| The purpose of this study was to examine therapists' perceptions of the efficacy of Cognitive-Behavioral Therapy for patients diagnosed with schizophrenia. Given that most of the early research occurred in the U.K., it was hypothesized that U.K. therapists would be more aware of the research and would be more likely to choose treatment modalities supported by the research. An on-line survey was distributed to therapists in the U.S. and U.K. The survey data was meant to reflect differences in the knowledge base and clinical practices of therapists in the U.S. and in the U.K.;This study included a review of the literature on schizophrenia, CBT, and CBT for schizophrenia. The section on schizophrenia examined etiological theories, treatment approaches, and research on treatment efficacy. The review of CBT included a brief history and a summary of the efficacy research, comparing and contrasting viewpoints on the value of efficacy research. The next section examined the theoretical underpinnings of cognitive-behavioral treatments for schizophrenia, placing CBT in the context of national attitudes and histories. Finally, the literature review concluded with a comprehensive review of the literature on the efficacy of CBT with schizophrenia.;The research method was to distribute an on-line survey to therapists in the U.S. and U.K. The survey questions were designed to identify clinical practices and perceptions of treatment efficacy. First, subjects were asked whether they typically have more than two patients diagnosed with schizophrenia in their caseload. Next subjects were asked to identify their own clinical practices and to rate the effectiveness of all of the treatment modalities commonly used to treat schizophrenia. Then each subject's knowledge base was estimated through broad questions about contact with the research literature and participation in continuing education seminars or trainings. Subjects were asked whether they were aware of research for specific treatments, and were asked to summarize any research findings for each treatment modality. Finally, subject's beliefs about the course of schizophrenia were addressed in a very broad sense as they were asked to estimate the chances of recovery.;The results of this study were as follows. Nearly every subject reported an awareness of the existence of research on CBT for schizophrenia (N=189, 99.5%). Furthermore, the overwhelming majority of subjects from both the U.S. and U.K. reported that the research supports the efficacy of CBT (N=173, 96.5%). Generally, subjects across the U.S. and U.K. rated CBT and medication as the two most effective treatments. However, there were significant differences between U.S. and U.K. subjects on several measures. U.K. subjects were more likely to practice CBT than U.S. subjects (91.3% of U.K. Ss vs. 58.6% of U.S. Ss, p<.000). Subjects in the U.K. rated CBT as more effective than did U.S. subjects (U.K. M=3.44, U.S. M=2.98, p<.000), while U.S. subjects rated medication as more effective than did U.K. subjects (U.S. M=3.51, U.K. M=3.24, P<.039). U.K. subjects also rated the likelihood of recovery from schizophrenia significantly higher than did U.S. subjects (U.K. M=3.44, U.S. M=2.51, p<.000).;In conclusion, there were significant differences between therapists in the U.S. and U.K. While both population samples were aware of the efficacy research and supported the use of CBT, U.K. subjects estimated the real-world effectiveness of CBT more highly, were more likely to practice CBT, and were more optimistic about the chances of recovery. These findings have clinical implications for American psychologists, particularly as the field moves towards evidenced-based practices. Currently there is a disconnection between efficacy research and clinical practices. U.S. therapists might benefit from advanced training on the delivery of CBT, greater access to systems that support CBT, or more comprehensive dissemination of the latest research findings. It is also significant that U.K. therapists are more optimistic about the chances of recovery from schizophrenia. This disconcerting finding suggests fundamental differences in etiological theories of schizophrenia, and draws into question the validity of existing diagnostic criteria. |
