Treatment process and outcome for long-term mentally ill patients in a comprehensive treatment program based on cognitive therapy

University dissertation from Div. of Psychiatry, Dept. of Clinical Neuroscience, University Hospital, SE-221 85, Lund, Sweden

Abstract: All patients admitted during a four-year period to a comprehensive, cognitive therapy based inpatient rehabilitation program for long-term mentally ill were invited to participate in the present study. A total of 28 patients were included. The patients were at admission and discharge assessed with regard to quality of life, symptoms, global functioning and target complaints. Every five weeks throughout the admission patients and therapists rated therapeutic alliance and made therapy session evaluations. The patients also rated perceived curative factors in treatment at the same rating points. Every 10 weeks throughout the admission the patients were assessed with regard to symptoms. In a 6-month and a 24-month follow-up study, quality of life, symptoms, global functioning, target complaints and use of inpatient psychiatric services were assessed. A matched control group receiving treatment as usual was in the follow-up study used as a contrast in the evaluation of use of psychiatric services, ability to establish an independent living and to function in working life. The results showed a significant improvement with regard to quality of life, global functioning and target complaints. The improvements were maintained during the follow-up period. The patients receiving cognitive therapy based rehabilitation were significantly more successful in achieving an independent living and spent significantly fewer days in inpatient care during the follow-up as compared to the patients in the matched control group. The therapeutic alliance was during the admission rated as fair or good by both therapists and patients. The patients perceived the therapeutic sessions and the therapeutic environment in the setting as the most helpful curative factors during the admission.

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