Helping patients with schizophrenia review their lives, imagine the future

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Life Review Therapy helps patients with schizophrenia imagine themselves in the past and the future, new research suggests.

Patients with schizophrenia have difficulty with mental time travel (MTT), which "can improve both the abilities to remember the past and imagine the future to a healthy level," lead author Dr. Gui-fang Chen, of the University of Chinese Academy of Sciences in Beijing, and colleagues write in their October 3 online article in Psychiatry Research.

To investigate a possible therapeutic option for enhancing MTT in people with schizophrenia, the researchers randomly assigned 50 stable adult inpatients with schizophrenia (mean age, 33) in China to receive either conventional medication treatment plus four weeks of “Life Review Therapy” or conventional medication treatment alone.

Life Review Therapy – “practicing retrieval of specific autobiographical events in different life periods” – involved two one-hour training sessions per week for four weeks. During the first three weeks, participants assigned to the intervention reviewed childhood, adolescence, adulthood (one each week); in the fourth week, they focused on the past year and a summary of the training.

All 50 participants plus a group of 25 matched healthy controls without schizophrenia completed symptom assessments, self-reported measures of emotions and life satisfaction, cognitive function tests, and an MTT test (based on the Autobiographical Memory Test) of remembering the past and imagining the future.

Although the intervention focused only on past personal events, the group randomized to receive it improved substantially on both the future and the past components of the MTT test, as well as on measures of emotional expression, semantic memory, and verbal fluency – such that their results at the end of the intervention did not differ significantly from those of the matched healthy controls.

No appreciable improvements on these parameters were found in the patients with schizophrenia who did not receive the intervention.

Dr. Raymond Cho of Baylor College of Medicine in Houston, Texas, told Reuters Health by email, "Prior studies employing Life Review Therapy in schizophrenia had only reported on improvements in autobiographical memory, but this study also examined potential improvements in future thinking ability. This interesting study’s positive findings highlight the potential promise of Life Review Therapy for the treatment of MTT impairments in schizophrenia."

Dr. Cho, who was not involved in the study, nevertheless offered some cautions: "Patients in the control arm of the study simply received medication treatment as usual,” he said. “A more ideal control intervention would have matched for time spent with the patient (Life Review Therapy had a total of eight hours over one month) and the degree of mental and interpersonal engagement."

"Indeed," he continued, "given the findings of improvements in semantic memory and verbal fluency, a very rigorous control intervention could have trained with cognitive tasks tapping these specific abilities, but with content that avoided any autobiographical memories. Such a robust control intervention would provide much firmer grounds on which to make claims about the benefits of Life Review Therapy per se for MTT impairments."

Dr. Cho also expressed concern about the study’s lack of description of blinding procedures: "For example, how robustly were the clinical raters kept blind to whether the patients were in the active versus control groups?"

The need for design improvements notwithstanding, Dr. Cho said, "This study provides preliminary evidence for Life Review Therapy as a promising cognitive-enhancing approach for MTT deficits in schizophrenia. . . . The fact that the intervention appears effective, requires relatively little time investment compared to other cognitive-enhancement approaches, and that it may be a more engaging way for patients to relearn and practice cognitive skills compared to some computer-based approaches, warrants further investigations.”

The study authors did not respond to requests for comment.

SOURCE: http://bit.ly/2yFeEGd

Psychiatry Res 2017.

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