Cognitive-Behavioral Therapy for Medication-Resistant Psychosis: A Meta-Analytic Review

Burns, Amy M. N.; Erickson, David H.; Brenner, Colleen A.

doi:10.1176/appi.ps.201300213

Cited by 178 publications

(113 citation statements)

References 58 publications

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“…These changes correspond to the treatment focus on persisting positive symptoms, and the effect sizes appear comparable with the small-to-medium effects observed in similar trials of CBTp. 33,34 However, caution is warranted because no significant group differences in favour of ACT were observed for the other outcome measures, and the befriending group unexpectedly showed significantly greater improvement in reported delusional distress, with a medium effect at follow-up. Additionally, no group differences were evident for any of the process measures.…”

Section: Discussionmentioning

confidence: 97%

Acceptance and commitment therapy for psychosis: Randomised controlled trial

et al. 2017

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BackgroundThe efficacy of acceptance and commitment therapy (ACT) in psychosis has been reported but not for medication-resistant psychosis.AimsTo test the efficacy of ACT in a sample of community-residing patients with persisting psychotic symptoms. (Australian New Zealand Clinical Trials Registry: ACTRN12608000210370.)MethodThe primary outcome was overall mental state at post-therapy (Positive and Negative Syndrome Scale –total); secondary outcomes were psychotic symptom dimensions and functioning. In total, 96 patients were randomised to ACT (n = 49) or befriending (n = 47). Symptom, functioning and process measures were administered at baseline, post-therapy and 6 months later.ResultsThere was no group difference on overall mental state. In secondary analyses the ACT group showed greater improvement in positive symptoms and hallucination distress at follow-up: Cohen's d = 0.52 (95% CI 0.07–0.98) and 0.65 (95% CI 0.24–1.06), respectively.ConclusionsImprovements reflected the treatment focus on positive symptoms; however, absence of process-measure changes suggests that the ACT intervention used did not manipulate targeted processes beyond befriending. Symptom-specific therapy refinements, improved investigation of process and attention to cognitive functioning and dose are warranted in future research.

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Section: Discussionmentioning

confidence: 97%

Acceptance and commitment therapy for psychosis: Randomised controlled trial

et al. 2017

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“…Nevertheless, at least seventeen meta-analyses conducted in the last decade, and half of them revealed inconsistent findings regarding the efficacy of CBTp. Meta-analyses indicated small to large effect sizes ranging from 0.21 to 1.31 for positive symptoms (53-61), 0.21 to 1.08 for negative symptoms (56,57,59,61), and from 0.21 (in favor of CBTp) to 0.65 for general psychopathology (53,57,61,62). However, several recent meta-analyses have suggested that CBTp has no significant effect on positive or negative symptoms, or overall psychopathology (g<0.2) (63)(64)(65).…”

Section: Cognitive Behavior Therapy For Psychosismentioning

confidence: 99%

Emerging behavioral and psychotherapeutic interventions for schizophrenia

O’Donnell¹,

Martin²

2016

Dusunen Adam

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“…DLPFC: dorsolateral prefrontal cortex shown that persistent symptoms, particularly delusions and depression, can be reduced by cognitive behaviour therapy for psychosis (CBTp) in such patients with medication-refractory symptoms [6][7][8]. More recent studies also indicate a role for CBTp in the prevention of psychosis [9,10].…”

Section: Neuroimaging Predictors Of Long Term Outcome Following Cbtpmentioning

confidence: 99%

“…However, not all patients respond equally well to it. Symptom reduction with CBTp is seen with modest effect sizes and found to a noticeable degree in only about 50% of patients who undergo this therapy [6][7][8]. Furthermore, according to a recent meta-analysis, the effect size for symptom reduction following CBTp may be even smaller when sources of potential bias, such as masking of outcome assessments, are controlled for [19].…”

Section: Neuroimaging Predictors Of Long Term Outcome Following Cbtpmentioning

confidence: 99%

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

Kumari¹,

Terca²

2017

J Neuroimaging Psychiatry Neurol

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Up to 40% of schizophrenia patients continue to suffer from distressing symptoms despite remaining compliant with their prescribed antipsychotic medication. Additional symptom reduction following cognitive behaviour therapy for psychosis (CBTp) has been shown, but only in about 50% of such patients. A clear understanding of the neural changes following CBTp (potential mediators of improvement in target outcomes) as well as neural predictors of CBTp-led improvement (possible moderators) may help to refine or develop it further and increase its effectiveness. We provide a review of studies published to date (9 in total) examining the neural effects and/or predictors of CBTp. The studies analysed comprised of one spectroscopic imaging study on pre-vs post-CBTp changes, five functional magnetic resonance imaging studies [two analysing prevs post-CBTp changes, two analysing pre-therapy brain properties as predictors of symptom reduction following CBTp, and one analysing pre-vs post-CBTp changes in functional connectivity as the predictors of long term (over 7 years) outcome following CBTp], and three structural magnetic resonance imaging studies [two on pre-therapy brain properties as predictors of symptom change following CBTp, and one analysing pre-vs post-CBTp changes]. The findings from pre-vs post-CBTp brain activation studies demonstrate that CBTp reduces fronto-limbic activation to social threat and normalises cortico-limbic functional connectivity, indicating improved affect regulation through top-down control after CBTp. Additionally, CBTp was found to reduce pituitary volume, potentially by lowering of symptom-related distress. The findings from studies analysing pre-therapy brain properties as predictors of symptom reduction following CBTp indicate that functional and structural properties of multiple brain areas that are implicated in a range of cognitive functions, particularly the dorsolateral (cognitive flexibility), medial (self-awareness) and inferior (verbal skills) frontal cortices, hippocampus (memory) and precuneus (self-awareness), predict symptom reduction following CBTp. These results suggest a role for cognitive enhancement in the context of CBTp.

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Cognitive-Behavioral Therapy for Medication-Resistant Psychosis: A Meta-Analytic Review

Cited by 178 publications

References 58 publications

Acceptance and commitment therapy for psychosis: Randomised controlled trial

Acceptance and commitment therapy for psychosis: Randomised controlled trial

Emerging behavioral and psychotherapeutic interventions for schizophrenia

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

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