Social and occupational recovery in early psychosis: a systematic review and meta-analysis of psychosocial interventions

Abstract

Background Psychosis, even in its early stages, ranks highly among the causes of disability worldwide, resulting in an increased focus on improved recovery of social and occupational functioning. This study aimed to provide an estimate of the effectiveness of psychosocial interventions for improving functioning in early psychosis. We also sought evidence of superiority between intervention approaches. Methods An electronic search was conducted using PubMed and PsycINFO to identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to December 2020 and is reported following PRISMA guidelines. Data were extracted on validated measures of functioning from included studies and pooled standardised mean difference (SMD) was estimated. Results In total, 31 studies involving 2811 participants were included, focusing on: cognitive behavioural therapy for psychosis (CBTp), family-based therapy, supported employment, cognitive remediation training (CRT) and multi-component psychosocial interventions. Across interventions, improved function was observed (SMD = 0.239; 95% confidence interval 0.115–0.364, p < 0.001). Effect sizes varied by intervention type, stage of illness, length and duration of treatment and outcome measure used. In particular, interventions based on CRT significantly outperformed symptom-focused CBT interventions, while multi-component interventions were associated with largest gains. Conclusions Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting psychosocial function as part of the standard provided by early intervention services.

Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review

“…The review indicates that interventions with a bio-psycho-social integrative approach combining for example psychoeducation and family or group interventions might be more effective than control conditions in reducing symptoms and improving functioning. These results are in line with recent systematic reviews focusing on RCT studies for adolescents with psychotic disorders ( 21 ) and on psychosocial interventions aiming to improve social and occupational function in the early stages of psychosis ( 69 ), which concluded that “psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function.” It has been suggested that CBT would be the recommendable psychosocial treatment for adults with psychotic disorders ( 11 , 70 ), but this outcome was not supported in our systematic review, which included young adults, since CBT outperformed the control treatments only in some of the outcome domains. Frawley et al ( 69 ) also reported that interventions based on CRT significantly outperformed symptom-focused CBT interventions, while the largest gains were associated with multi-component interventions.…”

Do cognitive impairments limit treatment gains in a standalone digital intervention for psychosis? A test of the digital divide

“…Evidence-based psychosocial treatments for psychosis have strong support for improving symptoms and recovery outcomes among people with serious mental illness (SMI), including schizophrenia spectrum disorders ( Bighelli et al, 2021 ; Frawley et al, 2021 ; Turner et al, 2018 ). However, as few as 10% of people with a diagnosed SMI receive these interventions ( Dixon et al, 2010 ).…”

Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study)

“…Thus, there is an urgent need for treatment optimization. As modern treatment concepts more and more aim at full recovery rather than mere reduction of clinical symptoms multi-component treatment packages are being developed (6)(7)(8). Treatments that directly target key determinants of functional outcome, such as cognitive functioning, social behavioral skills, and negative symptoms, seem to be the most promising components of such approaches.…”