Issues in Mental Health Nursing

ISSN: 0161-2840 (Print) 1096-4673 (Online) Journal homepage: http://www.tandfonline.com/loi/imhn20

Supportive Therapy for Schizophrenia

Lisa Whitehead PhD, MA, BSc (hons) RN

To cite this article: Lisa Whitehead PhD, MA, BSc (hons) RN (2016): Supportive Therapy for
Schizophrenia, Issues in Mental Health Nursing, DOI: 10.1080/01612840.2016.1249699

To link to this article: http://dx.doi.org/10.1080/01612840.2016.1249699

Published online: 02 Dec 2016.

Submit your article to this journal

Article views: 13

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=imhn20

Download by: [University of Otago] Date: 11 December 2016, At: 17:30

Issues in Mental Health Nursing, 37:1–2, 2016
Copyright C Taylor & Francis Group, LLC
ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.1080/01612840.2016.1249699
COCHRANE NURSING CARE
Supportive Therapy for Schizophrenia
Lisa Whitehead, PhD, MA, BSc (hons) RN
Edith Cowan University, School of Nursing and Midwifery, Joondalup, Western Australia
BACKGROUND
Schizophrenia is a severe mental disorder, affecting more
than 21 million people worldwide (WHO, 2016). Schizophre-
nia is characterized by profound disruptions in thinking that
can affect language, perception, and the sense of self (Moe
& Docherty, 2014). People living with schizophrenia describe
experiencing psychotic experiences, such as hearing voices or
delusions and the condition can disrupt education and have a
profound impact on the ability to maintain employment (Bevan
et al., 2013), and where schizophrenia typically begins in late
adolescence or early adulthood (Gogtay, Vyas, Testa, Wood, &
Pantelis, 2011). Most people living with schizophrenia will be
prescribed antipsychotic medications to help relieve the symp-
toms and may also receive therapy (Buckley, Maayan, Soares-
Weiser, & Adams, 2015). One therapy is supportive therapy,
characterised by the provision of general support, rather than
specific talking therapies such as cognitive behavioural therapy
(CBT) (Hellerstein, Pinsker, Rosenthal, & Klee, 1994). A num-
ber of definitions of supportive therapy exist and, in this review,
supportive therapy interventions delivered by a single person
aimed at maintaining a person’s existing situation or assisting in
people’s coping abilities and could involve listening to people’s
concerns, providing encouragement, or arranging support for
daily living were included. Exploring the effectiveness of sup-
portive therapy is important where it is commonly used as the
control arm of clinical trials for psychotherapies in schizophre-
nia and evidence for clinicians on the effectiveness of offering
this intervention and understanding the value of supportive ele-
ments in their own individual interactions with people who have
schizophrenia requires development.
OBJECTIVES
To review the effects of supportive therapy compared with
standard care, or other treatments in addition to standard care
for people with schizophrenia.
Address correspondence to Lisa Whitehead, PhD MA BSc (hons)
RN, School of Nursing and Midwifery, Edith Cowan Univer-
sity, 270 Joondalup Drive, Joondalup, Western Australia. E-mail:
l.whitehead@ecu.edu.au
1
INTERVENTION/METHODS
This review reports an update on an original review (search
completed in 2004) (Buckley, Pettit, & Adams, 2007). The
authors searched the Cochrane Schizophrenia Group’s register
of trials (November 2012) for all randomised trials involving
people with schizophrenia and comparing supportive therapy
with any other treatment or standard care. The primary out-
comes were relapse, hospitalisation, and general functioning
between supportive therapy and standard care.
Studies that met the inclusion criteria were quality rated and
data extracted data. For dichotomous data, the risk ratio (RR)
was estimated using a fixed effect model with 95% confidence
intervals (CIs). Where possible, an intention-to-treat analysis
was completed. For continuous data, the mean difference (MD)
fixed-effect was calculated with 95% CIs. Heterogeneity (I2
technique) and publication bias were estimated. The quality of
evidence was assessed using GRADE.
RESULTS
Four new trials were added to the original review taking the
total to 24 studies, with 2126 participants. Overall, the evidence
was very low quality. The authors found no significant differ-
ences in the primary outcomes of relapse, hospitalisation and
general functioning between supportive therapy and standard
care. Significant differences were found favouring other psy-
chological or psychosocial treatments over supportive therapy.
These included hospitalisation rates (4 RCTs, n = 306, RR 1.82
CI 1.11 to 2.99, very low quality of evidence), clinical improve-
ment in mental state (3 RCTs, n = 194, RR 1.27 CI 1.04 to 1.54,
very low quality of evidence) and satisfaction of treatment for
the recipient of care (1 RCT, n = 45, RR 3.19 CI 1.01 to 10.7,
very low quality of evidence). For this comparison (supportive
therapy versus other psychological treatments), no evidence of
significant differences for rate of relapse, leaving the study early
and quality of life were found.
CONCLUSIONS
There is insufficient data to identify a difference in out-
come between supportive therapy and standard care. There are
2 L. WHITEHEAD
several outcomes, including hospitalisation and general men-
tal state, indicating advantages for other psychological thera-
pies over supportive therapy but these findings are based on
a few small studies and the evidence was graded as very low
quality. Future research would benefit from larger trials that use
supportive therapy as the main treatment arm rather than the
comparator.
IMPLICATIONS FOR PRACTICE
Schizophrenia is a serious chronic mental disorder charac-
terized by delusions, hallucinations, and disorganised speech
and behaviour. Although with medications, many will recover
symptomatically, it has become apparent that functional recov-
ery does not inevitably follow symptomatic recovery (Zipursky,
Reilly, & Murray, 2013). Bevan et al. (2013) have identified
that even those receiving optimal medication are likely to
have recurrences, have trouble holding jobs and maintaining
relationships. As hospitalizations have become shorter, the
involvement of family and community mental health services
is considerable (Adamou, 2005; Glick, Stekoll, & Hays, 2011).
Recovery focussed care is a key driver for practice and reflects
the role of mental health nurses to support people to live as
fulfilling lives as possible, ideally in the community setting.
Mental health nurses are well placed to integrate the principals
of supportive therapy; however, the role of the nurse in this
field has not been explored. This, combined with the current
paucity of evidence on the effectiveness of supportive therapy
leaves the clinician unclear as to the best way forward. Further
work that not only explores supportive therapy as a treatment
arm but also the role of the nurse in delivering supportive
therapy as key providers of care would advance knowledge and
practice.
Declaration of Interest: The author reports no conflict of
interest. The author alone is responsible for the content and writ-
ing of this paper.
REVIEW REFERENCE
Buckley, L. A., Maayan, N., Soares-Weiser, K., & Adams, C. E. (2015).
Supportive therapy for schizophrenia. Cochrane Database of Systematic
Reviews 2015, 4, CD004716. doi:10.1002/14651858.CD004716.pub4.
Retrieved from http://www.cochrane.org/CD004716/SCHIZ_supportive-
therapy-for-schizophrenia
REFERENCES
Adamou, M. (2005). Community service models for schizophrenia. Evidence-
based implications and future directions. Psychiatry, 2(2), 24–30.
Bevan, S., Gulliford, J., Steadman, K., Taskila, T., Thomas, R., &
Moise, A. (2013). Working with schizophrenia: Pathways to employ-
ment, recovery & inclusion. Lancaster University. UK: The Work Foun-
dation. Retrieved July 29, 2016, from http://www.theworkfoundation.com/
downloadpublication/report/330_working_with_schizophrenia.pdf
Buckley, L. A., Pettit, T., & Adams, C. E. (2007). Supportive therapy for
schizophrenia. Cochrane Database of Systematic Reviews, 8(3), CD004716.
Glick, I. D., Stekoll, A. H., & Hays, S. (2011). The role of the fam-
ily and improvement in treatment maintenance, adherence, and outcome
for schizophrenia. Journal of Clinical Psychopharmacology, 31(1), 82–85.
doi:10.1097/JCP.0b013e31820597fa
Gogtay, N., Vyas, N. S., Testa, R., Wood, S. J., & Pantelis, C. (2011). Age of
onset of schizophrenia: Perspectives from structural neuroimaging studies.
Schizophrenia Bulletin, 37(3), 504–513. doi:10.1093/schbul/sbr030
Hellerstein, D. J., Pinsker, H., Rosenthal, R. N., & Klee, S. (1994). Supportive
therapy as the treatment model of choice. Journal of Psychotherapy Practice
and Research, 3(4), 300–306.
Moe, A., and Docherty, N. (2014). Schizophrenia and the sense of self.
Schizophrenia Bulletin, 40(1), 161–168. doi:10.1093/schbul/sbt121
WHO. (2016). Schizophrenia. Retrieved July 29, 2016, from http://www.
who.int/mental_health/management/schizophrenia/en/
Zipursky, R., Reilly, T., & Murray, R. (2013). The myth of schizophrenia
as a progressive brain disease. Schizophrenia Bulletin, 39(6), 1363–1372.
doi:10.1093/schbul/sbs135