Abstract
BackgroundThe effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention.MethodWe meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants).ResultsThe pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19).ConclusionsCBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention.
Highlights
The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects
CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19)
CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted
Summary
The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. With Kuipers et al [2*], over 60 randomised controlled trials (RCTs) have subsequently examined the efficacy of Cognitive Behavioural Therapy for psychosis (CBTp). These trials have typically looked at the effectiveness of CBTp in improving the core symptoms of schizophrenia i.e., positive symptoms, or delusions and hallucinations measured separately, and in some cases negative symptoms. They argued that this view of CBTp was inappropriate and that the intervention was more likely to have a distinctive profile of effects that are complementary to rather than substituting for drug treatment Such a view appears to be reflected in the two principal clinical guidelines in use in the UK, the National Institute for Care and Health Excellence (NICE) and the Scottish Intercollegiate
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