Wirksamkeit und Prozessmerkmale einer psychoedukativen und bewältigungsorientierten Gruppentherapie für schizophren und schizoaffektiv Erkrankte

Outcome and Process Characteristics of a Psychoeducational, Coping Oriented Group Therapy for Schizophrenia and Schizoaffective Patients Background: Psychoeducation is a core element in psychological therapy for schizophrenics. Its application has been intensively studied and well established in the family setting. Empirical data concerning its efficacy without involvement of relatives are scarce. Patients and Methods: In a randomized controlled trial, effects and process quality of a psychoeducational coping oriented group therapy for schizophrenia and schizoaffective patients were compared to those of a control group in which supportive discussions and training in problem solving were offered. Results: Both groups showed clear reductions in psychopathology and improved cognitive coping with the illness at completion of the therapy and at one-year follow-up. In addition, coping oriented therapy reduced relapse rates and days in hospital compared to the control group during the first year after therapy. Regarding process-outcome-relations a good therapeutic relationship, as perceived by the patients, was associated with the success of the psychoeducational, coping oriented intervention. In contrast, those patients of the supportive therapy who demonstrated the highest degree of psychopathology at the end of therapy, felt more comfortable in this treatment. Other assessments of the quality of the therapeutic process also revealed strong relations to the outcome at the end of therapy. These relations varied between the two treatment groups. Discussion: On the one hand, our results indicate that the patients’ ratings of the quality of the therapeutic relationship determine the success of the psychoeducational, coping oriented therapy. On the other hand, patients with more persistent symptoms may prefer the less structured supportive therapy approach. Therefore, in future psychotherapy research with schizophrenia patients it will be important to be more concerned with the formation of a good therapeutic relationship and to identify differential indication criteria to enhance the efficacy of psychological therapy approaches.