Dr. Beck and his staff have conducted extensive research into the psychological underpinnings and psychosocial treatment of chronic, low functioning patients with schizophrenia. These studies showed that the basis of their tendency to withdraw from the important life spheres are their defeatist attitudes about performance and socialization, the result of a lifetime of failure and rejection experiences (1). This new understanding was formulated into a book for this disorder: Schizophrenia: Cognitive Theory and Therapy (8).
Dr. Beck and his associates then conducted a randomized controlled trial for low functioning patients with chronic schizophrenia. The results showed that the functioning of this group can be improved to a new level. In addition to substantial improvements in social and vocational adjustment, the patients also showed a marked reduction in delusions and hallucinations (9). This finding is especially remarkable since this group of patients is generally considered to be refractory to all psychological and pharmacological interventions.
One of the Aaron T. Beck Psychopathology Research Center’s main research foci is recovery-oriented cognitive therapy (CT-R) for individuals with persistent schizophrenia. As a fusion of the recovery movement’s spirit with cognitive therapy’s evidence base and know-how, CT-R is a collaborative treatment approach that prioritizes attainment of personally-set goals, removal of roadblocks, and engagement of individuals in their own psychiatric rehabilitation. Center efforts to advance recovery-oriented care for individuals with schizophrenia fall into three categories: basic research elucidating treatment targets, the development and validation of CT-R treatment protocols, and dissemination and implementation of CT-R continuity of care programing.
Basic research conducted at the ATB-PRC aims to uncover psychological mechanisms that impair psychosocial functioning and thwart recovery for individuals with schizophrenia. Ongoing investigations involve the development of new measures, as well as cross-sectional, longitudinal, and experimental studies of negative symptoms, positive symptoms, communication disturbance, and poor psychosocial functioning.
Treatment Development and Validation
CT-R employs a variety of methods to target negative attitudes and associated beliefs in order to foster change, promote personal mastery, and remove roadblocks to self-sustaining movement toward recovery. CT-R is collaborative, person-centered, and personalized, with all interventions based on the individual’s cognitive case formulation, tailored for patients who have difficulties with attention, memory, and executive functioning, and/or who have low motivation.
Personnel in the ATB-PRC have translated the principles of CT-R into a group therapy format that promotes positive action and the engagement of individuals with schizophrenia in their own recovery process and psychiatric rehabilitation.
Dissemination and implementation: Promoting recovery through continuity of care in community behavioral health
ATB-PRC personnel have developed an innovative continuity of care dissemination and implementation program for CT-R through extensive training for psychiatric hospital staff, community behavioral health workers, and Assertive Community Treatment (ACT) teams. Peer specialists and front-line staff learn effective ways to understand and facilitate the recovery of individuals with schizophrenia. Clinicians learn individual and group therapy to help persons with schizophrenia to become motivated in their own psychiatric rehabilitation and experience pleasure and personal mastery.
- Grant PM, Beck AT. Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophr Bull. 2009;35(4):798-806.
- Grant PM, Beck AT. Evaluation sensitivity as a moderator of communication disorder in schizophrenia. Psychol Med. 2009;39(7):1211-1219.
- Grant PM, Beck AT. Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Res. 2010;177(1-2):65-70.
- Beck AT, Grant PM, Huh GA, Perivoliotis D, Chang NA. Dysfunctional attitudes and expectancies in deficit syndrome schizophrenia. Schizophr Bull. 2011.
- Beck AT, Baruch E, Balter JM, Steer RA, Warman DM. A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res. 2004;68:319-329.
- Riggs SE, Grant PM, Perivoliotis D, Beck AT. Assessment of cognitive insight: a qualitative review. Schizophr Bull. Mar 2012;38(2):338-350.
- Beck AT. Successful outpatient psychotherapy of a chronic schizophrenic with a delusion based on borrowed guilt. Psychiatry. 1952;15:305-312.
- Beck AT, Rector NA, Stolar NM, Grant PM. Schizophrenia: cognitive theory, research and therapy. NY: Guilford Press; 2009.
- Grant PM, Huh GA, Perivoliotis D, Stolar NM, Beck AT. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry. 2012;69(2):121-127.
- Perivoliotis D, Grant PM, Beck AT. Recovery-oriented cognitive therapy for schizophrenia: a comprehensive treatment manual. New York: Guilford; in press.
- Warman D, Grant P, Sullivan K, Caroff S, Beck AT. Individual and group cognitive behavioral therapy for schizophrenia: a pilot investigation. Journal of Psychiatric Practice. 2005;11(1):27-34.
- Stirman S, Bhar S, Spokas M, et al. Training and Consultation in Evidence-Based Psychosocial Treatments in Public Mental Health Settings: The ACCESS Model. Professional Psychology: Research and Practice. 2010;41(1):48-56.