Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias

Jauhar, Sameer; McKenna, Peter J.; Raduà, Joaquim; Fung, E.; Salvador, Raymond; Laws, Keith R.

doi:10.1192/bjp.bp.112.116285

Cited by 429 publications

(352 citation statements)

References 101 publications

(187 reference statements)

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“…Knowledge of group assignment in clinical trials can affect participant responses and induce researcher bias, potentially giving a skewed representation of treatment efficacy (Schulz, Chalmers, & Altman, 2002). For example, a recent metaanalysis by Jauhar et al (2014) reported that the effect of cognitive behavioral therapy on the symptoms of psychosis was lower when assessments were made by interviewers blind to treatment allocation. By ensuring high quality investigation of the efficacy of self-help for psychosis, inflated effect sizes may be avoided, thereby providing a clearer view of the effect of self-help interventions on outcomes.…”

Section: P R E P U B L I C a T I O N C O P Ymentioning

confidence: 99%

Self-help interventions for psychosis: A meta-analysis

Webb

Rowse

2015

Clinical Psychology Review

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Self-help has been shown to be an effective intervention for a wide range of mental health problems. However, there is less evidence on the efficacy of self-help for psychosis and, to date, there has been no systematic review. A search of bibliographic databases identified 24 relevant studies with a total sample size of N = 1816. Ten studies adopted a repeated measures design and 14 an independent group design (including RCTs and quasiexperimental studies). Self-help interventions had, on average, a small-to-medium-sized effect on overall symptoms (d + = 0.33, 95% CI: 0.17 to 0.48). Sub-analyses revealed that selfhelp interventions had a small-to-medium-sized effect on positive symptoms (d + = 0.42, 95% CI: 0.13 to 0.72), a small-to-medium-sized effect on negative symptoms (d + = 0.37, 95% CI: 0.07 to 0.66), and a small-sized effect on outcomes associated with the symptoms of psychosis such as quality of life (d + = 0.13, 95% CI: 0.02 to 0.24). Moderation analysis identified a number of factors that influenced treatment effects including the complexity of the intervention and amount of contact time. Self-help interventions for psychosis have a lot of potential and recommendations for further research are discussed. Word count: 190Key words: Self-help, psychosis, meta-analysis P r e P u b l i c a t i o n C o p y Self-help interventions for psychosis 3 Self-help interventions for psychosis: A meta-analysis "A massive, systematic, and yet largely silent revolution is occurring in mental health today and is gathering steam for tomorrow" (Norcross, 2000, p. 370) In the quote above, Norcross (2000) refers to the proliferation of self-help approaches for mental health conditions, an approach that has gathered momentum with practitioners, researchers, and policy makers placing an increasing emphasis on self-help for treating mental health problems (Lewis et al., 2003). Self-help interventions are defined as those that are "designed to be conducted predominantly independently of professional contact" (Bower, Richards, & Lovell, 2001, p. 839). Self-help interventions can be administered through a variety of mediums such as face-to-face or group meetings, through computers, mobile, and online platforms. Self-help typically involves working independently through a guide that describes the steps to be taken in order to apply a psychological treatment. A slight variation is guided self-help, which is distinguished "by the support that is given by a professional therapist or coach to the patient when working through the standardized treatment" (Cuijpers, Donker, van Straten, & Andersson, 2010, p. 1934. The support offered can range from assisting the person to work through the self-help program to emotional support and can be provided in a range of ways (e.g., face-to-face, telephone, or email). Most self-help interventions are based on standardized psychological treatments, with the most common interventions being those based on cognitive behavioral therapy (CBT: Cuijpers & Schuurmans, 2007). Self-help inter...

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Section: P R E P U B L I C a T I O N C O P Ymentioning

confidence: 99%

Self-help interventions for psychosis: A meta-analysis

Webb

Rowse

2015

Clinical Psychology Review

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“…(2) In general, one of the recurring controversies around meta-analyses is that studies are excluded based on the (sometimes idiosyncratic) criteria of authors, which can result in very different findings between meta-analyses on the same topic (Murray, 2014). As an illustration of this, a recent metaanalysis on CBTp by the same group (Van der Gaag et al 2014) arrived at very favorable conclusions -much in contrast to some other metaanalyses on CBTp that came out around the same time (Lynch et al 2010;Jauhar et al 2014;Mehl et al 2015). The authors of the latest one (Mehl et al 2015) indicate that the meta-analysis by van patients with high baseline paranoia scores generally benefit most from metacognitive intervention and contrast the effect size of the three studies with the highest baseline delusions scores, including the one by So et al (2015), against studies with the lowest delusions scores.…”

mentioning

confidence: 74%

Letter to the Editor: Should we focus on quality or quantity in meta-analyses? – a reply

Moritz

2016

Psychol. Med.

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“…Nevertheless, even critics of CBT agree that there is a real, albeit small effect size advantage for CBT over and above medication alone (8). Notably, the investigators found no evidence of publication bias in these studies (8).…”

Section: Schizophrenia and Related Psychotic Disordersmentioning

confidence: 99%

The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments

Thase

Kingdon

Turkington³

2014

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Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research.

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Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias

Abstract: Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the 'small' range. This reduces further when sources of bias, particularly masking, are controlled for.

Cited by 429 publications

References 101 publications

Self-help interventions for psychosis: A meta-analysis

Self-help interventions for psychosis: A meta-analysis

Letter to the Editor: Should we focus on quality or quantity in meta-analyses? – a reply

The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments

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