Integrated psychological therapy (IPT) for schizophrenia: is it effective?

Phantasy Therapy: Statistical Evaluation of a New Approach to Group Psychotherapy for Stationary and Ambulatory Psychotic Patients

BACKGROUND

Since 1995 we have developed a depth-psychological, experience- and expression-oriented approach to group therapy for psychotic patients--"Phantasy Therapy"--complementary to the main-stream emphasis upon behavioural, learn- and goal-oriented methods.

AIMS

A group psychotherapy for acute and remitting patients suffering from psychosis or schizophrenia is statistically evaluated under treatment-as-usual in a public psychiatric clinic.

METHODS

Phantasy Therapy is compared to an alternative treatment (art therapy = AT) and a placebo group (PG; weekly ward gatherings) via cognitive testing before and after each session.

RESULTS

(1) Improvement of cognitive deficits over the first 4 sessions: session 1 (effect size d = 0 between all 3 groups) versus session 4 (d = 0.2 and 0.4 of Phantasy Therapy over AT and PG, respectively). Averaged over the first 4 sessions, the cognitive test showed tendential improvements for Phantasy Therapy and AT compared to PG. (2) Self-rating (sum of 4 item scores) averaged over the first 4 sessions showed a small effect. Patients judged themselves more improved after Phantasy Therapy compared to AT (d = 0.2) or PG (d = 0.3); tendential d (0.1) of AT over PG. (3) Psychosocial communication skills considerably improved during Phantasy Therapy, slightly worsened during AT, and remained relatively unchanged during PG. The effect sizes of Phantasy Therapy for values averaged over the first 4 sessions was 0.6 compared to AT and 0.4 compared to PG.

CONCLUSIONS

Phantasy Therapy is better than PG and at least as good as AT. These results should be hardened by further studies.

Recent developments in psychosocial treatments for schizophrenic patients

Pessimistic views regarding the course and outcome of schizophrenia have been replaced by an emphasis on recovery. The concept of recovery emphasizes the need to provide access to treatments and services that are effective in both decreasing manifestations of the disorder and in assisting individuals to lead maximally productive and personally meaningful lives. To this end, the schizophrenia Patient Outcomes Research Team (PORT) published an updated consensus list of evidence-based practices that includes 14 recommendations, six of which describe psychosocial treatments (family interventions, supported employment, assertive community treatment, skills training, cognitive therapy and token economy programs). This paper reviews the schizophrenia PORT committee recommendations for psychosocial evidence-based practices, and discusses future needs and potential confounds that can have an impact on the effectiveness of these approaches. Among these potential confounds, the heterogeneity of individuals diagnosed with schizophrenia, variations in quality and integrity of implementation and the degree to which services listed are truly accessible and available as needed are paramount. The PORT psychosocial recommendations are an excellent foundation in the process of identifying evidence-based practices that can foster social recovery; they are not a comprehensive list. More innovation and research on psychosocial therapies remains to be accomplished in order to improve the chances for social recovery of patients diagnosed with schizophrenia.