A Three Year Multiple Baseline Evaluation of Cognitive-behavioral Treatment of Schizophrenia

William Bradshaw
Peters Hall
University of Minnesota
1404 Gortner Ave
St. Paul MN 55108
612.624.3568
bbradsha@che.umn.edu
Purpose:  The purpose of this study was to evaluate the effectiveness and acceptability of CBT in the treatment of schizophrenia.  The study used a single-system multiple baseline design across twenty-two subjects to evaluate change in clinical outcomes. The ABC design included a (A) baseline phase (B) behavioral intervention phase (C) and cognitive intervention phase.  A post-test only design was used to assess the acceptability of treatment to clients.
 
Methods:  Standardized measures of psychosocial functioning, severity of symptoms and attainment of treatment goals were used to assess clinical change over the course of three years treatment.  Data was collected every three months by the therapists and case managers. Inter-observer reliability was ICC .82 for symptoms and .88 for functioning. Acceptability of treatment was defined as client satisfaction, dropout rate and attendance rates calculated at the end of the treatment period.
 
Results: Analysis of clinical outcome data showed clients experienced a 57% reduction in symptomatology, 63% improvement in psychosocial functioning and exceeded the expected level of attainment of treatment goals.  Visual analysis of the SSD data indicate that change only occurred after the intervention was introduced. Data from a client satisfaction scale indicated uniformly high rates of satisfaction with treatment.  There were high rates of kept appointments, 72%, and a low drop out rate of 26% over the three-year treatment period.
 
Implications for Practice: Results suggest that cognitive-behavioral treatment is an effective intervention for persons with schizophrenia.  Clients were very satisfied with treatment and found it highly suited to their needs for treatment.  Social workers were able to be trained and provide the interventions with fidelity to the cognitive-behavioral treatment protocol. Issues regarding the applicability of single-system designs for the practitioner-researcher evaluation of mental health practice will be discussed.