Reports From The Field-Behavioral health

Cognitive training improves function in schizophrenics

Cognitive adaptation therapy is a novel psychosocial treatment approach designed to improve functioning by using compensatory strategies in the home or workplace to bypass the cognitive deficits associated with schizophrenia. A recent study in the American Journal of Psychiatry suggests that, novel or not, the treatment approach does improve function and reduce relapse rates in outpatients with schizophrenia.

Researchers randomly assigned 45 patients with DSM-IV schizophrenia or schizoaffective disorder to one of three treatment groups for nine months. Those groups were standard medication follow-up, standard medication follow-up plus cognitive adaptation training, and standard medication follow-up plus a condition designed to control for therapist time and provide environmental changes unrelated to cognitive deficits.

Clinicians unaware of which treatment group patients were assigned to conducted comprehensive assessments every three months. Researchers found significant differences among the treatment groups in levels of psychotic symptoms, motivation, and global functioning at the end of the nine-month period. Patients in the cognitive adaptation training group improved more overall, compared with patients in the other two groups. Also, the groups had significantly different relapse rates over the study period. Those relapse rates were 13% for the cognitive adaptation group, 69% for the group in which therapist time and environmental changes were controlled, and 33% for the group that received standard follow-up only.

[See: Velligan DI, Bow-Thomas CC, Huntizinger C, et al. Randomized controlled trial of the use of compensatory strategies to enhance adaptive functioning in outpatients with schizophrenia. Am J Psych 2000; 157:1,317-1,328.] 


Behavioral therapy may improve bulimia recovery chances

A recent study provides new insight into clinically useful predictors of attrition and outcome in treating bulimia nervosa with cognitive behavioral therapy. Researchers studied 194 women meeting the DSM-III-R criteria for bulimia nervosa who were treated with 18 sessions of manual-based cognitive behavioral therapy. In the three-site study, they found that patients who significantly reduced purging by session six were most likely to achieve a positive outcome.

Researchers evaluated differences between therapy dropouts and nondropouts and between recovered and nonrecovered participants. Differences were examined descriptively, and then signal detection analyses were used to determine clinically significant cutoff points predicting attrition and abstinence. Findings include:

• Patients who dropped out of therapy had more severe bulimic cognitions and greater impulsivity, but researchers were not able to identify clinically useful predictors of outcome.

• Patients with treatment failures were characterized by more severe adjustment and a lower body mass index, presumably indicating greater dietary restriction.

• Early progress in therapy was found to be the best predictor of outcome.

• Signal detection analyses revealed that poor outcome was predicted by a less than 70% reduction in purging by treatment session six of 18, allowing identification of a substantial proportion of prospective treatment failures.

[See: Agras WS, Crow SJ, Halmi KA, et al. Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multi-site study. Am J Psych 2000; 157:1,302-1,308.]