Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, UK.
Schizophr Res. 2011 Nov;132(2-3):135-9. doi: 10.1016/j.schres.2011.08.012. Epub 2011 Sep 9.
A clear challenge for schizophrenia research is to improve markedly the efficacy of psychological treatments for delusional beliefs. Effect sizes for the first generation of cognitive approaches are weak to moderate. These therapies now lag behind the transformation over the past ten years in understanding the causes of delusions. This paper advocates an interventionist-causal model approach: to focus on one putative causal factor at a time, show that an intervention can change it, and examine the subsequent effects on the delusional beliefs. A number of new studies that illustrate this approach with patients with schizophrenia spectrum disorders who have not responded to previous treatment are reviewed. These early stage studies show great promise in terms of efficacy, although remain to be subjected to methodologically rigorous evaluation. The advantages and difficulties of the interventionist approach applied to psychosis are considered, and future studies are highlighted. The importance for clinical services of cognitive approaches to psychosis will increase further if the theoretical advances can be translated into treatment.
精神分裂症研究面临的一个明确挑战是显著提高心理治疗对妄想信念的疗效。第一代认知方法的效果大小为弱到中度。这些疗法现在落后于过去十年中对妄想原因的理解的转变。本文提倡干预主义因果模型方法：一次关注一个假定的因果因素，表明干预可以改变它，并检查对妄想信念的后续影响。本文回顾了一些新的研究，这些研究用以前治疗未反应的精神分裂症谱系障碍患者说明了这种方法。这些早期研究在疗效方面显示出很大的希望，尽管仍有待进行严格的方法学评估。考虑了干预方法应用于精神病的优点和困难，并强调了未来的研究。如果理论进展能够转化为治疗，那么认知方法对精神病的重要性将进一步增加。
