Cognitive Behavior Therapy for Schizophrenia: Effect Sizes, Clinical Models, and Methodological Rigor

By T. Wykes, C. Steel, B. Everitt, N. Tarrier. Schizophrenia bulletin, 2007

1,096 citations recorded by the source corpus.

Background: Guidance in the United States and United Kingdom has included cognitive behavior therapy for psychosis (CBTp) as a preferred therapy. But recent advances have widened the CBTp targets to other symptoms and have different methods of provision, eg, in groups. Aim: To explore the effect sizes of current CBTp trials including targeted and nontargeted symptoms, modes of action, and effect of methodological rigor. Method: Thirty-four CBTp trials with data in the public domain were used as source data for a meta-analysis and investigation of the effects of trial methodology using the Clinical Trial Assessment Measure (CTAM). Results: There were overall beneficial effects for the target symptom (33 studies; effect size = 0.400 [95% confidence interval {CI} = 0.252, 0.548]) as well as significant effects for positive symptoms (32 studies), negative symptoms (23 studies), functioning (15 studies), mood (13 studies), and social anxiety (2 studies) with effects ranging from 0.35 to 0.44. However, there was no effect on hopelessness. Improvements in one domain were correlated with improvements in others. Trials in which raters were aware of group allocation had an inflated effect size of approximately 50%–100%. But rigorous CBTp studies showed benefit (estimated effect size = 0.223; 95% CI = 0.017, 0.428) although the lower end of the CI should be noted. Secondary outcomes (eg, negative symptoms) were also affected such that in the group of methodologically adequate studies the effect sizes were not significant. Conclusions: As in other meta-analyses, CBTp had beneficial effect on positive symptoms. However, psychological treatment trials that make no attempt to mask the group allocation are likely to have inflated effect sizes. Evidence considered for psychological treatment guidance should take into account specific methodological detail.

Subfields: Clinical Psychology, Psychiatry and Mental health

View Paper: https://www.semanticscholar.org/paper/360814e5c07a6214df44c998f16dec37e4447cc4

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In Clinical Psychology

In Psychiatry and Mental health

Citations in the corpus

A compassion focused model of recovery after psychosis (2010, background): “British Journal of Psychiatry, 185, 410-415. Thwaites, R., & Freeston, M.H. (2005). Safetyseeking behaviours: Fact or fiction: How can we clinically differentiate between safety behaviours and additive coping strategies across anxiety disorders.”
Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders (2016, background): “Although positive symptoms were the initial targets of CBTp, research has also been conducted using CBTp for negative symptoms and for comorbid depression, anxiety and substance use (Wykes et al., 2008).”
The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. (2010, methodology): “Both individual and group formats have been used to deliver CBT psychotherapy and seem to have similar benefit.(108)”
Neuroscience and Biobehavioral Reviews Auditory Verbal Hallucinations as Atypical Inner Speech Monitoring, and the Potential of Neurostimulation as a Treatment Option (neutral): “One meta-analysis reported an effect size of 0.4 for a reduction in positive symptoms of schizophrenia (Wykes et al., 2008), although this does not tell us specifically about CBT's efficacy in treating AVHs.”