Psychological Interventions for People with Psychotic Experiences: A Systematic Review and Meta-Analysis of Effectiveness and Economic Studies

Abstract

Background: Many people with psychotic experiences who seek help do not develop psychotic disorders, yet still demonstrate higher clinical complexity, suboptimal treatment response, and poor clinical and functional outcomes. Methods: We searched thirteen databases for studies concerning psychological interventions for adults with psychotic experiences, but not psychotic disorders. Our outcomes were the proportion of participants remitting/recovering from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, or quality of life; and economic outcomes (secondary). We analysed results using random-effects meta-analysis and narrative synthesis. Findings: Twenty-seven reports from 21 studies met inclusion criteria. Five reported the proportion of participants remitting from psychotic experiences. Non-meta-analytic evidence suggested that cognitive behavioural therapy (CBT) may promote symptomatic recovery. For secondary outcomes, CBT demonstrated effectiveness over treatment as usual (TAU) and supportive treatments (ST) in improving distress (pooled standardised mean difference: -0.23 [-0.36 to -0.10]), but no other outcome. Individual reports indicated that CBT, mindfulness, sleep CBT, systemic therapy, cognitive remediation therapy, and supportive treatments improved some clinical and/or functional outcomes. Only four reports, using data from two studies, included economic evaluations, which suggested CBT may be cost-effective compared with TAU. Interpretation: Initial evidence suggests that CBT may promote recovery from psychotic experiences and reduce associated distress, although scarcity of studies, small sample sizes, and variable study quality limit our ability to make definitive conclusions. The paucity of consistent evidence for improving other non-psychotic clinical and functional outcomes highlights a need for further research into psychological treatments for this population. Funding: This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0616-20003). Declaration of Interest: The authors declare no competing interests. Ethical Approval: Not applicable.