Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China

Li, Zhanjiang; Guo, Zhihua; Wang, Na; Xu, Zhifang; Qu, Ying; Wang, Xiangqun; Sun, Jing; Yan, Li-Qiong; Ng, Roger M. K.; Turkington, Douglas; Kingdon, David

doi:10.1017/s0033291714002992

Cited by 43 publications

(42 citation statements)

References 39 publications

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“…These trials provided comparisons of the following psychological treatments: CBT (N=40), metacognitive training (N=6), mindfulness (N=2), acceptance and commitment therapy (N=2), experience focused counselling (N=1), hallucination focused integrative treatment (N=1), and AVATAR therapy (N=1).…”

Section: Resultsmentioning

confidence: 99%

Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

et al. 2018

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Psychological treatments are increasingly regarded as useful interventions for schizophrenia. However, a comprehensive evaluation of the available evidence is lacking and the benefit of psychological interventions for patients with current positive symptoms is still debated. The present study aimed to evaluate the efficacy, acceptability and tolerability of psychological treatments for positive symptoms of schizophrenia by applying a network meta-analysis approach, that can integrate direct and indirect comparisons. We searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov for randomized controlled trials of psychological treatments for positive symptoms of schizophrenia, published up to January 10, 2018. We included studies on adults with a diagnosis of schizophrenia or a related disorder presenting positive symptoms. The primary outcome was change in positive symptoms measured with validated rating scales. We included 53 randomized controlled trials of seven psychological interventions, for a total of 4,068 participants receiving the psychological treatment as add-on to antipsychotics. On average, patients were moderately ill at baseline. The network meta-analysis showed that cognitive behavioural therapy (40 studies) reduced positive symptoms more than inactive control (standardized mean difference, SMD=-0.29; 95% CI: -0.55 to -0.03), treatment as usual (SMD=-0.30; 95% CI: -0.45 to -0.14) and supportive therapy (SMD=-0.47; 95% CI: -0.91 to -0.03). Cognitive behavioural therapy was associated with a higher dropout rate compared with treatment as usual (risk ratio, RR=0.74; 95% CI: 0.58 to 0.95). Confidence in the estimates ranged from moderate to very low. The other treatments contributed to the network with a lower number of studies. Results were overall consistent in sensitivity analyses controlling for several factors, including the role of researchers' allegiance and blinding of outcome assessor. Cognitive behavior therapy seems to be effective on positive symptoms in moderately ill patients with schizophrenia, with effect sizes in the lower to medium range, depending on the control condition.

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Section: Resultsmentioning

confidence: 99%

Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

et al. 2018

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“…Cognitive behavior therapy for psychosis (CBT-p) has been linked with improvements relative to treatment as usual in two separate trials 160,161 . A brief culturally adapted version of CBT-p was also linked with improvements in insight 162,163 .…”

Section: Psychological Interventions Which Can Affect Insightmentioning

confidence: 99%

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

et al. 2018

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Poor insight in schizophrenia is prevalent across cultures and phases of illness. In this review, we examine the recent research on the relationship of insight with behavior, mood and perceived quality of life, on its complex roots, and on the effects of existing and emerging treatments. This research indicates that poor insight predicts poorer treatment adherence and therapeutic alliance, higher symptom severity and more impaired community function, while good insight predicts a higher frequency of depression and demoralization, especially when coupled with stigma and social disadvantage. This research also suggests that poor insight may arise in response to biological, experiential, neuropsychological, social-cognitive, metacognitive and socio-political factors. Studies of the effects of existing and developing treatments indicate that they may influence insight. In the context of earlier research and historical models, these findings support an integrative model of poor insight. This model suggests that insight requires the integration of information about changes in internal states, external circumstances, others' perspectives and life trajectory as well as the multifaceted consequences and causes of each of those changes. One implication is that treatments should, beyond providing education, seek to assist persons with schizophrenia to integrate the broad range of complex and potentially deeply painful experiences which are associated with mental illness into their own personally meaningful, coherent and adaptive picture.

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“…Successful studies of CBTp and psychosis have taken place in countries in the developing world including Pakistan (Naeem et al, 2015b) and in China (Li et al, 2015). There has also been investigation of use of adapted CBT for people from minority ethnic groups in the UK and a successful study undertaken incorporating a range of necessary adaptations in theory e.g.…”

Section: Cultural Aspectsmentioning

confidence: 99%

Cognitive therapy of psychosis: Research and implementation

Kingdon

Turkington

2019

Schizophrenia Research

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Cognitive therapy for psychosis (CBTp), schizophrenia and psychotic symptoms has advanced rapidly over the past two decades and is having an increasing influence on clinical practice.Research has focused on symptoms, e.g. paranoia, negative symptoms and hallucinations, and stages of the disorder, e.g. early intervention and persistent symptoms. It has used a range of approaches, e.g. brief or lengthier interventions for individual and groups, and in different cultural settings.Recent meta-analyses of studies demonstrate that CBTp has benefits over and above medication and treatment as usual with moderate effect sizes. This is less with active controls, e.g. supportive therapy or befriending, but a consistent finding across studies.Depression in psychosis, people on clozapine and those who are not taking medication, are areas where research is occurring but further research is needed, e.g. for both younger and older patients, late onset psychosis, learning disability, forensic patients and with substance abuse.

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Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China

Abstract: Background: Meta-analyses support the efficacy of cognitive-behavioural therapy (CBT) for

Cited by 43 publications

References 39 publications

Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

Insight in schizophrenia spectrum disorders: relationship with behavior, mood and perceived quality of life, underlying causes and emerging treatments

Cognitive therapy of psychosis: Research and implementation

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