Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia
Editorial Group: Cochrane Schizophrenia Group
Published Online: 18 APR 2012
Assessed as up-to-date: 8 MAR 2010
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008712. DOI: 10.1002/14651858.CD008712.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 APR 2012
Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person's distress and problem behaviours to underlying patterns of thinking.
To review the effects of CBT for people with schizophrenia when compared with other psychological therapies.
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.
All relevant randomised controlled trials (RCTs) of CBT for people with schizophrenia-like illnesses.
Data collection and analysis
Studies were reliably selected and assessed for methodological quality. Two review authors, 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 risk ratio (RR) with the 95% confidence interval (CI) along with the number needed to treat/harm.
Thirty one 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 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, mean difference (MD) Beck Depression Inventory (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 of the interventions (2 RCTs, n = 103, MD Social Functioning Scale(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)
Trial-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other - and sometime much less sophisticated - therapies for people with schizophrenia.
Plain language summary
Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia
Cognitive behavioural therapy (CBT) is a talking therapy first mentioned in 1952 but only became recommended as a routine treatment in 2002. CBT encourages people to openly discuss their beliefs, emotions and experiences with a therapist (individually or in a group), as well as participate in assessing their symptoms, emotional distress and behaviour. Such discussion is thought to help develop ways of challenging, coping and managing unhelpful thoughts and problem behaviour. People with schizophrenia may have difficulties with concentration, attention and motivation. The capacity to think, feel pleasure, talk openly and act also may be reduced. All of which can mean making friends, living independently and finding employment are sometimes hard. The idea of CBT is to help with these problems by coming up with ‘real world’ coping strategies and problem solving skills.
Relatively little is known about the effects of CBT when compared with other psychological or talking therapies (such as supportive therapy, psycho- education, group, relaxation and family therapy) in helping people with schizophrenia. This review found that research in this area was often small scale and of limited quality. The majority of therapists (65%) met the review’s standard of being qualified (but this was not a complete finding as most studies did not take into account appropriate training and the qualification of therapists).
In the main, no difference in overall effectiveness was found between CBT and other talking therapies. Relapses (people with schizophrenia becoming unwell again) and re-hospitalisation (the need to go back into hospital) were not reduced. CBT was not any better at improving mental state compared to other talking therapies and CBT was no better or worse in managing the symptoms of schizophrenia, both in terms of managing positive symptoms (such as hearing voices or seeing things) and negative symptoms (not feeling emotions, inactivity which leads to weight gain).
No difference was found for leaving the study early or continuing treatment for CBT compared with other therapies, although the overall number of people who left the study early was relatively low compared to drug trials meaning that CBT and other talking therapies may better at retaining and keeping people with schizophrenia in treatment. No advantage for CBT was recorded with regard to death by natural causes or suicide, coping with anxiety, building self-esteem, developing insight or helping with anger or problem behaviours such as violence. Few studies reported the effect CBT had on quality of life and in developing better social or work skills.
The review, however, suggests that there might be some longer term advantage in CBT for dealing with emotions and distressing feelings. Some initial findings indicated that CBT may be of greater benefit to people with depression and managing its symptoms.
This Plain Language Summary was written by a consumer Benjamin Gray, Service User and Service User Expert,
Rethink Mental Illness. Email: firstname.lastname@example.org.
31篇論文說明20個試驗。試驗通常為小型且品質受限。當CBT與其他心理治療比較時，沒有發現與不良影響/事件相關成果的差異(2 RCTs, n = 202, RR 死亡0.57 CI 0.12 to 2.60)。在任何時間期間中復發並沒有顯著降低(5 RCTs, n = 183, 長期RR 0.91 CI 0.63 to 1.32)，再住院也沒有降低 (5 RCTs, n = 294, 於長期追蹤的為RR 0.86 CI 0.62 to 1.21)。各種不同的全球心理狀態測量皆無法顯示有差異 (4 RCTs, n = 244, RR 心理狀態無重要改變 0.84, CI 0.64 to 1.09)。更多特定心理狀態測量無法顯示精神分裂症正面或負面症狀上的不同效果，但就情感性症狀而言，可能有某些較長期的影響(2 RCTs, n = 105, 平均數差異(MD) 貝克憂鬱量表(BDI) -6.21 CI -10.81 to -1.61)。少數試驗報告社會功能或生活品質。發現沒有令人信服的支持任一種介入 (2 RCTs, n = 103, MD 社會功能量表 (SFS) 1.32 CI -4.90 to 7.54; n = 37, MD EuroQOL -1.86 CI -19.20 to 15.48)。就提早離開研究的成果而言， CBT與非積極控制治療(4 RCTs, n = 433, RR 0.88 CI 0.63 to 1.23)或積極治療比較時(6 RCTs, n = 339, RR 0.75 CI 0.40 to 1.43)沒有發現顯著益處。
認知行為治療(CBT)為談話療法，首次於1952年採用，但到2002年才成為建議的例行治療。CBT鼓勵民眾開放的與治療師討論他們的信念、情感以及經驗 (個別或於團體中)，並參與評估他們的症狀、情緒痛苦與行為。這樣的討論被認為有助於發展挑戰的方法、因應並管理無助的想法與問題行為。患精神分裂症的人們可能在集中、注意力與動機上有困難。思考能力、感覺樂趣、開放的談話與行為或許會降低。所有這些可以表示交朋友、獨立生活與找工作有時會有點困難 。CBT的理想是藉由追上”真實世界”以協助有這些問題者因應策略以及問題解決技能。
這個一般語言總結是由使用者及Rethink Mental Illness 的服務使用者、服務使用專家Benjamin Gray撰寫。
Rethink Mental Illness. Email: email@example.com.
翻譯: East Asian Cochrane Alliance