Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia

Abstract

BACKGROUND: Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person's feelings and patterns of thinking which underpin distress. OBJECTIVES: To review the effects of CBT for people with schizophrenia when compared to other psychological therapies. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group Trials Register (March 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected all references of the selected articles for further relevant trials, and, where appropriate, contacted authors. SELECTION CRITERIA: All relevant clinical randomised trials of cognitive behaviour therapy for people with schizophrenia-like illnesses. DATA COLLECTION AND ANALYSIS: Studies were reliably selected and assessed for methodological quality. Two reviewers, working independently, extracted data. We analysed dichotomous data on an intention-to-treat basis and continuous data with 65% completion rate are presented. Where possible, for dichotomous outcomes, we estimated a relative risk (RR) with the 95% confidence interval along with the number needed to treat/harm. MAIN RESULTS: Twenty-nine papers described 20 trials. Trials were often small and of limited quality. When CBT was compared with other psychosocial therapies no difference was found for outcomes relevant to adverse effect/events (2 RCTs, n=202, RR death 0.57 CI 0.12 to 2.60). Relapse was not reduced over any time period (5 RCTs, n=183, RR in long term 0.91 CI 0.63 to 1.32) nor was rehospitalisation (5 RCTs, n=294, RR in longer term 0.86 CI 0.62 to 1.21). Various global mental state measures failed to show difference (4 RCTs, n=244, RR no important change in mental state 0.84 CI 0.64 to 1.09). More specific measures of mental state failed to show differential effects on positive or negative symptoms of schizophrenia but there may be some longer term effect for affective symptoms (2 RCTs, n=105, MD BDI -6.21 CI -10.81 to -1.61). Few trials report on social functioning or quality of life. Findings do not convincingly favour either interventions (2 RCT, n=103, MD SFS 1.32 CI -4.90 to 7.54; n=37, MD EuroQOL -1.86 CI -19.20 to 15.48). For the outcome of leaving the study early we found no significant advantage when CBT was compared with either non-active control therapies (4 RCTs, n=433, RR 0.88 CI 0.63 to 1.23) or active therapies (6 RCTs, n=339, RR 0.75 CI 0.40 to 1.43) AUTHORS' CONCLUSIONS: Trail-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other and sometime much less sophisticated therapies for people with schizophrenia.