Integrated Psychological Therapy (IPT) and Wellness Self-Management (WSM) are two multimodal workbook-based treatments for individuals with schizophrenia. IPT was developed in 1994 and focuses on remediating cognitive deficits through group exercises before building social skills. Research shows IPT improves neurocognition, symptoms, and functioning. WSM was developed in 2001 from Illness Management and Recovery and uses a personal workbook to build competencies like medication management. Over 80% of facilities using WSM continued ten months later. Both treatments aim to improve functioning through cognitive and social rehabilitation, though IPT has more extensive research support currently.

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Running Header: IPT & WSM
Integrated Psychological Therapy (IPT) and Wellness Self-Management (WSM): Two
Multimodal Workbook Based Treatments for Individuals with Schizophrenia
Amanda Buschau
Email: buschaac@mcmaster.ca

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Integrated Psychological Therapy (IPT) and Wellness Self-Management (WSM): Two
Multimodal Workbook Based Treatments for Individuals with Schizophrenia
Integrated Psychological Therapy (IPT)
Literature search
CINAHL, PsychINFO, PubMED and the Cochrane Library databases were searched
using the term “Integrated Psychological Therapy” and limited to English articles only leading to
54 article for review. Many of the articles found were European and South American studies.
Abstracts were reviewed and 6 most appropriate articles were selected; two meta-analysis, two
book reviews on the IPT manual and two primary research studies.
Description of Integrated Psychological Therapy
Integrated psychological therapy (IPT) was published in 1994 by a team of researchers in Bern,
Switzerland with extensive experience in methods of cognitive remediation (Roder, Muller,
Brenner, Spaulding, Heuberger, 1994 as cited in Wedding, Mueser & McGurk, 2011). IPT is a
cognitive behavioral therapy (CBT) based program designed to be used in a groups of five to
eight individuals with Schizophrenia (Mueller, Schmidt & Roder, 2013). IPT is based on the
theory that social and independent function is dependent on the basic neurocognitive functions;
these basic functions are then organized and affect higher level behavior (Vita, et al. 2011). In
other words, individuals with Schizophrenia can present with cognitive deficits that have
negative effects on their higher order neurological and social functioning (Roder, Mueller,
Mueser & Brenner, 2006). IPT works by remediating rudimentary cognitive functioning and then
building on those basic skills in a social setting; the therapy operates using hierarchal

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subprograms, that is, the first subprogram must be completed before moving onto the next
(Roder et al., 2006; Mueller, Schmidt & Roder, 2013). IPT begins with targeting deficits in
attention, verbal memory, concept formation, cognitive flexibility using group exercises.
Secondly, social cognition is addressed by recognizing emotion in self and others. The third
subprogram links the first two subsections to the fourth and fifth, both which use role playing
techniques to provide practice for developing interpersonal skills (Roder et al., 2006).
The IPT manual consists of three sections the first being the theory and treatment
approaches behind IPT, the second part is step-by-step components of IPT and third is on-going
research; include assessment forms and worksheets in appendix. (Kovasznay, 2012). The five
subprograms in IPT are cognitive differentiation, social perception, verbal communication, social
skills and interpersonal problem solving skills. The manual can be purchased by PDF download
or ordered from Hogrefe & Huber publishing for $56 USD (Wedding, Mueser & McGurk,
2011).
Is IPT effective?
Roder and team (2006) conducted a meta-analysis to find out if IPT is effective on adults over 18
who have been diagnosed with Schizophrenia. Included 30 studies published over a 25 year
period. What the researchers found was that IPT groups showed significant improvements in
neurocognition, psychopathology, and psycho-social functioning. When control conditions were
combined with placebo groups, IPT yielded significantly higher symptoms reduction (p < 0.05).
The studies analyzed showed the IPT’s effect was significantly better with inpatients rather than
outpatient (p < 0.1). This increased effect size may have been due to the higher degree of
psychopathy that the inpatients began the treatment with. The meta-analysis indicated that IPT
showed significant effects for both symptom-stabilized patients and post-acute patients.

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The duration of illness was the only independent patient variable that had negative effect
on the global therapy outcome of IPT. Age and duration of hospitalization had a moderate
negative effect on the efficacy of IPT. That is, the individuals that had experienced a longer
period of illness where had greater cognitive deficits initially and therefore, showed the least
amount or little improvement using IPT. The setting or site conditions did not appear affect the
impact of IPT. However, trained Psychologists or Psychiatrists were facilitators of all the IPT
groups in every study. No other type of healthcare professional was listed.
In the studies analyzed the most frequently used outcome measures were Attention-Stress
Test (d2), Brief Psychiatric Rating Scale (BPRS), and the Global Assessment of Functioning
Scale (GAF). No differences between self-rated and expert reports were noted from the analysis.
However, the primary studies by academic centres had much higher effect sizes than non-
academic centre studies (Roder et al., 2006).
Group versus Individual Format
A single-blind randomized controlled trial with two groups was conducted, the study consisted of
IPT group and IPT individual sessions. The researchers used the cognitive determination or first
subsection of the IPT only (Ruiz, Fuentes, Roder, Tomas, Dasi & Soler, 2011). These researchers
were looking for the “active ingredient” in IPT and hypothesized that group participation was the
key. Executive functioning improved in the group and attention improved in individualized
therapy. Overall, the group factor is the active ingredient in improving the basic neurocognitive
deficits globally that are presented in individuals with Schizophrenia.
Ruiz and his team (2011), recommend tailoring group or individual IPT sessions to
patients depending on their own deficits. For example, if an individual has difficulty paying
attention in group situation having them take part in individual sessions will address their deficits

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in attention rather than having little global cognitive improvement overall because of difficulty
paying attention in group sessions.
Clinical Utility
IPT appears to be predominantly used in Europe and South America and the main bodies
of research are being conducted in these areas as illustrated from the database search. The IPT
approach differs from other psychosocial treatments used in Schizophrenia because it combines
or integrates neurocognitive and psychosocial methods of rehabilitation (Roder et al., 2006).
Both the neurocognitive and psychosocial treatments or skills training work together and have a
combined effect and improve both areas more effectively for the long term rather than just
performing them individually. IPT has also been shown to reduce psychopathology such as the
severity of symptoms, neurocognitive and psychosocial functioning (Vita et al., 2011). IPT
compared to control groups showed that the biggest effect sizes were in neurocognitive areas
with psychosocial areas being much smaller. It may have been difficult to accurately rate
inpatients for social functioning because of an institutional setting (Roder et al., 2006).
Only those patients that participated in both the neurocognitive and the psychosocial
cognition subprograms or complete IPT showed continued improvement until follow up stage at
seven to ten months following therapy. The recommended frequency of IPT sessions is two
times per week is the acceptable practice guideline. The researchers recommended further
studies with larger sample sizes to provide better data and increased generalizability (Roder et
al., 2006).

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Wellness Self-Management (WSM)
Literature search
A literature search was conducted on various databases: PubMED, PsychINFO,
COCHRANE REVIEW and CINAHL with the key terms “Wellness Self-Management”,
“Wellness” AND “Self-Management” and limits set to English Only. Resulting in three articles;
the abstracts were reviewed and two articles were chosen fitting the English criteria and
containing Wellness Self-Management as a treatment option.
Development
In 2001 the Substance Abuse and Mental Health Service Administration (SAMHSA)
funded practice projects supported by evidence in eight U.S. States. The overall goal was to close
the “research to practice gap” that prevents best practices from being adopted and sustained in
clinical settings (Salerno, Margolies, Cleek, Pollock, Gopalan & Jackson, 2011, p. 458).
Wellness Self-Management (WSM) has been developed from the best practice, Illness
Management and Recovery (IMR) (Covell et al., 2014; Salerno et al., 2011). IMR is an evidence
based psychosocial approach that uses a curriculum based treatment to help adults with mental
health issues progress and/or accomplish personalized goals (Salerno et al., 2011). IMR is
considered a best practice as treatment for individuals with severe mental health disorders.
Adapting the existing IMR for a sustainable practice in clinical settings was found
necessary after testing was conducted and feedback applied to the current IMR treatment. IMR
was used and observed for a year in three community mental health settings and one mental
health prison facility. At conclusion of the IMR programs, feedback was sourced from trained

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practitioners, program participants, and program facilitators. WSM was developed after applying
the researched feedback to IMR.
Wellness Self-Management
WSM is a curriculum based treatment that issues each participant a personal workbook
divided into chapters that foster self-directed learning and contain several core competencies
inserted throughout the workbook. Although the workbook is personal, the modality of WSM is
designed to be in group format. WSM curriculum is similar to IMR in that the treatment
includes: understanding mental illness and recovery; relapse prevention; stress management and
coping; locating and using social supports; medication information; problem solving; and
developing goals (Salerno et al., 2011).
WSM was researched for a year following development in 105 mental health facilities
that volunteered to be a part of the test. The workbook was been translated into Spanish, Chinese
and Korean. Solerno and the others (2011) followed up with 87 of the original facilities ten
months following the year trial. They found that 83% were still implementing WSM into
practice. Individual facilities using WSM were encouraged to develop their own ways to sustain
this treatment by developing cost effective and accessible training for staff, training DVDs,
downloadable workbooks, brochures and training guides for group facilitators. The main reason
for attrition was discharge from a facility (Solerno et al, 2011).
Since the original article the Centre for Practice Innovations (CPI) from the Columbia
University Psychiatry Department has developed online modules for various treatments such as
WSM (Covell et al., 2014). The purpose of the published article was to promote the awareness of
treatments such as WSM to encourage adoption of the practice in other facilities. The modules

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utilize interactive exercises; check your knowledge tests, personal recovery stories and vignettes
and expert panel discussions. Future work is being developed to support facilities outside of New
York State due to the demand for the treatment.
Limitations of WSM
Since only two articles were sourced through database searches and WSM is a new
treatment more evidence should be developed in order to support the New York State research
(Covell et al., 2014; Salerno et al., 2011). Both articles were also published by affiliates of the
CPI at Columbia University. The researchers have been using articles as a way to promote WSM
but have yet to address how facilities can access the online modules and workbooks in order to
test their own results and either support or dispute the findings of the researchers. A free copy of
the WSM workbook can be downloaded from SAMHSA
(http://vet2vetusa.org/LinkClick.aspx?fileticket=aY9UPl%2BL6uY%3D&tabid=67).
WSM versus IPT
Extensive research has been conducted in Europe since 1994 on IPT and it appears to be
effective in remediating cognitive and social deficits in individuals with Schizophrenia.
However, most of the research is driven by the original authors of IPT and that may influence the
types of studies. IPT also does not appear to have research in North America and this may be due
to the cultural differences. WSM is an adaptation of the best practice IMR but does not have
extensive research by any other institutions besides those in the two articles featured in this
paper. Perhaps WSM will reach best practice status with more research conducted by external
studies.

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IPT has been adapted from CBT and targets remediation of the basic cognitive elements
which previous research has hypothesized that these basic cognitive building blocks are needed
as a foundation in order to build the additional social and interpersonal skills on (Roder et al.,
2006). However, the bulk of research points to the fact that the full IPT must completed in order
to show and maintain improvement in individuals with Schizophrenia (Roder et al., 2006;
Mueller et al., 2013). With WSM the modules are developed to promote self-directed learning
and develop core competencies in terms of illness self-management including understanding
one’s illness, the symptoms associated with the diagnosis, medication management, finding
social supports developing personal goals and problem solving.
Both treatments put the recovery in social settings with adaptations for individual
sessions if necessary. At this point, IPT has a broader base of research but this may not be as
culturally relevant in North America whereas WSM was developed in New York. WSM does not
have as large a base of research behind the treatment as IMR in which the treatment was
developed from. Both therapies are useful but d ueto the differences in what each addresses
treatments should chose by healthcare teams depending on the needs of the population in
question on a case by case bases.

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References
Covell, N. H., Margolies, P. J., Myers, R. W., Ruderman, D., Fazio, M. L., McNabb, L. M., & ...
Dixon, L. B. (2014). State mental health policy: scaling up evidence-based behavioral
health care practices in New York State. Psychiatric Services, 65(6), 713-715.
Kovasznay, Beatrice. (2012). Review of Integrated psychological therapy (IPT) for the treatment
of neurocognition, social cognition, and social competency in schizophrenia patients.
Psychiatric Services, 63, 839.
Mueller, D. R., Schmidt, S. J., & Roder, V. (2013). Integrated Psychological Therapy:
Effectiveness in Schizophrenia Inpatient Settings Related to Patients' Age. The American
Journal of Geriatric Psychiatry, 21(3), 231-241.
Roder, Volker, Muelle, Daniel R, Mueser, Kim T & Brenner, Hans D. (2006). Integrated
Psychological Therapy (IPT) for Schizophrenia: Is It Effective? Schizophrenia Bulletin,
32, S81-S93.
Ruiz, Juan C, Fuentes, Inma, Roder, Volker, Tomas, Pilar, Dasi, Carmen & Soler, Maria J.
(2011). Effectiveness of the cognitive differentiation program of the Integrated
Psychological Therapy: Group versus individual treatment. Journal of Nervous and
Mental Disease, 199, 978-982.
Salerno, A., Margolies, P., Cleek, A., Pollock, M., Gopalan, G., & Jackson, C. (2011). Best
Practices: wellness self-management: an adaptation of the illness management and
recovery program in New York State. Psychiatric Services, 62(5), 456-458.
Vita, A, De Peri, L, Barlati, S, Cacciani, P, Cisima, M, Deste, G, et al. (2011). Psychopathologic,
neuropsychological and functional outcome measures during cognitive rehabilitation in

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schizophrenia: A prospective controlled study in a real-world setting. European
Psychiatry, 26, 276-283.
Wedding, D., Mueser, K. T., & McGurk, S. R. (2011). New tools for cognitive remediation and
psychiatric rehabilitation of schizophrenia. PsycCRITIQUES, 56(16), 2.