Cognitive Therapy for Schizophrenia:
Hope for Those Whom Drugs Haven't Helped

In an about-face, the British National Health Service recently adopted cognitive therapy as a valid and reimbursable treatment for schizophrenia, a disease of the mind that traditionally has been thought of as unresponsive to all but powerful drug therapies.

Researchers at the AAAS Annual Meeting in Denver today described the groundbreaking approach that led British public health officials to permit the use of psychological therapy — in conjunction with drug therapy — for people with schizophrenia, a disease that affects one percent of the world's population.

"The magnitude of the effect of this therapy is similar to the effects of the newest anti-psychotic medication — average reductions in symptoms of 20-40% — and without the side-effects that medications typically cause," said Philippa Garety, professor of clinical psychology at Guy's, King's and St Thomas' School of Medicine and the Institute of Psychiatry and head of psychology for the local South London mental health services.

According to Garety, cognitive behavioral therapy helps people with schizophrenia identify the negative thoughts that drive their emotions. She called the approach "a joint process of inquiry, in which therapist and client together test out new ways of thinking and behaving."

The discussion takes place against the backdrop of studies that suggest that genetic vulnerability to schizophrenia is more widespread in the general population than previously thought, as high as 10 to 20 percent, according to another panelist and leading geneticist, Robert Freedman, Professor and Chair of the Department of Psychiatry at the University of Colorado Health Sciences Center.

"From the perspective of education about stigma against mental illness, these findings suggest that schizophrenia is not the result of a rare aberration, but rather the result of a complex association between common elements," Freedman said. "Some of these common elements are likely part of the diversity in brain function that otherwise enriches the fabric of our society."

Schizophrenia is characterized by hallucinations and by major delusions and thought disorganization, and the public's attitude toward such symptoms continues to impede efforts at detection and treatment of schizophrenia. This point was made in a recent United States Surgeon General report on mental illness, which identified stigma as the greatest obstacle to the effective treatment of severe mental illness. Richard Warner described the success of an initiative of the World Psychiatric Association that uses social marketing efforts in countries around the world — in Europe, North America, South America and Asia — aimed at reducing the stigma of schizophrenia. Warner, a British psychiatrist, is the Medical Director of the Mental Health Center of Boulder County, Colorado, and clinical professor of psychiatry and adjunct professor of anthropology at the University of Colorado.

13 February 2003