Background
Schizophrenia is among the most persistent and debilitating mental health conditions worldwide. The American Psychological Association (APA) has identified 10 psychosocial treatments with evidence for treating schizophrenia and these treatments are typically provided in person. However, in-person services can be challenging to access for people living in remote geographic locations. Remote treatment delivery is an important option to increase access to services; however, it is unclear whether evidence-based treatments for schizophrenia are similarly effective when delivered remotely.
Study Design
The current study consists of a series of systematic reviews and meta-analyses examining the evidence-base for remote-delivery of each of the 10 APA evidence-based treatments for schizophrenia.
Results
Of the 10 treatments examined, only cognitive remediation (CR), cognitive-behavioral therapy (CBT), and family psychoeducation had more than 2 studies examining their efficacy for remote delivery. Remote delivery of CBT produced moderate effects on symptoms (g = 0.43) and small effects on functioning (g = 0.26). Remote delivery of CR produced small-moderate effects on neurocognition (g = 0.35) and small effects on functioning (g = 0.21). There were insufficient studies of family psychoeducation with equivalent outcome measures to assess quantitatively, however, studies of remotely delivered family psychoeducation suggested that it is feasible, acceptable, and potentially effective.
Conclusions
Overall, the evidence-base for remotely delivered treatment for schizophrenia is limited. Studies to date suggest that remote adaptations may be effective; however, more rigorous trials are needed to assess efficacy and methods of remote delivery that are most effective.
The traditional background hypothesis (TBH) is a long-standing belief associated with the Minnesota Multiphasic Personality Inventory (MMPI) L scale; a validity scale, which appears on every version of the family of MMPI instruments including the soon-to-be released MMPI-3. The L scale was originally designed to assess whether test respondents presented themselves in an unrealistically favorable light. Both researchers and clinicians noted, however, that those from traditional Christian faith–based groups produced elevated L-scale scores. A recent meta-analysis supported this observation, reporting an average L-scale elevation 0.50 SD greater than the MMPI-2 normative sample compared to samples of those with presumptively strong Christian–Judeo faith. Some limitations of this meta-analysis are that (a) the samples used in it included those undergoing an evaluative assessment, which could elevate L-scale scores independent of strength of faith belief, and (b) direct assessments of strength of faith or positive impression management were included or measured independently. Our primary goal in this study was to examine the TBH addressing these limitations with a sample of those who self-identified as believers in the Muslim faith (N = 267), the examination of which expands the scope beyond those of the Christian–Judeo faith. Consistent with previous results, the mean L-r (MMPI/MMPI-2 L scale counterpart on the MMPI-2—Restructured Form) was 56.41 T. Higher L-r scale scores were associated with increasing strength in the Muslim faith, and although increasing L-r scores were primarily associated with impression management, increasing Muslim-based faith values had a nontrivial influence on L-r scores and especially in the moderate score range of this scale.
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