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... s the chance of replication beyond its own setting, which is vital in being able to justify the use of CBT as a viable intervention for Schizophrenia. In this case experienced psychiatric nurses trained in CBT successfully treated the patients this alone makes CBT a more viable option for intervention as it means more health care professionals fall within the scope of being able to provide treatment. Equally as promising is that therapy could be undertaken in the community as it is less demanding on the patients.
However this study is badly flawed in that it was inherently biased as it was chosen to "represent the group most likely to benefit from direct effects of CBT", and due to the exclusion of non-compliant medication users the application of the study is limited, due to the psychiatric population being so high in this regard. This is tempered by the findings of Kemp et al (1996, 1998). This study used a psychological intervention that has adapted techniques from cognitive therapy and motivational interviewing. Its basis is to improve attitude towards medication, promoting post-discharge compliance and developing insight. The treatment is intended to be widely applicable in the clinical setting (Surguladze et al, 2002). The authors noted that the goals of their Compliance Therapy were achieved but there are methodological issues such as a high drop out, subjective reporting of compliance and an assessor who was not blind to the follow up at three months.
Garety et al. (1994) have considered a comprehensive cognitive behavioural approach that encompassed work by Tarrier et al (1993), belief system modification (Chadwick and Lowe, 1990) and psycho-education (Kingdon and Turkington, 1991). The approach was influenced by CBT for depression (Beck et al. , 1979). The study was designed as a non-random allocation trial with 20 patients, 13 of which were in the experimental group. The investigators report significant improvements in the delusional conviction scores, the brief psychiatric scale and the Beck Depression Inventory. The facts that blind raters were not involved and the numbers of subjects was small, limited these encouraging findings.
The evidence that exists for a psychological intervention that I have discussed here is mixed as while there are many encouraging aspects to them there are also many negative aspects namely in the design and management of the trials, also the levels of schizophrenia some studies was considered too low to be generis able to hospitalised patients (McGovern J. , Turkington D. , 2001). However there is enough evidence from well designed and robust studies to justify the CBT as an intervention for Schizophrenia as Bouchard et al, (1996) conclude that CBT can be effective in reducing or eliminating hallucinations or delusions in schizophrenic patients. Haddock et al. (1998 b) carried out a comprehensive and detailed review of cognitive behavioural treatment approaches to hallucinations and delusions. This concluded that the 'literature provides fairly strong evidence for the efficacy of cognitive behavioural approaches in the management of chronic psychotic and associated symptoms although there are a number of areas where further development is necessary'. A review by Jones et al. (1999) for the Cochrane review, focused on relevant randomized controlled trials of CBT for persons with a diagnosis of schizophrenia, possible schizophrenia or mental illnesses (non specific). The trials they looked at were Drury et al. , 1996, Kuipers et al. , 1997; Kemp et al. , 1996; Tarrier et al. , 1998.
The problems of theses trials were that none of them provided data on medication compliance or on the statistical power of the trials to detect an effect for CBT. From their analyses of these four studies they concluded that for those willing to receive CBT, access to this therapy is associated with a substantially reduced risk of relapse. They also commented on the high level of experience and skill of the therapists in the trials and the lack of data on whether CBT procedures would be as effective when applied by less experienced practitioners. (McGovern J. , Turkington D. , 2001). One interesting result of evaluating the evidence available on CBT is that there is very little available that describes the specific aspects of treatment that are effective in relieving particular symptoms, and the same can be said for research into whether CBT can be a standalone treatment.
A further area of concern was the lack of consensus on what are the most important outcomes to demonstrate a treatment effect. Process research on the active ingredients of symptom reduction and an accurate measure of treatment quality in terms of a therapeutic dose are all cited as problems which future trials will need to be addressed. Many of the clinical practitioners of CBT regard an individualized assessment as important both for engagement of the patient in treatment and the formulation of a successful treatment strategy (Haddock & Tarrier, 1998; Chadwick, Williams, & Mackenzie, 2003). This is a different approach to the implementation of a strictly prescribed protocol that is solely response based. And with mounting evidence that schizophrenic symptoms, such as hallucinations and high levels of unscientific beliefs are present in normal subjects supplemented by further evidence showing the presence of delusions in obsessive compulsive disorder (Kozak and Foa, 1994) it is unsurprising that as shown in the analysis of intervention studies, ways have been found to engage patients, and avoid serious exacerbations of conditions (Beck, 1952; Watts et al. , 1973; Kingdon and Turkington, 1991 a, b; 1994; Alford and Beck, 1994). References: Alford BA, Beck AT. 1994.
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Research essay sample on Evaluate Evidence For A Psychological Intervention Schizophrenia
