Efficacy of Remotely Delivered Evidence-Based Psychosocial Treatments for Schizophrenia-Spectrum Disorders: A Series of Systematic Reviews and Meta-Analyses

Abstract

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.

A feasibility and pilot trial of the Brief Educational Guide for Individuals in Need (BEGIN): Psychoeducation for individuals at risk for psychosis.

“…Our current sample is too small to analyze differences between these delivery modalities, but future work should investigate the characteristics of patients who choose telehealth or in-person sessions. Although work is emerging in this area (Best et al, 2023;DeLuca et al, 2020), more research is needed to understand best practices for using telehealth when working with CHR individuals and those with psychosis. Clinical implications include the facilitation of treatment engagement for CHR individuals, which is key at this early stage of illness.…”

“…For example, since telehealth provides greater flexibility and accessibility, it is possible that some patients choosing telehealth may have had better outcomes than if the study was solely in-person (e.g., via mitigation of transportation barriers and thus better engagement). Moreover, giving patients a choice in how they receive care could have generally bolstered outcomes by enhancing patient engagement and autonomy (Best et al, 2023). On the other hand, it is possible that some patients who opted for telehealth sessions had more severe symptom profiles (e.g., more depression, more paranoia) that could skew the results.…”

The Effects of Remote Cognitive Training Combined With a Mobile App Intervention on Psychosis: Double-Blind Randomized Controlled Trial

“…Future studies are needed to determine the effects of remotely delivered cognitive training provided with remotely delivered psychosocial treatments. A recent review and meta-analysis of remotely delivered, evidence-based psychosocial treatments for schizophrenia spectrum disorders found a limited number of studies, with effect sizes on functioning in the small range, and similar to the effect sizes of these treatments when provided in person [ 44 ]. One promising approach is metacognitive training, which combines psychoeducation, cognitive bias modification, and strategy teaching, with effect sizes ranging from small to moderate on functioning, and evidence of durable improvements in symptoms and functioning up to 1 year postintervention [ 45 ].…”

Training guidelines and competencies for serious mental illness (SMI) psychology.

“…While acknowledging the diversity and unique needs of persons with SMI, Morrison and Barratt (2010) found that most experts in Cognitive Behavioral Therapy for Psychosis also emphasize the importance of conceptualizing mental health on a spectrum of severity and distress and not seeing patients with psychosis as “very different” from patients with other mental health difficulties. Last, important modifications to interventions may be warranted as clinics adopt telehealth and/or hybrid levels of care (Best et al, 2023; Lavigne et al, 2022), since individuals with SMI may have varying levels of access and experience with technology (Klee et al, 2016) and/or may require certain in-person services at times (e.g., for long-acting injectable antipsychotics, and potentially other intensive therapies if important treatment components are lost in telehealth care). Overall, beyond the required knowledge and skills in relevant protocols and fidelity criteria, the modification process requires an understanding of core versus modifiable components, as well as significant adaptability on the provider’s part.…”