Fauzia Simjee McClure

Therapeutic Factors Contributing to Change in Cognitive-Behavioral Group Therapy for Older Persons with Schizophrenia

The contributions of homework, therapy participation, cognitive insight, and skills acquisition to treatment outcomes in group CBT for schizophrenia were examined. Increased cognitive insight was associated with reduced positive, negative and total symptoms, but not improved psychosocial functioning. Greater participation was associated with increased cognitive insight, reduction in total and negative symptoms, and a trend was found for positive symptoms. Greater homework adherence was associated with greater skill acquisition, but skill acquisition was not significantly associated with change in any outcome. The therapeutic factors contributing to change in CBT for schizophrenia appear different for symptom and psychosocial functioning outcomes.

Group Cognitive-Behavioral Social Skills Training for Older Outpatients With Chronic Schizophrenia

The number of older patients with schizophrenia is increasing rapidly. There is significant need for empirically validated psychotherapy interventions for these patients. Cognitive-behavioral and social skills training interventions have been shown to improve outcomes for younger patients with schizophrenia, but have not been studied in older patients. This article describes a group intervention for older patients with schizophrenia, cognitive-behavioral social skills training (CBSST), which we are currently studying in a randomized controlled clinical trial. CBSST teaches cognitive-behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. We highlight special issues and specific techniques relevant to working with older patients, and discuss the costs and benefits of using a group rather than individual approach with this population. To illustrate the approach, two case examples with outcome data are presented.