INT-Integrated Neurocognitive Therapy for Schizophrenia Patients

150 Pages·2015·9.833 MB·English

by  Volker Roder, Daniel R. Müller

Volker Roder
Daniel R. Müller
Editors
INT-Integrated
Neurocognitive
Therapy for
Schizophrenia
Patients
INT-Integrated Neurocognitive Therapy
for Schizophrenia Patients

Volker Roder
Daniel R. Müller
Editors
INT-Integrated
Neurocognitive Therapy
for Schizophrenia
Patients
Editors
Volker Roder
Professor of Clinical Psychology
University Hospital of Psychiatry and Psychotherapy
University of Bern
Switzerland
[email protected]
Daniel R. Müller
Senior Lecturer
University Hospital of Psychiatry and Psychotherapy
University of Bern
Switzerland
[email protected]
Translation of the German edition to English: Aaron Kuchle, South Korea
Translation sponsored by: Hans & Annelies Swierstra Stift ung: www.has-stift ung.ch
Additional material to this book can be downloaded from http://extras.springer.com
ISBN 978-3-319-13244-0 ISBN 978-3-319-13245-7 (eBook)
DOI 10.1007/978-3-319-13245-7
Library of Congress Control Number: 2015936146
Springer Cham Heidelberg New York Dordrecht London
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V
Preface to the German Edition
Since the turn of the century, international interest in the Th is treatment manual is divided into six chapters.
cognitive treatment of patients with schizophrenia has ▶ C hapter 1 (Th eoretical Background) provides an over-
steadily increased. Th is is in large part due to the fact that view of recovery, MATRICS, and IPT that is relevant to
several studies have shown that cognitions are of central the conception of INT.  Chapter 2 (Practical
importance for coping with life’s challenges successfully Implementation of INT) describes in a highly practical
and for social (re)integration – and thus for the overall life way INT’s four treatment areas (A–D) for the improve-
satisfaction of the persons concerned. At the beginning of ment of neurocognition and social cognition. Th is chapter
the 21st century, the NIMH (National Institute of Mental encompasses methods, therapy content, and numerous
Health) of the USA spearheaded the MATRICS initiative examples of practical implementation in INT groups. In
(Measurement and Treatment Research to Improve ▶ C hap. 3 (Th erapy Requirements, Possible Applications,
Cognition in Schizophrenia) with the objective, among and Indication), readers are given concrete information
others, of consistently defi ning and measuring cognitions. about starting INT groups in their own institutional con-
Th e initiative’s fi rst successes were in the area of neurocog- text. Finally, ▶   Chap. 4 (Diagnostic Instruments, Treatment
nition (e.g., attention, concentration, memory). Yet, there Planning, and Controlling the Treatment Process) focuses
was a growing realization that social cognition (e.g., emo- on conceptualizing cases and the signifi cance of INT
tions, social perception processes) is also a crucial factor application. Assessment tools for various functional areas
for persons aff ected by schizophrenia. As a result, the are presented in detail. ▶  C hap. 5 (Empirical Evidence of
MATRICS initiative further specifi ed and analyzed the INT) reports on the results of a multicenter evaluation of
area of social cognition during the end of the fi rst INT and critically discusses the relevance of those results
decade of the 21st century. Key exponents of the for INT practice. Finally, on the ▶ C D-ROM ( ▶  Chap. 6 :
MATRICS initiative include, among others, the Th erapy Materials for the Four Treatment Areas), exten-
psychologists Michael Green and Keith Nuechterlein sive materials are provided for the therapist to print out
of UCLA (University of California, Los Angeles). for distribution. Bibliographical references are listed at the
Associated therapeutic approaches were being conceived end of each chapter for the interested reader.
at the same time. Th e multicenter study ( ▶ C hap. 5 ) required about fi ve
Th e Integrated Psychological Th erapy (IPT) program, years to complete – writing and revision of the present
developed by our team in Bern in the 1980s, was one of volume, nearly one year more. Without the help and sup-
the fi rst international therapeutic approaches which, long port of many people, this work would never have suc-
before the “new wave of cognitive schizophrenia,” took ceeded. We would thus in conclusion like to thank all
into account the signifi cance of cognitions for the treat- those who directly or indirectly contributed to the success
ment of schizophrenia. In the meantime, 37 international of this treatment manual: fi rst and foremost of course, all
studies involving 1,632 patients have proven the success of the patients who were willing to try out the many new
IPT’s implementation. Th e IPT treatment manual has materials during group sessions, and also all the therapists
been translated into 13 languages and is being used in from the eight centers who implemented INT for the fi rst
Europe; North, Central, and South America; Asia; and time in the context of the multicenter evaluation study.
Australia. Th ese include, in Switzerland, the Psychiatric Hospital of
About seven years ago, the MATRICS initiative and the University of Zürich (A. Th eodoridou, M.D.), the Biel
IPT became the basis for the development of INT. Th e Center of Psychiatry (A. Rausch, M.D.), and the University
idea was to develop a therapy approach for patients who Hospital of Psychiatry and Psychotherapy in Bern; in
were largely socially integrated and in low-threshold treat- Germany, the Protestant Hospital of Bielefeld, the Bethel
ment, but who suff ered from defi cits in cognitive func- Clinic for Psychiatry and Psychotherapy (M. Driessen,
tioning. Such patients could not be reached optimally M.D.; C. Barenbrock, M.Sc.), the Rehabilitation Center for
using the cognitive subprograms of IPT, which had been the Mentally Ill in Peiting- Herzogsägmühle (S. Queri,
conceived more for patients with pronounced negative Ph.D.; A.  Gabrecht, M.D.), ARBEWE Rehabilitation
symptoms. INT thus systematically converts the areas Center in Nuremberg (A. Baumann, M.Sc.; G. Fisher),
defi ned by MATRICS into therapeutic approaches while and the Rehabilitation Center of Vitos Eltville
making use of IPT’s empirical results and practical experi- (G. Deutschle, M.Sc.); and in Austria, the State Hospital of
ence in practicing group therapy with persons suff ering Schwarzach/St. Veit (M. Keglevic, M.D.). In addition, we
from schizophrenia. thank our colleagues in Bern who were entrusted with
VI Preface to the German Edition
treatment or with diagnostic surveys and data evaluation:
Manuela Christen, M.Sc.; Juliane Emmerich, M.Sc.;
Annette Eugster, B.Sc.; Lea Hulka, M.Sc.; Stefanie Schmidt,
Ph.D.; Daniela Speiser, M.Sc.; and James Weiss, M.Sc. We
would like to extend special thanks to our former col-
league Marc Lächler, Ph.D., with whom we fi rst elaborated
the INT treatment approach. Many thanks also go to
Francine Perret, who assisted us in the preparation of vari-
ous photographs in the materials section.
Last but not least, we would like to extend our thanks
to Renate Scheddin, M.D., and Renate Schulz from
Springer Publishers, Germany, who showed understand-
ing for delays in manuscript deadlines and always pro-
vided us with helpful support.
Volker   Roder
Daniel   R.   Müller
Switzerland
VII
Foreword to the German Edition
Th e development of Integrated Neurocognitive Th erapy schema, and attribution style. INT is structured around
(INT) for schizophrenia patients represents the culmina- these separable cognitive domains, moving systematically
tion of a long and rich history of comprehensive psycho- from initial modules focusing on simpler neurocognitive
logical therapies coming from the group in Bern around and social cognitive processes to later modules focusing
Hans Brenner and Volker Roder. I remember well my sev- on high-level integrative neurocognitive and social cogni-
eral visits to Bern for stimulating international confer- tive processes. Th us, it covers within a single approach a
ences focused on the identifi cation and modifi cation of series of training exercises that target all of the cognitive
cognitive and social processes in schizophrenia. Th e Bern domains identifi ed by the MATRICS initiative.
tradition has been characterized for many years by sophis- Another key infl uence that Roder and Müller have
tication and breadth in conceptualizing the basic psycho- incorporated into INT is the use of computer-based cog-
logical and cognitive defi cits in schizophrenia. Well before nitive training, which was not a feature of IPT but has
the current scientifi c acceptance of systematic cognitive recently become popular in cognitive remediation. Th us,
remediation as an effi cacious intervention for the core INT includes computerized cognitive remediation as a
cognitive defi cits of schizophrenia, the Bern group devel- component of its sessions, increasing the ability to provide
oped one of the fi rst broad cognitive training approaches, multiple practice exercises in focused areas to improve
Integrated Psychological Th erapy (IPT). IPT is character- cognitive skills. At the same time, INT retains the distinc-
ized by a series of systematic, manualized modules using tive IPT tradition of group treatment sessions, using com-
group treatment to build skills ranging from basic neuro- puterized training as one modality but providing much
cognition to complex interpersonal problem solving. more group training in social reasoning, strategic plan-
Th rough IPT, the Bern group was one of the earliest to ning, and interpersonal problem solving than most cur-
integrate treatment of core neurocognitive defi cits (e.g., rent cognitive remediation approaches. INT also
attention, memory, problem solving) with treatment of emphasizes group processes to enhance engagement in
social cognitive defi cits (e.g., social perception, interper- the intervention, including team competition and debates
sonal problem solving), drawing creatively on the princi- to reach consensus.
ples of cognitive development, social learning, cognitive A third key feature of INT, relative to most other cog-
behavior therapy, and social skills training. Th e consider- nitive remediation approaches, is that it combines restor-
able literature evaluating the effi cacy of IPT is impressive ative and compensatory approaches to the core cognitive
and has led to its broad application. and social cognitive defi cits in schizophrenia. Other
Th e recent development of INT described here by prominent cognitive remediation approaches focus very
Volker Roder and Daniel Müller represents a substantial predominantly on one or the other. INT involves direct
refi nement and extension of IPT to incorporate more exercises to improve cognitive skills to reduce the core
recent theoretical and empirical advances in the fi eld. One defi cits, while recognizing that less severe cognitive defi -
key infl uence was the NIMH initiative, Measurement and cits will nevertheless remain. Th us, participants are helped
Treatment Research to Improve Cognition in to identify ways to work around remaining defi cits in the
Schizophrenia (MATRICS), inspired by the late Wayne context of situations from everyday life, which should fur-
Fenton at NIMH.  Th rough the MATRICS initiative, ther aid the impact of INT on functional outcomes in
Michael Green and I led a Neurocognition Committee schizophrenia.
that surveyed the empirical literature and brought together I n summary, Roder, Müller, and their colleagues are to
more than 100 experts to reach consensus on seven key be congratulated on the signifi cant advance that INT rep-
separable cognitive domains in schizophrenia that are resents. It retains distinctive features of IPT while incor-
fruitful intervention targets – speed of processing, atten- porating several recent key conceptual and methodological
tion/vigilance, working memory, verbal learning, visual advances. Th e results of their recent international multi-
learning, reasoning and problem solving, and social cog- site study of INT show the positive impact that this new
nition. A subsequent related NIMH conference further comprehensive intervention can achieve. Th e availability
delineated fi ve key aspects of social cognition – emotional of this volume will hopefully greatly aid the application of
processing, social perception, Th eory of Mind, social INT at additional sites. INT shows excellent promise for
VIII Foreword to the German Edition
improving the cognitive skills and social functioning of
patients with schizophrenia, which would be an important
step forward for all of us who labor to help those suff ering
from this disorder.
Keith H. Nuechterlein, Ph.D.
Professor, UCLA Departments of Psychiatry
and Biobehavioral Sciences and of Psychology
Co-Chair, MATRICS Neurocognition Committee
Director, Center for Neurocognition and Emotion
in Schizophrenia
Director, UCLA Aftercare Research Program
IX
Contents
1 Theoretical Background ..................................................................................................................................................................1
S. J. Schmidt, V. Roder
1.1 “Recovery” and its Eff ects on the Treatment and Rehabilitation Process .......................................................................................................2
1.1.1 Functional Recovery ................................................................................................................................................................................................................2
1.1.2 Subjective Recovery .................................................................................................................................................................................................................2
1.2 The Signifi cance of the MATRICS Initiative for Modern Treatment Concepts ................................................................................................3
1.3 Further Developments of Integrated Psychological Therapy (IPT): INT and WAF .......................................................................................7
References ..................................................................................................................................................................................................................................9
2 Practical Implementation of INT .................................................................................................................................................................13
D. R. Müller, S. J. Schmidt, M. Lächler, V. Roder
2.1 Overview, Structure, and Didactics of Integrated Neurocognitive Therapy ................................................................................................14
2.1.1 Therapeutic Approach ..........................................................................................................................................................................................................14
2.1.2 Therapeutic Goals ...................................................................................................................................................................................................................14
2.1.3 Therapy Components ............................................................................................................................................................................................................15
2.1.4 Didactic Structure of the INT Modules ............................................................................................................................................................................15
2.1.5 Therapy Materials ....................................................................................................................................................................................................................18
2.2 Therapeutic Infrastructure ................................................................................................................................................................................................18
2.2.1 General Conditions .................................................................................................................................................................................................................18
2.3 Treatment Areas A–D for Neurocognition and Social Cognition ......................................................................................................................20
2.3.1 INT Module A ............................................................................................................................................................................................................................20
2.3.2 INT Module B ............................................................................................................................................................................................................................44
2.3.3 INT Module C ............................................................................................................................................................................................................................66
2.3.4 INT Module D ............................................................................................................................................................................................................................86
2.4 Example Organization of 30 INT Sessions ................................................................................................................................................................106
2.5 Motivation Building, Forming Relationships, and Group Processes ............................................................................................................111
2.5.1 Building Motivation and Forming Relationships ......................................................................................................................................................111
2.5.2 Group Processes ...................................................................................................................................................................................................................113
References .............................................................................................................................................................................................................................114
3 Therapy Requirements, Possible Applications, and Indication .................................................................................115
D. R. Müller, V. Roder
3.1 Setting Conditions .............................................................................................................................................................................................................116
3.1.1 Types of Institutions ............................................................................................................................................................................................................116
3.1.2 Intra-institutional and Inter- institutional Options ...................................................................................................................................................116
3.1.3 Intra-institutional Options ................................................................................................................................................................................................116
3.1.4 Closed or Open Groups .....................................................................................................................................................................................................116
3.2 Patient Characteristics ......................................................................................................................................................................................................117
3.3 Group Composition ...........................................................................................................................................................................................................117
3.4 Therapist Requirements ..................................................................................................................................................................................................118
3.5 Diff erential Indication and Contrasts to IPT and WAF .........................................................................................................................................118
3.5.1 INT..............................................................................................................................................................................................................................................118
3.5.2 IPT ..............................................................................................................................................................................................................................................119
3.5.3 WAF ...........................................................................................................................................................................................................................................119
References .........................................................................................................................................................................................................119