Changes in experience and behavior of schizophrenic patients in therapy groups improve functioning and symptoms. RCT with 154 outpatients in CR-group compared to TAU

Müller-Szer, Rosa; Wechsler, Fabienne I.; Mueller, Daniel R. (2 June 2024). Changes in experience and behavior of schizophrenic patients in therapy groups improve functioning and symptoms. RCT with 154 outpatients in CR-group compared to TAU (Unpublished). In: Cognitive Remediation in Psychiatry 25th Annual Meeting. Clumbia University NYC. June 2 2023.

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For the treatment of schizophrenia patients, some evidence-based group therapy approaches with different treatment goals are available today, also in cognitive remediation. However, there is little to no data on how the group factor, as an unspecific mechanism of change, affects the treatment outcome in schizophrenia patients. Does participation in goal-directed groups per se affect treatment outcome?
Methods: To address this gap, a group approach to cognitive remediation developed in our laboratory (Integrated Neurocognitive Therapy, INT) was compared with control patients who did not participate in therapy groups (Treatment As Usual, TAU). 154 outpatients with schizophrenia were randomly assigned to INT (N=79) or TAU (n=75). INT was administered twice a week for a therapy duration of 15 weeks. A comprehensive test battery was assessed before and after therapy, as well as at the 1-year follow-up in both comparison groups. The group factor was assessed with the newly developed short questionnaire "Experience and Behavior in Therapy Groups EBIT", which comprises 11 items.
Results: The therapy group showed significantly better effects in EBIT outcome compared to controls regarding the global score (mean of all EBIT items) (GLM: F=5.42, p <.01) as well as the empirical 2-factor solution using factor analysis: factor 1 (inactivity and fear) (GLM: F=5.05; p <.01) and factor 2 (eye contact and attention during communication) (F=4.02, p=.02). Additionally, EBIT scores are significantly associated with improvement in cognition, negative and general symptoms after treatment. Furthermore, EBIT scores are also significantly correlated with treatment motivation and therapy attendance rate but not with positive symptoms and medication.
Conclusion: The group factor can be identified and measured using a brief questionnaire. Additionally, the experience and behavior in groups have a supplement positive effect on various group outcome variables.

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