Integrated Therapy Approaches in Schizophrenia: Evidence and Limitations

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Background

Up to date, an increasing number of manualized psychological therapy approaches with specific treatment aims for schizophrenia patients are available for clinical practice. Some of them have been recommended by national psychiatric guidelines based on the empirically-based evidence derived from RCTs or from meta-analyses including RCTs. Most recommended for specific treatment topics may be psychoeducation, family therapy, CBTp, social skills training, supported employment, assertive community treatment, and cognitive remediation approaches. However, no recommendation can be found regarding the integration of more than one of these interventions into one comprehensive therapy approach focusing on several therapy topics at once.

Ignoring integrated therapy approaches (ITA) in psychiatric guidelines represents a gap between still available empirical data and psychiatric care rationale. This gap may come as surprise because increased data support evidence for better generalization effects of ITA compared to treatments including only one intervention topic. Most of the cited evidence has been found in studies on cognitive remediation added with other intervention topics. At least four such ITA approaches are based on cognitive remediation in group format have been defined as “state of the art” interventions by the American Psychological Association some years ago. Less strong evidence of ITA could be observed for better long-lasting effects after therapy and transfer effects into daily life. First of all, it may be important to define ITA within therapy modalities. Based on this definition, empirical data focusing advantage of ITA may support its acceptance in psychiatric guidelines and health care organizations.

The focus of this Research Topic should be on empirical data that critically evaluate the advantage of ITA approaches in schizophrenia patients regarding various outcome domains. The evaluated ITA approach should be well described. More precisely defined, papers addressing the following topics are highly welcome:

• Definition of ITA
• Summary of national psychiatric guidelines for schizophrenia (e.g., US, UK, Germany)
• Empirical models declaring how ITA works
• Outcome studies (including controlled study design) on ITA focusing proximal and distal outcome
• Prediction studies to detect who benefits from ITA
• Empirical data focusing on generalization and transfer effects
• Moderator and mediator analysis of ITA therapy group factors
• Comparison studies (including controlled study design) with other treatments (broad scope of ingredients is possible)

Keywords: Psychotherapy, Schizophrenia, Integrated treatment, Cognition, Distal Outcome

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