Cognitive-behavioural therapy for schizophrenia in a forensic mental health setting
| Pages | 68-77 |
| Date | 04 February 2014 |
| DOI | https://doi.org/10.1108/JFP-12-2012-0028 |
| Published date | 04 February 2014 |
| Author | Emma Williams,Martha Ferrito,James Tapp |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Cognitive-behavioural therapy for
schizophrenia in a forensic mental
health setting
Emma Williams, Martha Ferrito and James Tapp
Dr Emma Williams is a
Consultant Clinical and
Forensic Psychologist, based
at Marlborough House, Milton
Keynes, Oxford Health NHS
Foundation Trust. Martha
Ferrito is a Clinical and
Research Assistant
Psychologist and James Tapp
is a Research Assistant
Psychologist, both are based
at Centralised Groupwork
Service, Newbury Therapy
Unit, Broadmoor Hospital,
West London Mental Health
Trust, Crowthorne, UK.
Abstract
Purpose – The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general
psychiatric settings has been widely investigated and its practice recommended in primary and secondary
care. In secure forensic mental health services the evidence is less established. The purpose of this paper is
to evaluate the effectiveness of group CBT for schizophrenia in a high secure hospital.
Design/methodology/approach – In all, 27 male forensic patients completed a manualised CBT group
and were compared on primary and secondary outcomes to patients receiving treatment as usual (TAU).
Primary outcomes were positive and negative symptoms as measured by the Scale for the Assessment of
Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and the Psychotic
Symptom Rating Scales (PSYRATS). A secondary outcome was interpersonal functioning as measured by
the Inventory of Interpersonal Problems (IIP-64).
Findings – CBT participants showed improvement on negative symptoms; affective flattening, alogia,
anhedonia and avolition; in comparison to participants in TAU. CBT participants also showed reductions in
delusions and hallucinations on the SAPS but not the PSYRATS. TAU participants improved on positive
symptoms as measured by the PSYRATS. CBT participants showed reductions in overall interpersonal
problems, and most notably in being socially inhibited and self-sacrificing. No iatrogenic effects of treatment
were found; improvements in depression anxiety and stress were reported by group completers, which
contrasted to experiences of the TAU group.
Research limitations/implications – Absence of random allocation to CBP or TAUgroups retains the risk
of recruitment bias. Findings are preliminary given the sample size. Multiple outcome assessments increase
risk of a type I error.
Practical implications – CBT for schizophrenia can be effective with clients in secure forensic mental
health settings. Improvements in negative symptoms and interpersonal functioning appear to be particular
gains. Self-report measures might be subject to specific demand characteristics in such settings.
Originality/value – The evaluation includes a comparator group in a high secure setting, which is typically
absent in reported evidence for this population (Blackburn, 2004). The study also investigated changes
in interpersonal functioning, which has previously been noted as an important but absent outcome in CBT
for psychosis (Haddock et al., 2009). Iatrogenic outcomes were also considered in the evaluation to ensure
no adverse effects were experienced from treatment.
Keywords Schizophrenia, CBT, Forensic patients
Paper type Research paper
Introduction
In the past decade over 30 trials comparing cognitive-behavioural therapy (CBT) with standard
care or other activetreatment for schizophreniahave been conducted and many have promoted
CBTas an effective treatmentin the reduction of psychotic symptoms(Barrowclough et al.,2006;
Pilling et al., 2002;Tarrier and Wykes, 2004;Wykes et al., 2005; Zimmerman et al., 2005). Whilst
more recent evidence suggests other therapies can be of equal benefit (e.g. Jones et al., 2012),
The authors would like to thank
those who participated in the
research and the following people
for supporting the delivery and
evaluation of the programme:
Estelle Moore, Brian Thomas, Julia
Woollatt, Anna Williams, Alison
Dudley, Fiona Clark, Adrian Coxell,
Sarah Keen and Claire Wilson.
PAGE 68
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 16 NO. 1 2014, pp. 68-77, CEmerald Group Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-12-2012-0028
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