Talk therapy results speak for themselves

The News Focus story “Talking back to madness” by M. Balter (14 March, p. [1190][1]) highlights the importance of talk therapies as part of mainstream treatment of schizophrenia. Balter focuses largely on one form of psychotherapy, cognitive behavioral therapy (CBT), which helps positive, or psychotic, symptoms, but does not benefit other types of symptoms ([ 1 ][2]). Other core features of schizophrenia, such as negative symptoms (social withdrawal, lack of motivation, and flat affect) and cognitive deficits (impairments in attention, memory, and problem-solving abilities) are more common, persist longer, and contribute more to the lifelong disability of schizophrenia. Fortunately, these symptoms also respond to psychotherapies. One meta-analysis showed that negative symptoms respond to social skills training ([ 1 ][2]). Another meta-analysis showed that cognitive remediation therapy improves cognitive functioning (though not other symptoms), especially when combined with psychiatric rehabilitation ([ 2 ][3]). The field may have relied too much, and for too long, on antipsychotic medications as the mainstay in treating schizophrenia. Medications work, but mainly for psychosis, and are limited by side effects. It is encouraging that psychotherapies are receiving more attention. Treatment of this chronic, complex illness must involve multipronged interventions, including medications and effective talking treatments, optimally tailored to the individual patient and phase of illness. 1. [↵][4]1. D. T. Turner, 2. M. van der Gaag, 3. E. Karyotaki, 4. P. Cuijpers , Am. J. Psychiatr. 10.1176/appi.ajp.2013.13081159 (2014). doi:10.1176/appi.ajp.2013.13081159 [OpenUrl][5][CrossRef][6] 2. [↵][7]1. T. Wykes, 2. V. Huddy, 3. C. Cellard, 4. S. R. McGurk, 5. P. Czobor , Am. J. Psychiatr. 168, 472 (2011). [OpenUrl][8][CrossRef][9][PubMed][10][Web of Science][11] [1]: pending:yes [2]: #ref-1 [3]: #ref-2 [4]: #xref-ref-1-1 "View reference 1 in text" [5]: {openurl}?query=rft.jtitle%253DAm.%2BJ.%2BPsychiatr.%26rft_id%253Dinfo%253Adoi%252F10.1176%252Fappi.ajp.2013.13081159%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1176/appi.ajp.2013.13081159&link_type=DOI [7]: #xref-ref-2-1 "View reference 2 in text" [8]: {openurl}?query=rft.jtitle%253DAmerican%2BJournal%2Bof%2BPsychiatry%26rft.stitle%253DAm.%2BJ.%2BPsychiatry%26rft.volume%253D168%26rft.issue%253D5%26rft.spage%253D472%26rft.epage%253D485%26rft.atitle%253DA%2Bmeta-analysis%2Bof%2Bcognitive%2Bremediation%2Bfor%2Bschizophrenia%253A%2Bmethodology%2Band%2Beffect%2Bsizes.%26rft_id%253Dinfo%253Adoi%252F10.1176%252Fappi.ajp.2010.10060855%26rft_id%253Dinfo%253Apmid%252F21406461%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [9]: /lookup/external-ref?access_num=10.1176/appi.ajp.2010.10060855&link_type=DOI [10]: /lookup/external-ref?access_num=21406461&link_type=MED&atom=%2Fsci%2F344%2F6188%2F1099.1.atom [11]: /lookup/external-ref?access_num=000290089000008&link_type=ISI