Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial

Röhricht, Frank; Priebe, Stefan

doi:10.1017/s0033291706007161

Cited by 124 publications

(94 citation statements)

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“…Cognitive behavioral therapy showed a positive effect on negative symptoms up to 24 months of follow-up (NICE, 2010). In addition there have been three small but promising trials on peer support groups (Castelein et al, 2008), music therapy (Gold et al, 2009) and body oriented psychosocial therapy (Rohricht and Priebe, 2006).…”

Section: Introductionmentioning

confidence: 99%

Duration of untreated psychosis and negative symptoms — A systematic review and meta-analysis of individual patient data

Boonstra

Klaassen

Sytema

et al. 2012

Schizophrenia Research

210

134

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Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Background: Longer duration of untreated psychosis (DUP) is associated with poorer outcome in terms of positive symptoms, relapse rate, and time to remission. In contrast, the association with negative symptoms is less consistent. Aims: The study had three aims. First, to arrive at a more precise estimate of the correlation between DUP and negative symptoms than previous reviews, by substantially increasing the amount of available data. Second, to see whether the strength of this correlation attenuated over longer follow-up intervals. Third, to determine whether there is a relationship between DUP and changes in negative symptoms. Method: Relevant databases were searched for studies published between December 1992 and March 2009 that reported data on DUP and negative symptoms. We obtained individual patient data where possible and calculated summary correlations between DUP and negative symptoms for each study at baseline, short and long-term follow-up. We used multilevel regression analysis to examine whether the effect of DUP on negative symptoms was the greatest in the early stages of illness. Results: We included 28 non-overlapping studies from the 402 papers detected by the search strategy. After contacting the authors we obtained individual patient data from 16 of these studies involving 3339 participants. The mean DUP was 61.4 weeks (SD = 132.7, median DUP = 12.0). Shorter DUP was significantly associated with less severe negative symptoms at baseline and also at short (1-2 years) and longer term follow-up (5-8 years) (r = 0.117, 0.180 and 0.202 respectively, p b 0.001). The relationship between improvement in negative symptoms and DUP was found to be non-linear: people with a DUP shorter than 9 months showed substantially greater negative symptom reduction than those with a DUP of greater than 9 months. Conclusions: Shorter DUP is associated with less severe negative symptoms at short and long-term follow up, especially when the DUP is less than 9 months. Since there is no effective treatment for negative symptoms, reducing DUP to less than 9 months may be the best way to ameliorate them.

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Section: Introductionmentioning

confidence: 99%

Duration of untreated psychosis and negative symptoms — A systematic review and meta-analysis of individual patient data

Boonstra

Klaassen

Sytema

et al. 2012

Schizophrenia Research

210

134

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“…Of the six studies included in the NICE review, 6 three studies [12][13][14] evaluated the effectiveness of music therapy, two studies 15,16 evaluated the effectiveness of art therapy and one study 17 evaluated the effectiveness of body-orientated psychotherapy. The BPT trial was an exploratory RCT, which tested a manualised form of the intervention in outpatients with persistent negative symptoms of schizophrenia.…”

Section: Body Psychotherapy and Schizophreniamentioning

confidence: 99%

“…As previously highlighted, one of the limitations in the earlier exploratory trial 17 was that the control condition was group-supportive counselling, which meant that the non-specific effects of physical activity could not be controlled for. In a recent Cochrane review, 30 there is some evidence to suggest that exercise may be at least partially effective in the treatment of negative symptoms, whereas others 31 have examined possible neurological effects of increased physical activity in schizophrenia.…”

Section: Effects Of Physical Activity In Schizophreniamentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial

Priebe

Savill

Wykes

et al. 2016

Health Technol Assess

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BackgroundThe negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control.DesignA parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted.ParticipantsEligibility criteria: age 18–65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. Exclusion criteria: inability to participate in the groups and insufficient command of English.SettingsParticipants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces.InterventionsControl intervention: a 10-week, 90-minute, 20-session group beginners’ Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist.OutcomesThe primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up.ResultsA total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) –1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI –1.23 to 0.00), and in extrapyramidal movement disorder symptoms –0.65 (95% CI –1.13 to –0.16) at the end of treatment and –0.58 (95% CI –1.07 to –0.09) at 6 months’ follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition.LimitationsOwing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care.ConclusionsIn comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms.Future workDetermining whether or not this lack of effectiveness extends to all types of art therapies would be informative.Trial registrationCurrent Controlled Trials ISRCTN842165587.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.

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“…This becomes more disheartening against the backdrop that people with a DUP <1 year show substantially greater negative symptom reduction, especially when DUP is <9 months, compared with those with a DUP of >1 year. [18] There is no established treatment for primary negative symptoms, [19,20] even though some treatments such as antipsychotics, [21] and some psychosocial treatments such as cognitive behavioural therapy, [22] peer support groups, [23] music therapy [24] and bodyoriented psychosocial therapy [25] have all been shown to have some positive effect on negative symptoms; however, positive effects are better felt when the DUP is <1 year, especially <9 months. [18] Since there is no effective treatment for negative symptoms [19,20] and perceptions of the symptoms of schizophrenia can influence the time and the type of help-seeking (and with early treatment positively influence the outcome), [7,26] reducing DUP to <1 year may be, for now, the best way to ameliorate the problems.…”

Section: Articlementioning

confidence: 99%

Positive and negative symptoms of schizophrenia as correlates of help-seeking behaviour and the duration of untreated psychosis in south-east Nigeria

et al. 2014

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Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial

Cited by 124 publications

References 35 publications

Duration of untreated psychosis and negative symptoms — A systematic review and meta-analysis of individual patient data

Duration of untreated psychosis and negative symptoms — A systematic review and meta-analysis of individual patient data

Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial

Positive and negative symptoms of schizophrenia as correlates of help-seeking behaviour and the duration of untreated psychosis in south-east Nigeria

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