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Meta-Analysis
. 2014 Jan;204(1):20-9.
doi: 10.1192/bjp.bp.112.116285.

Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias

Affiliations
Meta-Analysis

Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias

S Jauhar et al. Br J Psychiatry. 2014 Jan.

Abstract

Background: Cognitive-behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias.

Aims: To conduct a systematic review and meta-analysis of the effectiveness of CBT for schizophrenic symptoms that includes an examination of potential sources of bias.

Method: Data were pooled from randomised trials providing end-of-study data on overall, positive and negative symptoms. The moderating effects of randomisation, masking of outcome assessments, incompleteness of outcome data and use of a control intervention were examined. Publication bias was also investigated.

Results: Pooled effect sizes were -0.33 (95% CI -0.47 to -0.19) in 34 studies of overall symptoms, -0.25 (95% CI -0.37 to -0.13) in 33 studies of positive symptoms and -0.13 (95% CI -0.25 to -0.01) in 34 studies of negative symptoms. Masking significantly moderated effect size in the meta-analyses of overall symptoms (effect sizes -0.62 (95% CI -0.88 to -0.35) v. -0.15 (95% CI -0.27 to -0.03), P = 0.001) and positive symptoms (effect sizes -0.57 (95% CI -0.76 to -0.39) v. -0.08 (95% CI -0.18 to 0.03), P<0.001). Use of a control intervention did not moderate effect size in any of the analyses. There was no consistent evidence of publication bias across different analyses.

Conclusions: Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the 'small' range. This reduces further when sources of bias, particularly masking, are controlled for.

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Comment in

  • CBT for psychosis: not a 'quasi-neuroleptic'.
    Birchwood M, Shiers D, Smith J. Birchwood M, et al. Br J Psychiatry. 2014 Jun;204(6):488-9. doi: 10.1192/bjp.204.6.488a. Epub 2014 Jun 2. Br J Psychiatry. 2014. PMID: 25029689 No abstract available.
  • CBT for psychosis: not a 'quasi-neuroleptic'.
    Byrne RE. Byrne RE. Br J Psychiatry. 2014 Jun;204(6):489. doi: 10.1192/bjp.204.6.489. Br J Psychiatry. 2014. PMID: 25029690 No abstract available.
  • Authors' reply.
    McKenna PJ, Radua J, Jauhar S, Laws KR. McKenna PJ, et al. Br J Psychiatry. 2014 Jun;204(6):490. doi: 10.1192/bjp.204.6.490. Br J Psychiatry. 2014. PMID: 25029691 No abstract available.
  • An oversimplification of psychosis, its treatment, and its outcomes?
    Peters E. Peters E. Br J Psychiatry. 2014 Aug;205(2):159-60. doi: 10.1192/bjp.205.2.159a. Epub 2014 Aug 1. Br J Psychiatry. 2014. PMID: 25252324 No abstract available.
  • Authors' reply.
    McKenna PJ, Radua J, Laws KR, Jauhar S. McKenna PJ, et al. Br J Psychiatry. 2014 Aug;205(2):160-1. doi: 10.1192/bjp.205.2.160. Epub 2014 Aug 1. Br J Psychiatry. 2014. PMID: 25252325 No abstract available.
  • Dose and effect in CBT for schizophrenia.
    Gold C. Gold C. Br J Psychiatry. 2015 Sep;207(3):269. doi: 10.1192/bjp.207.3.269. Br J Psychiatry. 2015. PMID: 26329566 No abstract available.
  • Authors' reply.
    McKenna PJ, Laws KR, Jauhar S. McKenna PJ, et al. Br J Psychiatry. 2015 Sep;207(3):269-70. doi: 10.1192/bjp.207.3.269a. Br J Psychiatry. 2015. PMID: 26329567 No abstract available.

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