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Release: April 19, 2002

UI to pilot study on cognitive therapy for people with schizophrenia

People with schizophrenia can gain benefits from medication but still have symptoms that cause significant problems. Cognitive therapy used in concert with medications might help these individuals lead less disrupted lives, a possibility that University of Iowa Health Care researchers recently received funding to investigate.

The Nellie Ball Charitable Trust awarded a $19,000 grant to Scott Temple, Ph.D., UI associate professor (clinical) in psychiatry, and Beng Choon Ho, M.D., UI assistant professor of psychiatry, for a pilot study to compare patients who receive cognitive therapy plus standard treatment (medication and case management services) with patients who receive only standard treatment at the UI Mental Health Clinical Research Center. Temple said it is one of the first such studies in the United States.

"Despite adequate trials of medication therapy, people with schizophrenia often continue to experience moderate to severe symptoms," Temple said. "Studies in Great Britain found that cognitive therapy techniques that had been developed for depression and anxiety disorder could be used for schizophrenia. We want to see if here in Iowa we can provide patients better coping skills to dampen some of the impact of the illness."

Schizophrenia symptoms include hallucinations (usually auditory) and delusions. Temple said these symptoms can cause patients to avoid situations where hallucinations will cause difficulty for them, including the workplace and social events. Such withdrawal, in turn, leads to loss of quality of life.

Cognitive therapy is a well-established form of psychotherapy that has considerable empirical evidence for depression and anxiety disorders and is increasingly being investigated for use with personality and other mood disorders, Temple said.

The therapy is based on getting patients to consider how they interpret and deal with their symptoms and then helping them develop and test alterative ways of managing those symptoms.

"A patient might report that it's really hard for them to go places and be in public because of the symptoms," Temple said. "So I'll work with the patient to see how they interpret their symptoms and help them come up with an alternative reaction to them.

"Then the patient will go test out the interpretation we build in therapy and compare it to their original interpretation of the experience, " he said.

As an example, Temple said a patient might state, "I can't go to a restaurant because when I'm in a restaurant I'm convinced everyone there is picking up the voices I hear."

Temple could work with the patient to develop a test of that interpretation such as going to a restaurant and looking for any evidence that tells them that people know what they're thinking.

"We'll be looking for a reduction in the effects of the symptoms," Temple said.

Family members of people with schizophrenia might participate in the therapy. "Family members may be the people on whom the patients first want to test out their interpretations as interpersonal problems are very common," Temple said.

The UI pilot study is expected to involve about 20 patients. Temple said that after the team examines the data, they can consider expanding the research to train more people to administer the therapy and modify it as needed to help patients.

The Nellie Ball Charitable Trust was established in 1977 by Ball's estate. The trust is administered locally through Iowa State Bank and supports research related to chronic mental illnesses, primarily schizophrenia and paranoia.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.