Nonpharmacological Approaches

Abstract

Cognitive-behavioral therapy (CBT), although labor-intensive, can be helpful even in patients considered treatment-refractory, and has been evaluated in controlled clinical trials in patients with treatment-resistant schizophrenia. In a 6-month randomized controlled trial comparing CBT plus social skills training and clozapine versus supportive therapy and clozapine in 41 patients, subjects who had received CBT plus social skills training had lower psychopathology scores than those who received supportive therapy. In a 21-week controlled but nonrandomized trial with 21 patients comparing CBT plus clozapine versus befriending plus clozapine, the CBT group showed a significant improvement in psychopathology and quality of life, and the improvement in psychopathology persisted at the 6-month follow-up assessment. However, mixed results were found in another controlled study comparing CBT versus counseling in 62 patients taking at least one atypical antipsychotic (mostly clozapine). Patients receiving CBT had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.