Considering the negative effects of depressive symptoms and anxiety on the course of schizophrenia, it seems that the combination of cognitive-behavioral group therapy with self-care skills can increase the effectiveness of this treatment in reducing the distress of patients with chronic schizophrenia. Therefore, a study was designed and conducted to determine the effect of cognitive-behavioral therapy group of self-care skills on the symptoms of anxiety and depression in women with chronic schizophrenia.

 

This randomized controlled clinical trial was performed on 30 women with chronic schizophrenia admitted to Hejazi Psychiatric Hospital in Mashhad.
Based on the preliminary study and using the formula 1 by calculating the mean and standard deviation of the total score of depression and anxiety after the intervention with a 95% confidence interval and 85% test power for each group of thirteen people and taking into account 15% sample size loss, fifteen people were considered in each group (a total of thirty people).
Formula 1 : 

Inclusion criteria were: DSM-5-based diagnosis of schizophrenia, age between 25 and 55 years, verbal ability, education of eight classes or more, and no change in standard antipsychotic dose in the last three months. Exclusion criteria also included: substance and alcohol abuse, epilepsy and mental retardation, conflict with legal issues, and serious physical illnesses requiring treatment.
The samples of the present study were randomly assigned to two groups of intervention and control. The intervention group (n = 15) underwent cognitive-behavioral therapy group of self-care skills during 10 sessions of one and a half hours and the control group (n = 15) received a routine care. The data collection tool was the Hamilton Anxiety and Depression Scale which was completed in three stages.
Research data were analyzed using SPSS software version 25 (SPSS Inc., Chicago, IL., USA). Kolmogorov-Smirnov and Shapiro Wilks tests were used for normal distribution of quantitative data, descriptive statistics were used to describe the frequency of data, and independent Chi-square and t-tests were used to compare data. Also, in order to compare within-group changes in anxiety and depression variables before and after the intervention and six months after the intervention, repeated measures analysis of variance was used and to compare within-group changes in depression and anxiety during the test stages, independent t-test was used. It is worth mentioning that in the performed tests, 95% confidence level and significance level α = 0.05 were considered. The data collector researcher and data analyst divided the subjects into two groups of experimental and blind control.

 

Results

Discussion

The present study was the first study in which cognitive-behavioral therapy was designed based on the self-care skills of patients with chronic schizophrenia, the results of which were consistent with the results of Freedland et al. (2015); as they also found that cognitive-behavioral therapy based on self-care skills is effective in reducing post-intervention anxiety in patients with heart failure (37). The results of other studies on the effect of cognitive-behavioral therapy approaches on anxiety showed that muscle relaxation therapy can reduce stress and acute anxiety status in patients with schizophrenia (38).
Cognitive-behavioral therapy is often used to reduce anxiety and distress in patients with schizophrenia. Successful management of anxiety symptoms involves adopting appropriate coping strategies to reduce anxiety, which can also help reduce the symptoms of psychosis (18). Poor self-care performance in patients with schizophrenia, including skills related to bathing, dressing, nutrition, nail care, and sleep habits, can reduce social relationships and prevent them from successfully joining the community (41) ending in reducing their standard of living and independent living (42). Therefore, it seems that strengthening self-care skills as an adaptive strategy through cognitive-behavioral therapy group can help reduce anxiety symptoms in patients with chronic schizophrenia.
Due to the rejection and lack of emotional support of family and community from patients with chronic schizophrenia participating in the present study, it seems that the treatment of depression in them is facing more major problems. It is noteworthy that although negative symptoms and depression in patients with schizophrenia have been conceptualized as separate clinical syndromes; the overlap of these symptoms in patients with schizophrenia has made it possible to examine their heterogeneity (44) and may not be extractable with questionnaire information.
One of the limitations of this study was the short-term group sessions, cognitive-behavioral therapy, and self-care skills, which were not cost-effective for researchers. In addition, due to the cultural conditions in Iran based on the need for written consent of the family (patient guardian) for the patient to participate in the research, many people were excluded from participating in the study; since the families did not often support the patients in this hospital due to the chronic illness and symptoms, they kept them in the hospital permanently.

 

Conclusion

Cognitive-behavioral group therapy can be effective in reducing anxiety symptoms, but to increase the duration of its effect, the duration of sessions should be increased.

 

Acknowledgments

This article was extracted from a research project with the clinical trial code IRCT20180817040818N1, which was approved on August 15, 2016 with the code 970417 in the field of research of Mashhad University of Medical Sciences. The authors would like to thank Mashhad University of Medical Sciences for their sincere cooperation in providing this research and the officials, nurses and head nurses of Hejazi Psychiatric Hospital, as well as the participants in the study.

 

Conflicts of Interest

The authors declared no connflict of interest.