This report describes the development and pilot administration of an intervention designed to provide the necessary skills for older patients with schizophrenia to manage their illness and improve their functioning. We sought to integrate two well-established, empirically validated interventions. Although our preliminary findings are limited, patients reported that they found a variety of components helpful. This feedback suggests that future evaluations of this intervention hold promise. In addition, the high levels of participation and compliance with homework suggest that participants were able to engage effectively in these exercises.
This project demonstrates 1) the feasibility of recruiting older patients with schizophrenia to participate in therapy group; 2) the active participation of members in cognitive and skills-building activities in and out of group; and 3) good treatment adherence by a majority of participants.
Nonetheless, several caveats are in order. Although some participants filled out the SDS at both pre- and post-treatment, we did not report statistical analyses because of the small sample size and uncertain reliability of the measure. In future studies, investigators should use interview- and observation-based assessments of functioning and symptom change to assess the impact of treatment, particularly since patients with schizophrenia may not provide reliable responses on self-report instruments.
There are limits to the intervention as developed, as well. The intervention tested is quite brief. Previous studies have involved interventions that lasted several months to years, and in future studies it will be necessary to address the length of treatment necessary to effect change. The current intervention allowed little time for repeated practice of each skill learned in session, and lower-functioning patients in particular may need more in-class training. Also, the use of a group format may be difficult for some patients. The patient who missed the most sessions had difficulty with paranoia, which may have been exacerbated in the group setting. It may be important to have individual therapy available for some patients.
To address some of these issues, randomized, controlled trials, in which a relevant comparison group is included, are necessary to determine whether the combined CBSST intervention adds benefits beyond standard pharmacotherapy and simple supportive contact. It will also be necessary to measure hypothesized mediators of change (e.g., social skills, improved cognitive functioning, reduced negative beliefs) to determine which proposed mechanisms of improvement are in fact contributing to better functioning. We believe that the preliminary study presented here points to a need for further work in this promising approach to treatment.