Abstract
BackgroundSchizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and “third wave” cognitive – behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO’s International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains.MethodsMedline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. s and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines.ResultsA total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating “third wave” approaches. Overall, traditional CBT interventions addressed more disability domains than “third wave” approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive.ConclusionsTraditional CBT interventions address more disability domains than “third wave” therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions seem to be a promising treatment approach as they target disability from a broader perspective including activity and participation domains. Although their effectiveness is inconclusive, they reflect users’ views of recovery and trends towards improvement of mood, negative symptoms and functioning are shown.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0912-8) contains supplementary material, which is available to authorized users.
Highlights
Schizophrenia is a disabling disease that impacts all major life areas
In the present systematic review we provide a comprehensive overview on disability domains considered by cognitive-behavioral therapy (CBT) interventions in schizophrenia using the International Classification of Functioning (ICF) as reference framework
Traditional CBT interventions addressed more disability domains than “third wave” therapies, in both approaches there was a strong emphasis on mental functions reflecting schizophrenia symptoms
Summary
Schizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. This study aimed to systematically review the extent to which traditional and “third wave” cognitive – behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO’s International Classification of Functioning, Disability and Health (ICF) as a frame of reference. An individual with lived experience of schizophrenia, might experience disability due to impairments of thought or perceptual functions (mental functions) as well as difficulties in family relationships and interpersonal interactions or in acquiring and keeping a job (activities and participation) Environmental factors such as accessibility to health services and appropriate treatment, systems and policies of a country, or stigmatizing societal attitudes as well as personal factors e.g. low self-esteem impact the level of disability experienced
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