Efficacy of third wave cognitive therapies in the treatment of psychosis: a meta-review

Abstract

The therapeutic approaches of the so-called "third wave" of clinical cognitivism have assumed increasing relevance in recent years alongside cognitive-behavioral therapy in the treatment of psychosis. To evaluate the efficacy of some of the most relevant third wave cognitive-behavioral approaches (metacognitive interventions and therapies based on mindfulness and acceptance) in the treatment of psychosis. A systematic research was carried out for systematic reviews and meta-analysis on the efficacy of metacognitive interventions and mindfulness- and acceptance-based therapies in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis. 7 meta-analysis were selected: 4 for metacognitive therapies (3 of low quality, 1 of critically low quality) and 3 for mindfulness- and acceptance-based therapies (1 of medium quality, 2 of low quality). Among metacognitive therapies, metacognitive training has shown promising results on positive symptoms and in particular on the psychopathology of delusions. Mindfulness- and acceptance-based therapies have shown mild to moderate effects on general and positive symptoms as well as some effects on negative symptoms, depressive symptoms, hospitalization rates and length. However, further research is needed to confirm overall the encouraging results of both metacognitive training and mindfulness- and acceptance-based therapies as the small number of randomized controlled trials and the low methodological quality of most meta-analysis realized up to date does not allow to draw yet sufficiently solid conclusions on their efficacy in the treatment of psychosis.