Early intervention for relapse in schizophrenia: Impact of cognitive behavioural therapy on negative beliefs about psychosis and self-esteem

• Published in: British journal of clinical psychology 2006-06, Vol.45 (2), p.247-260
• Main Authors: Gumley, Andrew, Karatzias, Athanasios, Power, Kevin, Reilly, James, McNay, Lisa, O'Grady, Margaret
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Attitude to Health; Behavior therapy. Cognitive therapy; Behavioural disorders; Beliefs; Biological and medical sciences; Clinical psychology; Cognitive behaviour therapy; Cognitive psychology; Cognitive Therapy - methods; Culture; Female; Humans; Loss; Male; Medical sciences; Middle Aged; Negative beliefs; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychosis; Psychotic Disorders - psychology; Recurrence; Relapse; Schizophrenia; Schizophrenia - therapy; Self Concept; Self-esteem; Selfesteem; Surveys and Questionnaires; Time Factors; Treatments
• ISSN: 0144-6657; 2044-8260
• DOI: 10.1348/014466505X49925

Objectives. The study aimed to test two hypotheses. Firstly, that participants who relapsed during the 12‐month follow‐up period of our randomized controlled trial, would show increased negative beliefs about their illness and reduced self‐esteem, in comparison to the non‐relapsed participants. Secondly, that cognitive behavioural therapy (CBT) for early signs of relapse would result in a reduction in negative beliefs about psychosis and an improvement in self‐esteem at 12 months. Design and methods. A total of 144 participants with schizophrenia or a related disorder were randomized to receive either treatment as usual (TAU; N=72) or CBT (N=72). Participants completed the Personal Beliefs about Illness Questionnaire (PBIQ; Birchwood, Mason, MacMillan, & Healy, 1993) and the Rosenberg Self‐Esteem Scale (RSES; Rosenberg, 1965) at entry, 3 months, 6 months, and 12 months. Results. At 12 months, relapsers showed greater increase in scores for PBIQ entrapment compared with non‐relapsers. In addition, after controlling for baseline covariates (treatment group and PBIQ self versus illness), relapsers also showed greater increase in scores for PBIQ self versus illness at 12 months. Furthermore, in comparison to treatment as usual, participants who received CBT showed greater improvement in PBIQ loss and in Rosenberg self‐esteem. Conclusions. The study provides evidence that relapse is associated with the development of negative appraisals of entrapment and self‐blame (self vs. illness). In addition, this is the first study to show that CBT reduces negative appraisals of loss arising from psychosis and improvements in self‐esteem. Implications for future research and treatment are discussed.