Negative Symptoms of Schizophrenia as Primary Target of Cognitive Behavioral Therapy: Results of the Randomized Clinical TONES Study

• Published in: Schizophrenia bulletin Vol. 37; no. suppl 2; pp. S98 - S110
• Main Authors: KLINGBERG, Stefan, WÖLWER, Wolfgang, ENGEL, Corinna, WITTORF, Andreas, HERRLICH, Jutta, MEISNER, Christoph, BUCHKREMER, Gerhard, WIEDEMANN, Georg
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2011
• Subjects: Adult; Adult and adolescent clinical studies; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive Therapy - methods; Endpoint Determination - methods; Feasibility Studies; Female; Humans; Male; Medical sciences; Middle Aged; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Regular; Research Design; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - therapy; Schizophrenic Psychology; Single-Blind Method; Treatment Outcome; Treatments; Psychosis; cognitive behavioral therapy; Cognitive therapy; Treatment; Negative symptom; Cognitive remediation; negative symptoms; Schizophrenia; Controlled therapeutic trial; randomized clinical trial; Behavior therapy
• ISSN: 0586-7614; 1745-1701
• DOI: 10.1093/schbul/sbr073

Clinical studies on cognitive behavioral therapy (CBT) that include schizophrenia patients primarily on the basis of negative symptoms are uncommon. However, those studies are necessary to assess the efficacy of CBT on negative symptoms. This article first gives an overview of CBT on negative symptoms and discusses the methodological problems of selecting an adequate control group. Furthermore, the article describes a clinical study (the TONES-Study, ISRCTN 25455020), which aims to investigate whether CBT is specifically efficacious for the reduction of negative symptoms. This multicenter randomized clinical trial comparing CBT with cognitive remediation (CR) for control of nonspecific effects is depicted in detail. In our trial, schizophrenia patients (n = 198) participated in manualized individual outpatient treatments. Primary outcome is the negative syndrome assessed with the positive and negative syndrome scale, analyzed with multilevel linear mixed models. Patients in both groups moderately improved regarding the primary endpoint. However, against expectation, there was no difference between the groups after treatment in the intention to treat as well as in the per-protocol analysis. In conclusion, psychotherapeutic intervention may be useful for the reduction of negative symptoms. However, there is no indication for specific effects of CBT compared with CR.