The psychosocial treatment of schizophrenia: An update

Objective: The authors sought to update the randomized controlled trial lit erature of psychosocial treatments for schizophrenia. Method: Computerized literature searches were conducted to identify randomi zed controlled trials of Various psychosocial interventions, with emphasis on studies published since a previous review of psychosocial treatments for schizophrenia in 1996. Results: Family therapy and assertive community treatment have clear effect s on the prevention of psychotic relapse and rehospitalization. However, th ese treatments have no consistent effects on other outcome measures (e.g., pervasive positive and negative symptoms, overall social functioning, and a bility to obtain competitive employment). Social skills training improves s ocial skills but has no clear effects on relapse prevention, psychopatholog y, or employment status. Supportive employment programs that use the place- and-train vocational model have important effects on obtaining competitive employment. Some studies have shown improvements in delusions and hallucina tions following cognitive behavior therapy. Preliminary research indicates that personal therapy may improve social functioning. Conclusions: Relatively simple, long-term psychoeducational family therapy should be available to the majority of persons suffering from schizophrenia . Assertive community training programs ought to be offered to patients wit h frequent relapses and hospitalizations, especially if they have limited f amily support. Patients with schizophrenia can clearly improve their social competence with social skills training, which may translate into a more ad aptive functioning in the community. For patients interested in working, ra pid placement with ongoing support offers the best opportunity for maintain ing a regular job in the community. Cognitive behavior therapy may benefit the large number of patients who continue to experience disabling psychotic symptoms despite optimal pharmacological treatment.