Process analysis of trauma-focused cognitive behavioural therapy for individuals
with schizophrenia.
Author(s): O'Driscoll C(1), Mason O(1), Brady F(1), Smith B(2), Steel C(3).
Affiliation(s): Author information:
(1)Research Department of Clinical, Educational and Health Psychology, University
College London, UK. (2)North East London NHS Foundation Trust, London, UK.
(3)Charlie Waller Institute, School of Psychology and Clinical Language Sciences,
University of Reading, UK.
Publication date & source: 2015, Psychol Psychother. ,
OBJECTIVE: Therapeutic alliance, modality, and ability to engage with the process
of therapy have been the main focus of research into what makes psychotherapy
successful. Individuals with complex trauma histories or schizophrenia are
suggested to be more difficult to engage and may be less likely to benefit from
therapy. This study aimed to track the in-session 'process' of working alliance
and emotional processing of trauma memories for individuals with schizophrenia.
DESIGN: The study utilized session recordings from the treatment arm of an open
randomized clinical trial investigating trauma-focused cognitive behavioural
therapy (TF-CBT) for individuals with schizophrenia (N = 26).
METHOD: Observer measures of working alliance, emotional processing, and affect
arousal were rated at early and late phases of therapy. Correlation analysis was
undertaken for process measures. Temporal analysis of expressed emotions was also
reported.
RESULTS: Working alliance was established and maintained throughout the therapy;
however, agreement on goals reduced at the late phase. The participants appeared
to be able to engage in emotional processing, but not to the required level for
successful cognitive restructuring.
CONCLUSION: This study undertook novel exploration of process variables not
usually explored in CBT. It is also the first study of process for TF-CBT with
individuals with schizophrenia. This complex clinical sample showed no difficulty
in engagement; however, they may not be able to fully undertake the
cognitive-emotional demands of this type of therapy. Clinical and research
implications and potential limitations of these methods are considered.
PRACTITIONER POINTS: This sample showed no difficulties engaging with TF-CBT and
forming a working alliance. However, the participants may not have achieved a
level of active involvement required for successful cognitive restructuring of
trauma memories. This discrepancy may relate to the mediating role of both
working alliance and cognitive-emotional processing. The results underscore the
importance of therapists understanding the relationship between alliance and
other process factors which may be implicit in facilitating change.
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