CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 28GROUP THERAPYJOHN R. McQUAIDFor approximately the past 50 years, effective treatment of schizophrenia has dependedon pharmacotherapy. However, many clinicians and researchers have also recognized thelimits of medication in facilitating functional outcomes for patients. Investigators havetherefore explored the use of adjunctive treatments, including group therapy, to improvethe outcomes of patients with schizophrenia. In this chapter I first discuss theoretical andpragmatic issues of using group treatments for patients with schizophrenia. I then describeinterventions that inform group therapies for schizophrenia and the integration ofthose interventions into cognitive-behavioral social skills training (CBSST), a newly developedgroup intervention for schizophrenia.CHALLENGES IN THE TREATMENT OF PSYCHOSISWITH PSYCHOSOCIAL INTERVENTIONSSchizophrenia, by its very nature, is difficult to treat via talk therapy. Positive psychoticsymptoms (e.g., delusions and hallucinations) impair patients’ accurate perception oftheir environment. Delusional thinking leads to the misinterpretation of stimuli (e.g., perceivinginnocuous glances from others as evidence of a plot), and hallucinations providemisleading data (e.g., a voice telling the patient that there is a plot). Negative symptomssuch as anergia, anhedonia, and disinterest in interpersonal relationships can interferewith the likelihood of patients with schizophrenia engaging in behaviors that can improveeither their symptomatology or their level of functioning. Negative symptoms can particularlyundermine psychosocial interventions that are predicated on behavioral principles.If a patient finds no activity rewarding, then it is difficult to initiate, and even more difficultto maintain, the behavior.Beyond the symptoms of psychosis, individuals with schizophrenia often have extensivedeficits in cognitive processing that reduce their ability to perceive or encodedisconfirming or corrective information and to learn functional skills. Some studies indicatethat cognitive impairments in areas of abstraction and cognitive flexibility are better279