Cognitive-Behavioural Therapy by Novices for Supervised Community Hostel Residents with Treatment-Resistant Schizophrenia in Hong Kong: A Pilot Study

Abstract Objective: Despite extensive research in cognitive-behavioural therapy (CBT) for psychosis in the United Kingdom and the United States, there are very limited data about its efficacy in other parts of the world. This pilot study aimed to investigate the efficacy of CBT by novice therapists (mainly social workers) for regularly supervised community hostel residents with treatment-resistant psychotic symptoms. Participants and Methods: Ten novice CBT therapists with a social work background provided weekly individual CBT to a group of hostel residents, who had an ICD-10 diagnosis of schizophrenia and with persistent psychotic symptoms despite adequate medication. Before the commencement of CBT, the severity of psychotic symptoms, emotions associated with psychosis (depression, anger, and anxiety), insight, and self-esteem were measured. The measurements were repeated after 6 months of CBT. Results: At the end of the sixth month, there was a reduction in the severity of psychotic symptoms (as measured by the Positive and Negative Syndrome Scale, and Psychotic Symptom Rating Scale) and improvement in self-esteem. However mood symptoms and insight level remained relatively unchanged. Conclusion: Cognitive-behavioural therapy conducted by novice therapists under regular supervision may be useful in reducing symptoms and distress in a group of supervised community hostel residents in Hong Kong. Due to the small sample size and other methodological limitations, this conclusion is only tentative. A randomised controlled trial is warranted to confirm these preliminary finding. Key words. Cognitive therapy; Community mental health services; Psychotic disorders [TEXT NOT REPRODUCIBLE IN ASCII] Introduction Cognitive-behavioural therapy (CBT) for psychosis is an effective adjunctive treatment for reducing the distress and intensity of delusions, (1,2) the frequency and distress of auditory hallucinations, (3) and possible relapse of psychosis (if specifically targeted early). (4) Its efficacy has been confirmed in medication-resistant psychotic outpatients, (1,5) first-episode psychotic patients, (6) inpatients with resistant psychotic symptoms, (7) psychosis with co-morbid substance abuse, (8) and young individuals at high risk of conversion to psychosis. (9) Apart from therapy conducted by expert psychologists, (1) CBT has also been effectively delivered by other mental health professionals, including general psychiatrists (10) and experienced mental health nurses. (5,11-13) Cognitive-behavioural therapy also appears to reduce psychotic symptom severity, speed up recovery from acute psychosis, (14,15) enhance medication adherence, (16) and be an efficacious adjunct for treating psychosis, although there are still unanswered questions as to its impact on relapse, quality of life, and violent behaviour. (17) However, most of these studies were conducted in the West and in Caucasian populations. Thus, it is not clear whether CBT (a short-term individual-directed psychological treatment emphasising collaboration, scientific empiricism, and Socratic dialogue) would be equally acceptable and applicable to nonwestern populations. Notably, recent studies support the value of CBT for some psychiatric disorders in Chinese populations, (18-20) but there are no data with regard to Chinese patients suffering from psychosis. This was therefore a preliminary study to investigate the effectiveness of CBT in patients suffering from treatment-resistant schizophrenia. Furthermore, if an empirically validated psychological treatment is to be delivered to a full range of sufferers of schizophrenia in the community, then such an intervention must have demonstrably worthwhile clinical outcomes. (13) The largest workforce in regular contact with patients with schizophrenia consists of mental health nurses and social workers. Cognitive-behavioural therapy conducted by mental health nurses in this setting provides clear benefits to the patients. …