Review: social skills training, supported employment programmes, and cognitive behaviour therapy improve some outcomes in schizophrenia

Main results 18 studies published since the previous review were identified. 2 evaluated family therapy, 2 case management, 5 social skills training, 3 supported employment programmes, 5 cognitive behaviour therapy (CBT), and 1 compared individual with family therapy. Studies published before 1996 showed the superiority of family therapy in reducing relapse rates (24% v 64% among those who received routine treatment); however, the 3 recently published studies evaluating family therapy did not find a reduction in relapse rates. Treatment intensity and format of family therapy did not appear to differentially affect outcome. The 2 recently published studies evaluating assertive community treatment (a form of case management) found no effect on readmissions to hospital. Previous reports found consistent effects for reduction in time spent in hospital and improvement in housing stability. Neither family therapy nor assertive community treatment had consistent effects on symptoms, overall social functioning, or ability to obtain competitive employment. The 5 studies evaluating the effectiveness of social skills training found improvements in social adjustment, independent living skills, cognitive measures, social competence, and skill acquisition with treatment. There were no clear effects on relapse prevention, psychopathology, or employment status. The 3 studies of supported employment programmes that used the “place and train” vocational model consistently showed higher competitive employment rates (65% v 26% for control conditions) but showed no benefit for non-vocational outcomes. Of the 5 RCTs evaluating CBT, some provided evidence for the effectiveness of CBT in reducing delusions and hallucinations in medication resistant patients and for its use as a complement to pharmacotherapy in acute psychosis. One study of individual therapy appeared promising in improving overall social adjustment.