Tarrier N, Beckett R, Harwood S, Baker A, Yusupoff L, Ugarteburu I
Department of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University Hospital of South Manchester, West Didsbury.
Br J Psychiatry. 1993 Apr;162:524-32. doi: 10.1192/bjp.162.4.524.
Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counter-demand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in psychotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.
尽管服用了抗精神病药物，但许多精神分裂症患者仍会持续出现残留的阳性精神病性症状。这些残留症状会导致痛苦和功能障碍。我们报告了一项针对两种认知行为疗法的对照试验，旨在减轻残留的幻觉和妄想。49名患者被纳入试验，其中27名进入试验并完成了治疗后评估，23名在六个月随访时接受了重新评估。患者被随机分配到应对策略增强（CSE）组或问题解决（PS）组。一半患者被分配到高期望积极要求组，另一半被分配到反要求组，以评估改善期望。与处于等待期且无改善的患者相比，接受任何一种认知行为疗法的患者的精神病性症状均有显著减轻。有一些证据（尽管不明确）表明，接受CSE治疗的患者比接受PS治疗的患者改善得更多。没有证据表明改善会扩展到阴性症状或社会功能，也没有证据表明对治疗益处的期望有助于治疗效果。
