University of Groningen Bottom-up rehabilitation in schizophrenia Appelo, Martinus IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 1996 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Appelo, M. T. (1996). Bottom-up rehabilitation in schizophrenia Groningen: s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 10-02-2018
RIJKSUNIVERSITEIT GRONINGEN BOTTOM-UP REHABILITATION IN SCHIZOPHRENIA Proefschrift ter verkrijging van het doctoraat in de Geneeskunde aan de Rijksuniversiteit Groningen op gezag van de Rector Magnificus Dr. F. van der Woude in het openbaar te verdedigen op woensdag 24 januari 1996 des namiddags te 4.00 uur door Martinus Theodoor Appelo geboren op 20 juni 1962 te Zwartsluis
Promotores: Prof. dr. R.J. van den Bosch Prof. dr. P.M.G. Emmelkamp Referenten: Dr. M. van der Gaag Dr. C.J. Slooff
It ain't what you do it's the way that you do it (Bananarama)
Photograph cover: Chris Kliphuis Druk: Stichting Drukkerij Regenboog, Groningen (1995) ISBN: 90 367 0562 2
Acknowledgement. This study was part of the Schizophrenia Rehabilitation Research Group Groningen/Assen (SRRG), a cooperation of the Psychiatric Hospital 'Licht en Kracht' in Assen, and the departments of Clinical Psychiatry and Clinical Psychology of the University of Groningen. The study has been realized thanks to the financial support by the Dutch Praeventiefonds. Without the 'executive control' by Frank Woonings, Jan Willem Louwerens and Wim Appelo, the stress related to finishing this study, would have exceeded my 'treshold'.
Contents. Introduction. 3 1 Schizophrenia and rehabilitation. 5 1.1 Schizophrenia. 5 1.2 Theoretical starting points. 7 1.3 A special note on negative symptoms. 9 1.4 The concept of rehabilitation. 11 1.5 Schizophrenia and rehabilitation: the state of the art. 14 2 Information processing and schizophrenia. 17 2.1 Introduction. 17 2.2 A cognitive model for skills acquisition. 17 2.3 Cognitive disturbances in chronic schizophrenia. 19 2.4 Cognitive disturbances and symptoms. 21 3 Methodological tactics in rehabilitation. 23 3.1 Introduction. 23 3.2 Behaviour therapeutic tactics in rehabilitation. 23 3.2.1 Tactics at the declarative stage. 24 3.2.2 Tactics for knowledge compilation. 25 3.2.3 Tactics for production tuning. 26 3.2.4 General tactics for professionals. 27 3.3 Towards a pilot-study. 28 4 Pilot-study: cognitive and social skills training. 29 4.1 Introduction. 29 4.2 Cognitive training in schizophrenia. 29 4.3 Content of the combination-training. 31 4.4 Method of the pilot-study. 33 4.4.1 Subjects. 33 4.4.2 Assessment. 33 4.5 Results of the combination-training. 34 4.5.1 General impression. 34 4.5.2 Results. 35 4.6 Conclusions and implications. 37
5 Selection of instruments for rehabilitation research. 39 5.1 Introduction. 39 5.2 Operationalization of theoretical starting points. 40 5.2.1 Cognitive functions. 40 5.2.2 Coping-style. 46 5.2.3 Social skills. 46 5.2.4 General functioning. 48 5.2.5 Symptoms. 49 5.2.6 Demographics. 50 5.3 Selection of variables. 51 6 A bottom-up rehabilitation programme. 55 6.1 Introduction. 55 6.2 Content of the rehabilitation programme. 56 6.2.1 Subdivisions at the first and second stage. 56 6.2.2 Subdivisions at the first stage. 59 6.2.3 Subdivisions at the second stage. 60 6.2.4 The meaning of the programme. 61 6.3 Content of the control conditions. 62 7 Methods. 63 7.1 Aims of the study. 63 7.2 Subjects. 63 7.3 Assessment. 66 7.3.1 Assessment of syndromes of schizophrenia. 68 7.4 Design and procedure. 70 7.5 Hypotheses and questions. 71 7.5.1 Hypothesis on the effect of the programme. 71 7.5.2 The additional value of cognitive skills training. 72 7.5.3 Predictors of successful rehabilitation. 73 7.6 Statistical procedures. 75 8 Results. 77 8.1 Introduction. 77 8.2 Correlations at the first assessment. 77 8.3 Do drop-outs differ from non-drop-outs? 79 8.4 The results of the programme. 80 8.4.1 Results on cognitive organization. 80 8.4.2 Results on problem oriented coping. 84
8.4.3 Results on social skills. 84 8.4.4 Results on general functioning. 84 8.4.5 Results on reality distortion. 85 8.4.6 Results on accommodation. 86 8.4.7 Results on daily activities. 87 8.4.8 Conclusion. 87 8.5 The additional value of cognitive skills training. 89 8.5.1 Conclusion. 90 8.6 Predictors of successful rehabilitation. 94 8.6.1 Stability of CPT-d'. 94 8.6.2 Predicting improvement. 95 8.6.3 Conclusion. 100 9 Discussion. 101 9.1 Introduction. 101 9.2 How to improve rehabilitation in schizophrenia? 103 9.2.1 Bottom-up or top-down rehabilitation? 103 9.2.2 The reduction of profound reality distortion. 105 9.2.3 The establishment of problem oriented coping. 106 9.2.4 The role of society. 107 9.2.5 Methodological considerations for further research. 107 9.3 Summary and conclusion: schizophrenia and selfcontrol. 109 Samenvatting. 111 References. 119 Appendix. 133