Efficacy of Psychological Therapy in Schizophrenia: Conclusions From Meta-analyses

Abstract

Over the past years, evidence for the efficacy of psychological therapies in schizophrenia has been summarized in a series of meta-analyses. The present contribution aims to provide a descriptive survey of the evidence for the efficacy of psychological therapies as derived from these meta-analyses and to supplement them by selected findings from an own recent meta-analysis. Relevant meta-analyses and randomized controlled trials were identified by searching several electronic databases and by hand searching of reference lists. In order to compare the findings of the existing meta-analyses, the reported effect sizes were extracted and transformed into a uniform effect size measure where possible. For the own meta-analysis, weighted mean effect size differences between comparison groups regarding various types of outcomes were estimated. Their significance was tested by confidence intervals, and heterogeneity tests were applied to examine the consistency of the effects. From the available meta-analyses, social skills training, cognitive remediation, psychoeducational coping-oriented interventions with families and relatives, as well as cognitive behavioral therapy of persistent positive symptoms emerge as effective adjuncts to pharmacotherapy. Social skills training consistently effectuates the acquisition of social skills, cognitive remediation leads to short-term improvements in cognitive functioning, family interventions decrease relapse and hospitalization rates, and cognitive behavioral therapy results in a reduction of positive symptoms. These benefits seem to be accompanied by slight improvements in social functioning. However, open questions remain as to the specific therapeutic ingredients, to the synergistic effects, to the indication, as well as to the generalizability of the findings to routine care.

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

“…Evidence suggests that family interventions are effective at reducing patient psychotic relapse and readmissions (Pilling et al, 2002) as well as relatives' high levels of EE (Pfammatter et al, 2006;Pharoah et al, 2010). However, one key issue around family work is implementation.…”

Psychological Treatment of Psychosis

“…A fourth (Pilling, Bebbington et al, 2002) found no evidence for any kind of effectiveness. A broader meta-analysis of SST and related psychosocial treatment (Pfammatter et al, 2006) found qualified evidence for effectiveness. A review of the problem solving component in SST (Xia & Li, 2007) found insufficient studies to conduct a quantitative meta-analysis, and did not reach positive or negative conclusions.…”

“…A substantial amount of research has demonstrated that providing family interventions can significantly reduce relapse rates of people with psychosis over follow-up periods (Pfammatter et al, 2006;Pharaoh et al, 2006). Family interventions are based on the assumption that a stressful interpersonal environment in which an individual lives can exacerbate psychotic symptoms and lead to premature or more frequent relapse of illness.…”

“…Family interventions have been rigorously evaluated indicating consistent superiority of the approach compared to treatment as usual on relapse rates (Pfammatter et al, 2006) with replications in many parts of the world including Eastern and developing countries (Xiong et al, 1994). Recent meta-analyses have varied in their conclusions however, reviews consistently conclude that family interventions can significantly reduce relapse.…”

La terapia cognitivo conductual y los síntomas negativos en la esquizofrenia

“…Las intervenciones de psicoeducación combinadas con los medicamentos antipsicóticos han demostrado ser eficaces para incrementar el funcionamiento psicosocial y disminuir la emotividad expresada, 3 la sintomatología clínica, las recaídas y las hospitalizaciones; 22 también han demostrado efectividad en variables más indirectas como el mantenimiento del empleo; 23 se ha reportado que estos resultados dependen en gran medida de que los programas psicoeducativos estén fundamentados en las características y necesidades familiares.…”