cognitive approaches: cognitive–behavioural therapy and cognitive remediation therapy
- from Part 2 - Treatment approaches
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- By Craig Steel, Psychology Department, University of Reading, Til Wykes, Professor of Clinical Psychology and Rehabilitation and Vice Dean for Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Rumina Taylor, Department of Psychology, Institute of Psychiatry, King's College London
- Edited by Frank Holloway, Sridevi Kalidindi, Helen Killaspy, Glenn Roberts
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- Book:
- Enabling Recovery
- Published online:
- 02 January 2018
- Print publication:
- 01 July 2015, pp 136-152
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Summary
Introduction
The cognitive underpinnings of schizophrenia took some time to be recognised, despite the phenomenology including cognition as a main distinguishing factor in all diagnostic descriptions over the past 100 years. Thinking was described as problematic because of two issues: poor communication, engendered through either delusional thinking or the problems of understanding syntactically or semantically disorganised language; and the cognitive problems in memory, concentration and attention described by patients, or cognitive disorganisation or loose associations as described by Kraepelin and Bleuler. It is only relatively recently that these phenomena have been the focus of targeted treatments in psychology, in the form of cognitive–behavioural therapy for psychosis (CBTp) and cognitive remediation therapy (CRT). These approaches take their roots in the two different aspects of poor cognition but have now begun to move together under the guise of metacognition. Both ascribe the problems of cognition as part of the disorder and this has now been recognised in the new version of the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2013).
This chapter sets out the two broad psychological approaches, their similarities and differences. The evidence base for both therapies is similar, as are their effect sizes (Wykes et al, 2008, 2011). At the time of writing, CBTp is firmly recommended within evidence-based guidelines for the treatment of schizophrenia. CRT has not yet achieved this level of recognition, although a recently published national guideline, from Scotland, states that: ‘Cognitive remediation therapy may be considered for individuals diagnosed with schizophrenia who have persisting problems associated with cognitive difficulties’ (Scottish Intercollegiate Guidelines Network, 2013).
Historical context
Although single case reports of psychological interventions for psychosis date back more than 50 years (e.g. Beck, 1952), significant developments in this area did not occur until the 1980s. Early behavioural interventions were aimed at symptom management and were predominantly embedded within the traditional psychiatric view of schizophrenia. However, the development of cognitive–behavioural models for affective disorders had a significant impact on psychosis research during the late 1990s. This work highlighted the extent to which the development and maintenance of symptoms could be understood with reference to psychological processes. The traditional view that schizophrenia symptom content should be ignored was challenged and therapists began to examine the content of psychotic symptoms directly and to use this dialogue as a basis for collaborative discussion.
Tackling Social Cognition in Schizophrenia: A Randomized Feasibility Trial
- Rumina Taylor, Matteo Cella, Emese Csipke, Charles Heriot-Maitland, Caroline Gibbs, Til Wykes
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 44 / Issue 3 / May 2016
- Published online by Cambridge University Press:
- 09 June 2015, pp. 306-317
- Print publication:
- May 2016
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Background: Social cognition difficulties in schizophrenia are seen as a barrier to recovery. Intervention tackling problems in this domain have the potential to facilitate functioning and recovery. Social Cognition and Interaction Training (SCIT) is a manual-based psychological therapy designed to improve social functioning in schizophrenia. Aims: The aim of this study is to evaluate the feasibility and acceptability of a modified version of SCIT for inpatient forensic wards. The potential benefits of the intervention were also assessed. Method: This study is a randomized single blind controlled design, with participants randomized to receive SCIT (N = 21) or treatment as usual (TAU; N = 15). SCIT consisted of 8-week therapy sessions twice per week. Participants were assessed at week 0 and one week after the intervention on measures of social cognition. Feasibility was assessed through group attendance and attrition. Participant acceptability and outcome was evaluated through post-group satisfaction and achievement of social goals. Results: The intervention was well received by all participants and the majority reported their confidence improved. The SCIT group showed a significant improvement in facial affect recognition compared to TAU. Almost all participants agreed they had achieved their social goal as a result of the intervention. Conclusions: It is feasible to deliver SCIT in a forensic ward setting; however, some adaptation to the protocol may need to be considered in order to accommodate for the reduced social contact within forensic wards. Practice of social cognition skills in real life may be necessary to achieve benefits to theory of mind and attributional style.