David Murray has posted a blog[i] that reviews an article about the effectiveness of Cognitive Behavioral Therapy for the treatment of schizophrenics who refuse to take the anti-psychotic medication. It is an interesting article in the Lancet that a documents a study in which CBT was compared to the outcome of treatment with medication.[ii] In the study those treated with medicine and those who underwent cognitive therapy without medicine seemed to do about the same. It is an interesting study which is offered to show the value of CBT. But, the study has a flaw. As I read the original study I saw a comment article off on the right border and I read that one too. The following is my reply to David’s comments on the original article.
“Hello David, It does not look like anyone is going to say too much about this study so I will. As the authors note, no one will recommend CBT to treat schizophrenia alone. The article is an interesting parallel to depression, medical treatment and biblical counseling. The idea of treating schizophrenia with only CBT talk therapy would seem to most an outrageous idea.
What did catch my eye was a comment article to the right of the abstract. The comment article makes an interesting point about the study.
"First, the study did not have a placebo intervention. The potential effect of this limitation should not be underestimated because placebo effects can be large in schizophrenia trials, and have contributed to failed studies of new drug treatments for schizophrenia. The absence of placebo might be important in this trial because, although the assessors were masked to group allocation, patients were not, and the outcome measures rely on patient self-report. Although these measures are standard in schizophrenia trials, the risk of reporting biases might be large for cognitive therapy, because it explicitly focuses on the patient and therapist forming a close collaborative relationship.”[iii]
As with any intervention in the life of a struggler the relationship may be the key. Just having someone to talk to without regard to what they might discuss may have a profound effect on their outcome whether they are schizophrenic or depressed.
Maybe that is the most important thing we have to offer either the schizophrenic or the depressed individual; a human being with whom to talk.” (end of my comment)
While the original study is flawed and as a result falls short of proving that CBT is uniquely beneficial in schizophrenia, the study does show one important thing. Counseling of any sort will benefit from a relationship built in trust between the counselor and the counselee. As Paul would say in 2 Corinthians 7:6, “God who comforts the depressed, comforted us by the coming of Titus.” The best counseling is found in strong, biblically supportive relationships.
[i] http://headhearthand.org/blog/2014/02/10/schizophrenia-helped-by-cbt/#comment-44778
[ii] Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial
Prof Anthony P Morrison D Clin Psy,Prof Douglas Turkington MD,Melissa Pyle BSc,Helen Spencer BA,Alison Brabban D Clin Psy,Prof Graham Dunn PhD,Tom Christodoulides D Clin Psy,Rob Dudley PhD,Nicola Chapman D Clin Psy,Pauline Callcott MSc,Tim Grace PG Dip,Victoria Lumley PG Dip,Laura Drage MPhil,Sarah Tully MSc,Kerry Irving BSc,Anna Cummings BSc,Rory Byrne BSc,Prof Linda M Davies MSc,Paul Hutton D Clin Psy
The Lancet - 6 February 2014
DOI: 10.1016/S0140-6736(13)62246-1
[iii] Cognitive therapy: at last an alternative to antipsychotics?
Oliver Howes
The Lancet – 6 February 2014
DOI: 10.1016/S0140-6736(13)62569-6
“Hello David, It does not look like anyone is going to say too much about this study so I will. As the authors note, no one will recommend CBT to treat schizophrenia alone. The article is an interesting parallel to depression, medical treatment and biblical counseling. The idea of treating schizophrenia with only CBT talk therapy would seem to most an outrageous idea.
What did catch my eye was a comment article to the right of the abstract. The comment article makes an interesting point about the study.
"First, the study did not have a placebo intervention. The potential effect of this limitation should not be underestimated because placebo effects can be large in schizophrenia trials, and have contributed to failed studies of new drug treatments for schizophrenia. The absence of placebo might be important in this trial because, although the assessors were masked to group allocation, patients were not, and the outcome measures rely on patient self-report. Although these measures are standard in schizophrenia trials, the risk of reporting biases might be large for cognitive therapy, because it explicitly focuses on the patient and therapist forming a close collaborative relationship.”[iii]
As with any intervention in the life of a struggler the relationship may be the key. Just having someone to talk to without regard to what they might discuss may have a profound effect on their outcome whether they are schizophrenic or depressed.
Maybe that is the most important thing we have to offer either the schizophrenic or the depressed individual; a human being with whom to talk.” (end of my comment)
While the original study is flawed and as a result falls short of proving that CBT is uniquely beneficial in schizophrenia, the study does show one important thing. Counseling of any sort will benefit from a relationship built in trust between the counselor and the counselee. As Paul would say in 2 Corinthians 7:6, “God who comforts the depressed, comforted us by the coming of Titus.” The best counseling is found in strong, biblically supportive relationships.
[i] http://headhearthand.org/blog/2014/02/10/schizophrenia-helped-by-cbt/#comment-44778
[ii] Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial
Prof Anthony P Morrison D Clin Psy,Prof Douglas Turkington MD,Melissa Pyle BSc,Helen Spencer BA,Alison Brabban D Clin Psy,Prof Graham Dunn PhD,Tom Christodoulides D Clin Psy,Rob Dudley PhD,Nicola Chapman D Clin Psy,Pauline Callcott MSc,Tim Grace PG Dip,Victoria Lumley PG Dip,Laura Drage MPhil,Sarah Tully MSc,Kerry Irving BSc,Anna Cummings BSc,Rory Byrne BSc,Prof Linda M Davies MSc,Paul Hutton D Clin Psy
The Lancet - 6 February 2014
DOI: 10.1016/S0140-6736(13)62246-1
[iii] Cognitive therapy: at last an alternative to antipsychotics?
Oliver Howes
The Lancet – 6 February 2014
DOI: 10.1016/S0140-6736(13)62569-6
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