Randomized comparison of group cognitive behaviour therapy and group psychoeducation in acute patients with schizophrenia: effects on subjective quality of life.

OBJECTIVE: Although the clinical efficacy of cognitive behaviour therapy (CBT) has been established for patients with schizophrenia, the data on effects on quality of life (QoL) are lacking. The purpose of the present study was therefore to compare the effects of a brief group CBT and a group psychoeducational (PE) programme in patients with schizophrenia on QoL. METHOD: A total of 88 inpatients with schizophrenia were randomized to receive a therapy envelope of 8 weeks including either 16 sessions of group CBT or eight sessions of group PE treatment. QoL was assessed using the Modular System for Quality of Life at baseline, post-treatment assessment and 6 month follow up. RESULTS: QoL improved significantly in both treatments in most QoL dimensions. Within-group effect sizes for general QoL at follow up were 0.25 for CBT and 0.29 for PE. No significant differences between CBT and PE were found at post-treatment and at 6 month follow up. CONCLUSIONS: Both brief group CBT and group PE improve subjective QoL in patients with schizophrenia.

Determinants of subjective quality of life in post acute patients with schizophrenia.

Although Quality of Life (QoL) is of growing interest in schizophrenia research, little is known about putative causal determinants of this multidimensional construct. The present study explored the utility of objective indicators, psychopathological symptoms and psychosocial concepts drawn from empirical findings in community samples and the vulnerability-stress-coping model of schizophrenia for predicting general subjective QoL in post acute patients with schizophrenia. The analyses were based on cross-sectional data from 66 post acute patients with schizophrenia. The relationships between QoL and possible determinants were investigated using correlational analysis, regression analysis and structural equation techniques. As a result no significant relationships between objective indicators and general QoL were found. The strongest significant determinants were depressive symptoms and the psychosocial concepts of negative coping, perceived social support and self-efficacy. The empirical causal modelling results indicated that depression led to a direct negative impact upon QoL, whereas the other determinants had direct negative or positive effects on depression and affected QoL indirectly. One could conclude that to enhance patients' QoL, improvements in depressive symptoms, negative coping style, social support and self-efficacy seem to be most effective.

The role of operant conditioning in chronic pain: an experimental investigation.

The role of operant conditioning for the development and maintenance of chronic pain was examined in 30 chronic back pain patients (CBP) and 30 matched healthy controls. Half of each group was reinforced for increased, half for decreased pain reports while EEG, EOG, heart rate, skin conductance and muscle tension levels were recorded. Both groups showed similar learning rates, however, the CBP patients displayed slower extinction of both the verbal and the cortical (N150) pain response. In addition, the CBP group displayed prolonged elevated electromyogram levels to the task. These data suggest that CBP patients are more easily influenced by operant conditioning factors than healthy controls and this susceptibility may add to the maintenance of the chronic pain problem.

Processing of pain- and body-related verbal material in chronic pain patients: central and peripheral correlates.

The processing of pain-related, body-related and neutral words was assessed in chronic pain patients and matched healthy controls. During and after word presentation at perception threshold, electromyographic activity (EMG), heart rate, skin conductance level and electroencephalographic (EEG) data from 11 electrode sites were recorded. Startle responses were measured to suprathreshold word stimuli. Although the patients did not recognize more pain-related words, they produced an enhanced left-hemispheric N100 and N200 to pain-related as compared to neutral words. In addition, the patients did not show a distinct P300 but a continuous positive shift to all words extending into the 800-ms range. Skin conductance levels to the pain-related words were also enhanced in patients only. These data partially support the notion of pain-related implicit memory structures in the brain of chronic pain patients that may selectively draw attention to pain-related stimuli and may thus enhance pain perception.