Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Accessible Summary What is known on the subject? Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence‐based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta‐analysis have been conducted. What the paper adds to existing knowledge CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. What are the implications for practice? The results of this review suggest that the brief CBFI is an effective family‐inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. AbstractIntroductionCognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI.AimThis review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families.MethodEligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random‐effects models.ResultsFour studies consisting of 524 participants were included. The risk of bias was low–unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post‐treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal.DiscussionThe findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention.Implications for PracticeMental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse‐led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.

The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression

“…Results of the current study suggested that intervention focusing on reducing CC domains of EE might have a more significant benefit to change relapse outcomes. Two recent systematic reviews found cognitive behavioural family intervention and compassion-focused therapy may be beneficial to the schizophrenic patients and their families, in which both of the interventions target on the cognitive reappraisal and emotional resilience to foster a family climate and dynamic (Ma et al, 2020; Mui et al, 2019). These evidences confirmed the foci of family intervention with the purpose of reducing EE, specifically CC domains and enhancing the sense of warmth.…”

A qualitative exploration of the acceptability of a cognitive behavioural therapy self-help book for people with psychosis in Nicaragua

“…It may be useful to factor in families (e.g. Habib et al, 2015;Ma et al, 2020;Nickels et al, 2016) and religion (Heffernan et al, 2016;Turner & Hodge, 2020) when designing psychosis self-help tools in the Nicaraguan and Latin American context. Future research could develop different versions of CBT-based self-help, and make a comparison of the effectiveness of these tools.…”

Feasibility of brief distress screening for family caregivers of adults diagnosed with schizophrenia in Changsha, Hunan, China

“…Moreover, our findings suggest that reductions in patients’ severity of illness may alleviate FGs’ distress. Previous reviews conclude that Cognitive Behavioral Therapy for psychosis (CBTp), Family Interventions for psychosis (FIp) and Cognitive Behavioral Family Intervention (CBFI), which integrates CBTp and FIp, are effective reducing psychotic symptoms and slightly improving FGs’ mental health (Claxton, Onwumere, & Fornells‐Ambrojo, 2017; Ma et al., 2019). These interventions tend to modify or improve attitudes, insights or appraisal of treatment and caregiving in patients diagnosed with mental illness or their FGs.…”

“…Furthermore, they share some components such as psychoeducation about the illness, emotion management, social and coping skills training, and communication with peers and healthcare providers (Claxton et al., 2017; Ma et al., 2019). However, these reviews failed to find a strong and persistent effect on reducing FGs’ distress (Claxton et al., 2017; Ma et al., 2019). A better understanding of FGs’ unmet needs and barriers to engagement in interventions should be clarified in future studies.…”

“…It should be emphasized that although the optimal cut-off score has been chosen in the present study, healthcare providers or nurses need to decide a range of DT scores for further assessment based on the screening purpose. For example, for a wide screening (Claxton, Onwumere, & Fornells-Ambrojo, 2017;Ma et al, 2019). be delivered by mental health nurses.…”