Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation

Abstract

Background. Social skills training and cognitive remediation are psychological techniques with considerable face validity for the treatment of negative symptoms of schizophrenia and their consequences. This paper provides a meta-analytical review of these treatments. It includes an appreciable number of randomized controlled trials, using comparisons against both standard care and other active interventions. However, the assessment of particular outcomes sometimes had to be based on single studies. Method. A detailed search strategy was used to identify randomized controlled trials of social skills training and cognitive remediation, primarily employing electronic databases. Randomized controlled trials (RCTs) that met predefined criteria were then subjected to meta-analysis on a variety of outcome measures. Results. There was no clear evidence for any benefits of social skills training on relapse rate, global adjustment, social functioning, quality of life or treatment compliance. Cognitive remediation had no benefit on attention, verbal memory, visual memory, planning, cognitive flexibility or mental state. Conclusions. Social skills training and cognitive remediation do not appear to confer reliable benefits for patients with schizophrenia and cannot be recommended for clinical practice.

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

“…There is currently no evidence suggesting that other non-pharmacological therapies (family interventions, social skills training, cognitive remediation, psychoeducation, assertive community treatment) have consistent effects on negative symptoms in schizophrenia (Bustillo et al 2001 ;Pilling et al 2002;Turkington et al 2004).…”

Psychological Treatment of Psychosis

“…Three meta-analyses of SST studies (Benton & Schroeder, 1990;Corrigan, 1991;Dilk & Bond, 1996) found strong evidence for effectiveness in improving social competence, suppressing symptoms and postponing relapse. A fourth (Pilling, Bebbington et al, 2002) found no evidence for any kind of effectiveness. A broader meta-analysis of SST and related psychosocial treatment (Pfammatter et al, 2006) found qualified evidence for effectiveness.…”

“…First, as Pilling, Bebbington et al (2002) pointed out, it has strong a priori validity. The relevance of competent interpersonal functioning to recovery from severe mental illness is obvious.…”

Treatment–Refractory Schizophrenia

“…Nonpharmacological, social, family, and personal needs that might affect illness manifestation and nonresponse to treatment should be addressed. [70][71][72][73] Realistic treatment targets, which consider the premorbid (often poor) functioning, should then be set. It is essential to remember that in an illness that is by definition chronic, such as schizophrenia, response is a relative term and that many patients continue to suffer from low-level symptoms even after a significant response to treatment has occurred.…”