Psychotic disorders are among the top ten causes of long-term disability and have a high
chronicity potential and a high risk of invalidity. One-fifth of all patients with
schizophrenia suffer from chronic symptoms and impairments, and the disease is associated
with low long-term work performance, a high degree of all mental health care resources
and high socioeconomic costs. These findings demonstrate the importance of sufficient
treatment for psychotic disorders and, most importantly, point to a need for research so
that more effective treatments can be developed in the future.
In the recent decade, various psychotherapeutic programs with cognitive-behavioral
background have been developed for patients with psychosis, and their efficacy has been
investigated. Meta-analyses have shown superiority of cognitive-behavioral therapy for
psychosis over standard treatment, both in combination with antipsychotic medication and
without. Many of the psychological approaches have focused primarily on treating the
deficits associated with psychosis, as for example cognitive remediation or social skills
training. However, these methods are not feasible in the acute setting and there are only
a few psychotherapeutic instruments that can be used within a short period of time for
inpatient treatment.
The guidelines for the treatment of schizophrenia recommend a combination of
antipsychotic medication and psychosis-specific cognitive behavioral therapy. This
includes all stages of the illness, also in the acute phase. The Swiss Society for
Psychiatry and Psychotherapy (SGPP) has stated in its treatment guidelines for
schizophrenia that "our group recommends a structured psychotherapeutic approach even in
the acute phase of the disease. The best evidence currently exists for
cognitive-behavioral approaches, [...]. In any case, the psychotherapeutic procedure must
be adapted to the circumstances of the acute phase and there is an urgent need for
research on how this can be arranged in the setting of an acute ward.". Despite this
explicit recommendation, to our knowledge there have been no studies that have
systematically investigated this in the acute setting and results of which could
therefore inform future treatment recommendations. As proposed by the SGPP, the aim is to
systematically test and evaluate psychotherapeutic interventions in the setting of an
acute care unit in an initial pilot trial.
Therapeutic alliance during the acute phase of psychotic illness is one of the most
pressing obstacles for successful long term recovery. In order for patients to accept
much-needed medication and psychosocial therapy and not drop out prematurely, intrinsic
motivation to adhere to therapy is crucial. Motivational Interviewing is a method, that
has been developed and evaluated over the last three decades and that shows promising
results, not only for patients with addiction but also for other patients who struggle
with compliance and ambivalence towards treatment and change of behavior.
It is well known from clinical experience that patients are offered psychotherapy only
late during the course of hospitalizations and not when it is highly needed - during the
acute phase of their illness. Accordingly, there is a clear gap in the literature as to
which interventions are particularly useful in this challenging yet crucial phase of the
illness.