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Schizophrenia is a chronic mental health disorder, which changes rapidly the life of the persons and their families, who suffer from it. It causes high biological and psychological vulnerability as well as cognitive, emotional and behavioral disorders. Nowadays, evidence-based pharmacotherapy and psychotherapy are available aiming the rehabilitation and recovery of individuals with schizophrenia. A democratic society is obliged to give these people the opportunity to have an access to those treatments.
The following three published studies present this dissertation thesis and have a common focus on the implementation of evidence-based psychotherapy in individuals with schizophrenia.
The first study evaluates the efficacy of the Integrated Psychological Therapy (IPT) in Greece, one of the most evaluated rehabilitation programs. IPT was compared to
Treatment as Usual (TAU) in a randomized controlled trial (RCT) with 48 individuals with schizophrenia. Significant effects favouring IPT were found in working memory,
in social perception, in negative symptoms, in general psychopathology and in insight. This study supports evidence for the efficacy of IPT in Greece.
The second study evaluates a second hypothesis, when IPT is more and less effective regarding treatment resistant schizophrenia (TRS) and non treatment resistant
schizophrenia (NTRS). It is a part of the first paper. Significant effects favouring NTRS were found for verbal memory, for symptoms, for functioning and quality of
life. Effect sizes showed superiority of NTRS in comparison to TRS. IPTTRS showed on the other side some significant improvements. This study presents the initial findings of a larger study to be conducted internationally for the first time.
The third study is a systematic review, which aims to evaluate the efficacy of Cognitive Behavioral Therapy (CBT), of Meta Cognitive Therapy (MCT), Metacognitive Training (MCTR), Metacognitive Reflection and Insight Therapy
(MERIT), of various Rehabilitation Programs and Recovery Programs in individuals with schizophrenia. 41 RCTs and 12 Case Studies were included. The above interventions are efficacious in the improvement of cognitions, symptoms, functional outcome, insight, self-esteem, comorbid disorders and metacognitive capacity.
The three studies provide insight regarding the importance of evidence-based psychotherapy in persons with schizophrenia leading to recovery and reintegration into
society. Future RCTs with larger samples and long-term follow up, combining evidence-based psychotherapies for individuals with schizophrenia need to be done.
This study examined whether positive resource change and two types of baseline stressors would influence general life satisfaction and satisfaction with health at the end of treatment in mothers attending an inpatient rehabilitation or preventive program for mothers, fathers and children. Parenting self-efficacy was included as an indicator of resources while baseline distress was operationalized in terms of parenting-related stressors and depressive symptoms, respectively. Drawing on Hobfoll- conservation of resources theory, it was hypothesized that resource change and baseline stressors would interact in their effect on satisfaction measures at the end of the preventive/rehabilitation program: resource gains were expected to influence satisfaction more strongly in patients who reported higher stress levels at baseline (as compared to patients with lower baseline distress; primary research question). Hypotheses were tested using a sample of N=1724 female prevention and rehabilitation patients by means of structural equation modeling including latent interactions. Results showed that parenting-related stressors were negatively associated with general satisfaction as well as satisfaction with health while resource gains had a small positive effect on satisfaction. There was, however, no significant interaction of parenting-related stressors and positive resource change. When depressive symptoms were included as a measure of baseline distress, they were negatively associated with both facets of satisfaction. In these models, there were only small positive associations of resource gains and satisfaction measures. Again, no interaction effects were found. Additional analyses that comprised both stressor types as predictors showed that the effects of depressive symptoms on satisfaction were more pronounced than the influence of parenting-related stressors; the effects of resource gains were small to negligible. In addition, it was examined whether problem-oriented coping strategies mediated the influence of positive resource change on general life satisfaction and satisfaction with health, respectively (secondary research question). Correlations between coping, resource change and satisfaction were low or not significant. Given this lack of direct associations between the relevant variables, no further path analytic testing was performed; the hypothesized mediating role of problem-oriented coping could thus not be confirmed. All in all, study results show that contrary to the hypotheses derived from conservation of resources theory, the effects of positive resource change and distress indicators on patients" life satisfaction and satisfaction with health were not interdependent.