A pilot study on the effect of brief cognitive behavioral therapy combined with routine treatment for schizophrenia in communities of Beijing

Objective To evaluate the efficacy of brief cognitive behavioral therapy (BCBT) combined with routine treatment (RT) for patients with schizophrenia in communities of Beijing. Methods 64 patients who met the criteria for schizophrenia according to the International Statistical Classification of Diseases and Related Health Problem, Tenth Revision (ICD-10) were randomly allocated to two groups, one group received 8 sessions of BCBT combined RT and the other group received only RT. All the subjects were evaluated using the Positive and Negative Syndrome Scale (PANSS), Schedule for Assessing Insight (SAI) and Personal and Social Performance Scale (PSP) at baseline, weeks 12, 38 and 64. The effective and recurrence rates were also calculated and compared between the two groups. Results (1) Compared with the baseline, the scores of PANSS total (all P=0.000), PANSS-positive (all P=0.000), PANSS-negative (P= 0.049, 0.045, 0.024) and PANSS-general (all P=0.000) in BCBT group decreased significantly at weeks 12, 38 and 64. The scores of PANSS total (P=0.001, 0.004) and PANSS-general (P=0.003, 0.001 )in RT group decreased significantly at 38 and 64 week and the score of PANSS-positive (P=0.002) in RT group decreased significantly at 38 week compared with the baseline. The scores of PANSS total (53.9±10.9, 51.0± 11.1, 48.1±11.9) and PANSS-negative (12.1±4.3, 12.1±4.3, 11.2±4.4) in BCBT group were significantly lower than that in RT group (59.4±13.2, 57.3±11.9, 57.6±12.9;14.3±5.2, 14.4±5.1, 14.3±5.1) at 12,38 and 64 week (F=3.875, 4.747, 9.943; P=0.042, 0.033, 0.002; F=7.989, 8.814, 14.355; P=0.006, 0.004, 0.000) and the scores of PANSS-positive and PANSS-general were significantly lower than that in RT group (10.8± 3.8 vs. 12.8±4.3; 25.6±5.3 vs. 28.7±6.8) at 64 week (F=5.223, P=0.040; F=4.229, P=0.044).(2) After treatment, the score of SAI in BCBT group increased significantly (P=0.000, 0.001, 0.000) and there was no change of SAI in RT group (all P=1.000).The score of SAI in BCBT group (9.4±3.0, 10.4±3.6) were significantly higher than that of RT group (7.0±3.7, 7.8±3.9) at 12 and 64 week (F=8.139, 8.936; P=0.006, 0.004).(3) The scores of PSP in BCBT group increased significantly after treatment (all P<0.01) and the scores of PSP in RT group increased significantly at 38 and 64 week (P=0.000, 0.030). The scores of PSP in BCBT group (69.1±13.0, 75.6±12.6) were significantly higher than that of RT group (63.4±11.6, 61.9±10.8) at 38 and 64 week (F=7.548, 21.419, P=0.042, 0.000).(4) By the end of follow-up, the effective rates of CBT and RT group were 59.4% (19/32) and 28.1% (9/32) respectively and the difference between the two groups was significant (χ2=6.349, P<0.05).The recurrence rates of both groups were 9.4% (3/32). Conclusions Both RT and BCBT combined with RT showed benefits on the overall symptoms, positive symptoms, general psychopathology symptoms and social functioning of community patients with schizophrenia, and the latter had better effect than the former in the long term. Adjunct BCBT could also improve patients' negative symptoms and insight better than only RT. Key words: Schizophrenia; Cognitive therapy; Drug therapy; Community mental health services