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. 2022 Jul 12;7(7):CD009608.
doi: 10.1002/14651858.CD009608.pub2.

Cognitive behavioural therapy (group) for schizophrenia

Giuseppe Guaiana  1 , Massimiliano Abbatecola  2 , Ghazaleh Aali  3 , Federica Tarantino  2 , Ikenna D Ebuenyi  4   5 , Valeria Lucarini  6 , Wei Li  7 , Caidi Zhang  7 , Antonio Pinto  8
Affiliations

Cognitive behavioural therapy (group) for schizophrenia

Giuseppe Guaiana et al. Cochrane Database Syst Rev. .

Abstract

Background: Schizophrenia is a disabling psychotic disorder characterised by positive symptoms of delusions, hallucinations, disorganised speech and behaviour; and negative symptoms such as affective flattening and lack of motivation. Cognitive behavioural therapy (CBT) is a psychological intervention that aims to change the way in which a person interprets and evaluates their experiences, helping them to identify and link feelings and patterns of thinking that underpin distress. CBT models targeting symptoms of psychosis (CBTp) have been developed for many mental health conditions including schizophrenia. CBTp has been suggested as a useful add-on therapy to medication for people with schizophrenia. While CBT for people with schizophrenia was mainly developed as an individual treatment, it is expensive and a group approach may be more cost-effective. Group CBTp can be defined as a group intervention targeting psychotic symptoms, based on the cognitive behavioural model. In group CBTp, people work collaboratively on coping with distressing hallucinations, analysing evidence for their delusions, and developing problem-solving and social skills. However, the evidence for effectiveness is far from conclusive.

Objectives: To investigate efficacy and acceptability of group CBT applied to psychosis compared with standard care or other psychosocial interventions, for people with schizophrenia or schizoaffective disorder.

Search methods: On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, four other databases and two trials registries. We handsearched the reference lists of relevant papers and previous systematic reviews and contacted experts in the field for supplemental data.

Selection criteria: We selected randomised controlled trials allocating adults with schizophrenia to receive either group CBT for schizophrenia, compared with standard care, or any other psychosocial intervention (group or individual).

Data collection and analysis: We complied with Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated risk ratio (RR) and 95% confidence interval (CI) for binary data and mean difference (MD) and 95% CI for continuous data. We used a random-effects model for analyses. We assessed risk of bias for included studies and created a summary of findings table using GRADE.

Main results: The review includes 24 studies (1900 participants). All studies compared group CBTp with treatments that a person with schizophrenia would normally receive in a standard mental health service (standard care) or any other psychosocial intervention (group or individual). None of the studies compared group CBTp with individual CBTp. Overall risk of bias within the trials was moderate to low. We found no studies reporting data for our primary outcome of clinically important change. With regard to numbers of participants leaving the study early, group CBTp has little or no effect compared to standard care or other psychosocial interventions (RR 1.22, 95% CI 0.94 to 1.59; studies = 13, participants = 1267; I2 = 9%; low-certainty evidence). Group CBTp may have some advantage over standard care or other psychosocial interventions for overall mental state at the end of treatment for endpoint scores on the Positive and Negative Syndrome Scale (PANSS) total (MD -3.73, 95% CI -4.63 to -2.83; studies = 12, participants = 1036; I2 = 5%; low-certainty evidence). Group CBTp seems to have little or no effect on PANSS positive symptoms (MD -0.45, 95% CI -1.30 to 0.40; studies =8, participants = 539; I2 = 0%) and on PANSS negative symptoms scores at the end of treatment (MD -0.73, 95% CI -1.68 to 0.21; studies = 9, participants = 768; I2 = 65%). Group CBTp seems to have an advantage over standard care or other psychosocial interventions on global functioning measured by Global Assessment of Functioning (GAF; MD -3.61, 95% CI -6.37 to -0.84; studies = 5, participants = 254; I2 = 0%; moderate-certainty evidence), Personal and Social Performance Scale (PSP; MD 3.30, 95% CI 2.00 to 4.60; studies = 1, participants = 100), and Social Disability Screening Schedule (SDSS; MD -1.27, 95% CI -2.46 to -0.08; studies = 1, participants = 116). Service use data were equivocal with no real differences between treatment groups for number of participants hospitalised (RR 0.78, 95% CI 0.38 to 1.60; studies = 3, participants = 235; I2 = 34%). There was no clear difference between group CBTp and standard care or other psychosocial interventions endpoint scores on depression and quality of life outcomes, except for quality of life measured by World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF) Psychological domain subscale (MD -4.64, 95% CI -9.04 to -0.24; studies = 2, participants = 132; I2 = 77%). The studies did not report relapse or adverse effects.

Authors' conclusions: Group CBTp appears to be no better or worse than standard care or other psychosocial interventions for people with schizophrenia in terms of leaving the study early, service use and general quality of life. Group CBTp seems to be more effective than standard care or other psychosocial interventions on overall mental state and global functioning scores. These results may not be widely applicable as each study had a low sample size. Therefore, no firm conclusions concerning the efficacy of group CBTp for people with schizophrenia can currently be made. More high-quality research, reporting useable and relevant data is needed.

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Conflict of interest statement

GG – is an Editor at Cochrane Common Mental Disorder Group and he was not involved in any editorial process of this review.

MA – none.

GA – was Assistant Managing Editor at Cochrane Schizophrenia Group until April 2021 and is currently Managing Editor of Cochrane Gut group. She was excluded from any editorial process of this review.

FT – none.

IE – none.

VL – none.

WL – none.

CZ – none.

AP – is a practitioner and content expert of CBTp. No other conflict of interest declared.

Figures

1
1
Mental state: overall: average endpoint score – end of treatment (PANSS total, high = poor).
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Study flow diagram.
5
5
Leaving the study early: for any reason – end of treatment.
1.1
1.1. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 1: Leaving the study early: for any reason – end of treatment
1.2
1.2. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 2: Mental state: overall: average endpoint score – end of treatment (PANSS total, high = poor)
1.3
1.3. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 3: Mental state: overall: average endpoint score – end of treatment (BPRS total, high = poor)
1.4
1.4. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 4: Mental state: overall: average endpoint score – end of treatment (PSYRATS total, high = poor)
1.5
1.5. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 5: Mental state: overall: average endpoint score – end of treatment (SCL‐90‐R, high = poor)
1.6
1.6. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 6: Mental state: specific: positive symptoms – average endpoint score – end of treatment (PANSS positive, high = poor)
1.7
1.7. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 7: Mental state: specific: positive symptoms – average endpoint score – end of treatment (SAPS, high = poor)
1.8
1.8. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 8: Mental state: specific: average endpoint total score – delusions – end of treatment (PSYRATS delusions, high = poor)
1.9
1.9. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 9: Mental state: specific: average endpoint total score – voices – end of treatment (PSYRATS voices, high = poor)
1.10
1.10. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 10: Mental state: specific: average endpoint total score – voices – end of treatment (AHRS, high = poor)
1.11
1.11. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 11: Mental state: specific: negative symptoms – average endpoint score – end of treatment (PANSS negative, high = poor)
1.12
1.12. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 12: Mental state: specific: negative symptoms – average endpoint score – end of treatment (SANS, high = poor)
1.13
1.13. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 13: Mental state: specific: depression/anxiety – average endpoint score – end of treatment (HADS total, high = poor)
1.14
1.14. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 14: Mental state: specific: depression – average endpoint score – end of treatment (BDI‐II, high = poor)
1.15
1.15. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 15: Mental state: specific: depression – average endpoint score – end of treatment (HAMD, high = poor)
1.16
1.16. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 16: Mental state: specific: depression – average endpoint score – end of treatment (MADRS, high = poor)
1.17
1.17. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 17: Mental state: specific: depression – average endpoint score – end of treatment (HADS depression, high = poor)
1.18
1.18. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 18: Mental state: specific: anxiety – average endpoint score – end of treatment (BAI, high = poor)
1.19
1.19. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 19: Mental state: specific: anxiety – average endpoint score – end of treatment (HADS anxiety, high = poor)
1.20
1.20. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 20: Mental state: specific: anxiety – average endpoint score – end of treatment (HARS, high = poor)
1.21
1.21. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 21: Mental state: specific: social anxiety – average endpoint score – end of treatment (SAD, high=poor)
1.22
1.22. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 22: Service use: number of people hospitalised during the study
1.23
1.23. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 23: Quality of life: average endpoint score – end of treatment (MSQoL, high = good)
1.24
1.24. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 24: Quality of life: average endpoint score – end of treatment (QLS, high = good)
1.25
1.25. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 25: Quality of life: average endpoint score – end of treatment (WHOQOL‐BREF – Psychological domain subscale, high = good)
1.26
1.26. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 26: Quality of life: average endpoint score – end of treatment (GQOLI‐74, high = good)
1.27
1.27. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 27: Functioning: overall: global assessment of functioning – average endpoint score – end of treatment (GAF, high = good)
1.28
1.28. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 28: Functioning: specific: living skills – average endpoint score – end of treatment (ILSS, high = good)
1.29
1.29. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 29: Functioning: specific: social – average endpoint score – end of treatment (SBS, high = poor)
1.30
1.30. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 30: Functioning: specific: social – average endpoint score – end of treatment (SFS, high = good)
1.31
1.31. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 31: Functioning: specific: social – average endpoint score – end of treatment (PSP, high = good)
1.32
1.32. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 32: Functioning: specific: social – average endpoint score – end of treatment (IPROS, high = poor)
1.33
1.33. Analysis
Comparison 1: Group cognitive behavioural therapy (CBT) versus standard care, Outcome 33: Functioning: specific: social – average endpoint score – end of treatment (SDSS, high = poor)
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    1. Penzenstadler L, Chatton A, Huguelet P, Lecardeur L, Bartolomei J, Brazo P, et al. Does change over time in delusional beliefs as measured with PDI predict change over time in belief flexibility measured with MADS? Psychiatric Quarterly 2010;90(4):693-702. - PubMed
    1. Penzenstadler L, Chatton A, Lecomte T, Huguelet P, Lecardeur L, Azoulay S, et al. Does the Beck Cognitive Insight Scale predict change in delusional beliefs? Psychology and Psychotherapy 2020;93(4):690-704. - PubMed
ISRCTN50247539 {published data only}
    1. ISRCTN50247539. Reflex. www.isrctn.com/ISRCTN50247539 (first received 4 May 2009).
    1. Pijnenborg GH, Vos AE, Timmerman ME, Gaag M, Sportel BE, Arends J, et al. Social cognitive group treatment for impaired insight in psychosis: a multicenter randomized controlled trial. Schizophrenia Research 2019;206:362-9. - PubMed
    1. Pijnenborg GH, Gaag M, Bockting CL, Meer L, Aleman A. Reflex, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT. BMC Psychiatry 2011;11:161. - PMC - PubMed
ISRCTN95603741 {published data only}
    1. Feasibility study of culturally adapted cognitive behaviour therapy for psychosis for ethnic minority groups. www.isrctn.com/ISRCTN95603741 (first received 21 May 2010).
    1. Husain N, Mehmood N, Husain MO, Kiran T, Naeem F, Chaudhry IB. Feasibility study of culturally adapted cognitive behaviour therapy for psychosis in Pakistan. European Psychiatry 2016;33:S578-9.
    1. Phiri P. Adapting cognitive behaviour therapy for psychosis for black and minority ethnic communities. Dissertation Ann Arbor University of Southampton (United Kingdom) 2012.
Jia 2005 {published data only}
    1. Jia Y, Lou F, Feng M. Cognitive behavioral nursing therapy for patients with schizophrenia [精神分裂症 患者认 知行 为护理疗法探讨]. Journal of Nursing Science 2005;20:10-2.
Jiang 2005 {published data only}
    1. Jiang Y. Cognitive behavioral therapy term effect of the episode schizophrenia [认知行为治疗对首发精神分裂症近期疗效的影响]. In: Proceedings of the 2005 Zhejiang Psychiatry Annual Conference. 2005:284-6.
Jiang 2008 {published data only}
    1. Jiang JF, Wei JY, Bian MJ, Xu YF, Gu JY. Effect of cognitive behavioral intervention on recovery of social function of patients with schizophrenia [认知行为干预对精神分裂症患者恢复 社会功能 的作 用]. Heilongjiang Nursing Journal 2008;14:701-2.
Johnson 2008 {published data only}
    1. Johnson DP, Penn DL, Bauer DJ, Meyer P, Evans E. Predictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinations. British Journal of Clinical Psychology 2008;47:171-83. - PubMed
Kaizerman‐Dinerman 2018 {published data only}
    1. Kaizerman-Dinerman A, Josman N, Roe D. The use of cognitive strategies among people with schizophrenia: a randomized comparative study. Open Journal of Occupational Therapy 2019;7:1-12.
    1. Kaizerman-Dinerman A, Roe D, Josman N. An efficacy study of a metacognitive group intervention for people with schizophrenia. Psychiatry Research 2018;270:1150-6. - PubMed
Klingberg 2010 {published data only}
    1. Klingberg S, Wittorf A, Fischer A, Jakob-Deters K, Buchkremer G, Wiedemann G. Evaluation of a cognitive behaviourally oriented service for relapse prevention in schizophrenia. Acta Psychiatrica Scandinavica 2010;121:340-50. - PubMed
Landa 2018 {published data only}
    1. Landa Y, Mueser K, Jacobs M, Jespersen R, Wyka K, Swiderski C, Cahalan C, et al. Group and family based cognitive behavioral therapy for youth at risk for psychosis: from research to real-word practice. Early Intervention in Psychiatry 2018;12(Suppl 1):183.
Langer 2012 {published data only}
    1. Langer AI, Cangas AJ, Salcedo E, Fuentes, B. Applying mindfulness therapy in a group of psychotic individuals: a controlled study. Behavioural and Cognitive Psychotherapy 2012;40(1):105-9. - PubMed
Lecomte 2002 {published data only}
    1. Lecomte T, Leclerc C, Corbiere M, Wykes T, Wallace CJ, Spidel A. Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. Journal of Nervous and Mental Disease 2008;196:866-75. - PubMed
    1. Lecomte T, Leclerc C, Wykes T, Spidel A. Group CBT for early psychosis – are there still benefits 1 year later? Early Intervention in Psychiatry 2010;4(Suppl 1):150.
    1. Lecomte T, Leclerc C, Wykes T, Wallace CJ, Spidel A, Corbiere M. Group CBT versus skills training for first episodes of psychosis – results of a RCT. Schizophrenia Research 2006;86(Suppl 1):S45-6.
    1. Lecomte T, Leclerc C, Wykes T, Wallace CJ, Spidel A, Greaves C. Effectiveness of group cognitive-behaviour therapy for first episode psychosis – results of a randomized controlled trial. Schizophrenia Bulletin 2007;33:440.
    1. Lecomte T, Leclerc C, Wykes T, Wallace CJ. Group CBT versus group symptom management for treating psychotic symptoms of young individuals presenting a first episode of schizophrenia: preliminary results. In: Proceedings of the 3rd International Conference on Early Psychosis; 2002 Sep 25-28; Copenhagen, Denmark. 2002:88-9.
Lecomte 2020 {published data only}
    1. Lecomte T, Corbiere M, Giguere CE, Titone D, Lysaker P. Group cognitive behaviour therapy for supported employment – results of a randomized controlled cohort trial. Schizophrenia Research 2020;215:126-33. - PubMed
Li 2005 {published data only}
    1. Li Y, Li Z, Xin L, Hou L, Zhao Y, Hou C. The efficacy of special cognitive-behavior approaches on schizophrenia during acute-phase [特 定 认 知 行 为 技 术 对 急 性 期 精 神 分 裂 症 的 干 预 效 果]. Hebei Medicine 2005;21:1018-20.
Li 2007 {published data only}
    1. Li S, Su M, Su T, Wang C, Ling H, Cheng G. The effect of cognition therapy on the insight and the compliance of schizophrenia patients [认知领 影响 悟治疗对精神分裂症患者 自知力及治疗依从性的]. International Medicine and Health Guidance News 2007;13:18-21.
Li 2009 {published data only}
    1. Li X. The impact of cognitive intervention on the rehabilitation of patients with split mental disorder [认 知 干 预 对 精 神 分 裂 症 患 者 康 复 的 影 响]. Journal of Qilu Nursing 2009;15:11-2.
Li 2014a {published data only}
    1. Li L, Hu L, Liang Z, Wen Z. The effect of cognitive intervention on the quality of life and related factors in patients with chronic schizophrenia [认知干预对慢性精神分裂症患者生活质量及相关因素的影响]. Clinical Medical Engineering 2014;21:1073-4.
Li 2014b {published data only}
    1. Li H. The effect of cognitive psychotherapy on the treatment compliance of patients with first episode schizophrenia [认知心理治疗对首发精神分裂症患者治疗依从性的影响]. Medical Information 2014;27:524.
Li 2014c {published data only}
    1. Li Y. The clinical effect of cognitive therapy in the treatment of schizophrenia and its influence on social function [认知疗法在精神分裂症患者治疗中的临床疗效及对社会功能的影响]. Medical Journal of Chinese People's Health 2014;26:38-9.
Liang 2002 {published data only}
    1. Liang Q, He Z, Deng L, Lu H. Cognitive therapy to improve the efficacy of schizophrenia insight analysis [认知治疗对改善精神分裂症患者自知力的疗效分析]. Modern Rehabilitation 2002;6:3234.
Lincoln 2011 {published data only}
    1. Lincoln T, Ziegler M, Mehl S, Luellmann E, Kesting ML, Westermann S, et al. Effectiveness of CBT in a German outpatient setting. Short and long term results of a controlled randomised trial. European Archives of Psychiatry and Clinical Neuroscience 2011;261:S18.
Liu 2012 {published data only}
    1. Liu G. The effect of cognitive psychotherapy on the quality of life and stigma of patients with schizophrenia during rehabilitation [认知心理治疗对精神分裂症康复期患者生活质量及病耻感的影响]. Psychologist 2012;8:71.
Liu 2015 {published data only}
    1. Liu J, Yong S, Xu X, Zhang J, Xie P, Xu C, et al. The effect of cognitive behavioral therapy on the rehabilitation of inpatients with schizophrenia [认知行为治疗对住院精神分裂症患者康复效果的影响]. Journal of Clinical Psychosomatic Diseases 2015;21:64-6.
Long 2001 {published data only}
    1. Long R, Li L. Cognitive behavioral therapy in the psychological care work (control analysis of 100 cases of schizophrenia) [认知行为疗法在 心理护理工作 中的应用 (附 100例住院精神分裂症对照分析]. Shandong Archives of Psychiatry 2001;14:261-3.
Luo 2010 {published data only}
    1. Luo H, Wu X. Episode schizophrenia patients with cognitive therapy follow-up study [首发精神分裂症患者认知治疗疗效随访研究]. Internal Medicine of China 2010;5:272-4.
Ma 2007 {published data only}
    1. Ma WH, Hu XF, Wang ZQ. A comparison of schizophrenic treated with method of corrected – behavior [精神分裂症认知行为疗法的对照研究]. Medical Journal of Chinese People's Health 2007;19:441, 443.
Ma 2012 {published data only}
    1. Ma Y, Li ZJ, Xu ZY, Gu ZH, Qu Y, Wang XQ, et al. Effects of cognitive behavioral therapy on quality of life in patients with schizophrenia: a single blind randomized controlled study [认知行为治疗改善精神分裂症患者 生活质量的随机单盲对照试验]. Chinese Mental Health Journal 2012;26:801-7.
Ma 2013 {published data only}
    1. Ma Y, Li Z, Xu Z, Guo Z, Qu Y, Wang X, et al. Effects of cognitive behavioral therapy on coping style for patients with schizophrenia [认知行为治疗对精神分裂症患者应对方式的影响]. Chinese Journal of Clinical Psychology 2013;21:455-7.
Mo 2015 {published data only}
    1. Mo Y, Li X, Fu C, He R, Cai Y, Mo T. The influence of cognitive behavior intervention on the mental state of vagrants with mental illness [认知行为干预对流浪精神疾病患者心理状态的影响]. Chinese Journal of Modern Drug Application 2015;9:201-2.
NCT01704833 {published data only}
    1. Landa Y, Chadwick P, Beck AT, Alexeenko L, Sheets M, Zhu Y, et al. Targeting information processing biases and social avoidance in group cognitive behavioral therapy for paranoia: a pilot randomized controlled clinical trial. Schizophrenia Bulletin 2011;37:271.
    1. Landa Y, Chadwick P, Stern E, Pan H, Alexeenko L, Zhu Y, et al. Cognitive behavioral therapy for paranoia: a pilot randomized controlled clinical trial and fMRI investigation of systems-level brain circuit modulation. Biological Psychiatry 2012;8(Suppl 1):65S-6S.
    1. NCT01704833. Cognitive behavioral therapy for paranoia in schizophrenia. clinicaltrials.gov/ct2/show/NCT01704833 (first received 11 October 2012).
NCT02254733 {published data only}
    1. Granholm E, Holden JL, Sommerfeld D, Rufener C, Perivoliotis D, Mueser K, et al. Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial. Trials 2015;16:438. - PMC - PubMed
    1. Sommerfeld DH, Aarons GA, Naqvi JB, Holden J, Perivoliotis D, Mueser KT, et al. Stakeholder perspectives on implementing cognitive behavioral social skills training on assertive community treatment teams. Administration and Policy in Mental Health 2019;46:188-99. - PMC - PubMed
Nie 2016 {published data only}
    1. Nie S, Deng L, Yang Y, Zhou Y. The effect of cognitive behavioral intervention on treatment compliance and quality of life of patients with schizophrenia in remission [认知行为干预对精神分裂症缓解期患者治疗依从性和生活质量的影响]. Chinese Clinical Nursing 2016;8:461-4.
Owen 2015 {published data only}
    1. Owen M, Sellwood W, Kan S, Murray J, Sarsam M. Group CBT for psychosis: a longitudinal, controlled trial with inpatients. Behaviour Research and Therapy 2015;65:76-85. - PubMed
Park 2013 {published data only}
    1. Park H. A randomized controlled pilot study of CBSST (cognitive behavioral social skills training) for middle-or older-aged patients with schizophrenia: a pilot study, revisited cognitively. International Psychogeriatrics 2013;25(Suppl 1):159.
Pijnenborg 2013 {published data only}
    1. Pijnenborg G, Vos A, Meer L, Sportel E, Bockting C, Gaag M, Aleman A. Results of a metacognitive group treatment to improve insight in psychosis (correct version of the abstract, this replaces the previously submitted abstract on reflex). Schizophrenia Research 2014;153(Suppl 1):S354.
    1. Pijnenborg G, Vos A, Meer L, Sportel E, Bockting C, Gaag M, et al. A metacognitive group treatment to improve insight in psychosis. Schizophrenia Research 2014;153(Suppl 1):S162.
    1. Pijnenborg M, Vos A, Meer L, Bockting C, Gaag M, Aleman A. A metacognitive group treatment to improve insight in psychosis and to reduce self-stigma. European Archives of Psychiatry and Clinical Neuroscience 2015;1:S72.
    1. Pijnenborg M, Meer L, Vos A, Bockting C, Gaag M, Aleman A. A metacognitive group treatment to improve insight in psychosis. Schizophrenia Bulletin 2013;39:S349.
Pu 2016 {published data only}
    1. Pu X, Wang Y. The effect of cognitive behavioral therapy on the coping style of patients with schizophrenia [认知行为治疗对精神分裂症患者应对方式的影响]. Health today 2016;15:87.
Puig‐Navarro 2020 {published data only}
    1. Puig-Navarro O, Badia F, Baeza I, Varela E, Sugranyes G, Garcia-Rizo C, et al. Efficacy of cognitive-behavioral social skills training improving symptoms and functioning in patients with early-onset psychosis: a randomized controlled trial. Schizophrenia Bulletin 2020;46:S39.
Reddy 2019 {published data only}
    1. Reddy F, Glynn S, Green M. Group-augmented motivational interviewing + CBT for negative symptoms. Schizophrenia Bulletin 2019;45:118-9.
Rees 2015 {published data only}
    1. Rees CS, Hasking P, Breen LJ, Lipp OV, Mamotte C. Group mindfulness based cognitive therapy vs group support for self-injury among young people: study protocol for a randomised controlled trial. BMC Psychiatry 2015;15:154. - PMC - PubMed
Roncone 2004 {published data only}
    1. Roncone R, Mazza M, Frangou S, Risio A, Ussorio D, Tozzini C, et al. Rehabilitation of theory of mind deficit in schizophrenia: a pilot study of metacognitive strategies in group treatment. Neuropsychological Rehabilitation 2004;14:421-35.
Tan 2015 {published data only}
    1. Tan C, Ye H, Huang M, Zhang Y, Zhong L. The effect of cognitive behavioral intervention on patients with first episode schizophrenia [认知行为干预对首发精神分裂症患者的影响]. Qilu Nursing Journal 2015;21:36-8.
Tan 2016 {published data only}
    1. Tan Y. The effect of cognitive behavioral nursing therapy on the insight of schizophrenia [认知行为护理疗法对精神分裂症自知力的影响]. China Health and Nutrition 2016;1:51.
Tang 2007 {published data only}
    1. Tang X, Zou J, Lu X. Effect of cognitive-behavioral therapy on therapeutic effect of the first-episode schizophrenic patients during recovery period [对首发精神分裂症康复期患者实施认知行为干预的效果观察]. China Journal of Health Psychology 2007;15:588-9.
Tao 2016 {published data only}
    1. Tao Y. The effect of cognitive behavioral therapy on the social function of patients with schizophrenia during rehabilitation [认知行为疗法对康复期精神分裂症患者社会功能的影响]. Modern Chinese Doctor 2016;54:16-9.
Wang 2003 {published data only}
    1. Wang Y. The role of cognitive therapy to improve the understanding of schizophrenia and some capacity [认知治疗改善精神分裂症患者认识及 部分行为能力的作用]. Modern Rehabilitation 2003;7:91.
Wang 2004 {published data only}
    1. Wang H. Controlled study of cognitive behavioral psychological care for schizophrenia [认知行为心理护理对精神分裂症疗效的对照研究]. Chinese Clinical Medicine and Nursing 2004;5:10-1.
Wang 2012 {published data only}
    1. Wang C, An Q. The effect of cognitive behavioral therapy on the compliance behavior of patients with schizophrenia [认知行为治疗对精神分裂症患者遵医行为的影响]. Seek Medical Advice 2012;7:651.
Wang 2013 {published data only}
    1. Wang H, Chen Y, Xie W, Xiao B, Qiu C, Xie S. The effect of cognitive therapy on treatment compliance of outpatients with schizophrenia [认知治疗对门诊精神分裂症患者治疗依从性的影响]. Medical Journal of Chinese People's Health 2013;25:16-8.
Wang 2014 {published data only}
    1. Wang Z, Guo Z, Han G, Wang J, Li Z. The effect of cognitive behavioral therapy on patients with schizophrenia in the community [认知行为治疗对社区精神分裂症患者的疗效]. China Journal of Health Psychology 2015;23:16-9.
    1. Wang Z, Guo Z, Wang J, Yan G, Han G, Li Z. The impact of standardized cognitive behavioral therapy on the quality of life and social function of patients with residual schizophrenia in the community [规范化认知行为治疗对社区残留型精神分裂症患者生活质量和社会功能的影响]. Neurological Diseases and Mental Health 2014;14:495-6.
Wu 2008 {published data only}
    1. Wu N, Wang Q, Kong L. A controlled study of cognitive behaviour therapy in chronic schizophrenia [认知行为治疗慢性精神分裂症对照研究]. Journal of Clinical Psychosomatic Diseases 2008;14:206-7.
Wu 2013 {published data only}
    1. Wu L. Psychological intervention in patients with chronic schizophrenia and negative symptoms [心 理 干 预 在 慢 性 精 神 分 裂 症 阴 性 症 状 患 者]. Medical Journal of Chinese People's Health 2013;25:81-2.
Xia 2008 {published data only}
    1. Xia JX, Gao SN, Qing GX. The effect of cognitive treatment on compliance of patients with schizophrenia [认知治疗对精神分裂症患者服药依从性及复发的影响]. Chinese Journal of Prevention and Control of Chronic Non Communicable Diseases 2008;16:41-2.
Xie 2013 {published data only}
    1. Xie W, Xie Y, Xiao Y, Wang H, Xiao B. Schizophrenia patients multimedia to enhance the effect of cognitive intervention study [精神分裂症患者应用多媒体加强认知干预的效果研究]. Journal of Nursing 2013;20:57-9.
Yang 2010 {published data only}
    1. Yang C. Systemic cognitive intervention for first-episode schizophrenia patients: clinical observation of rehabilitation effect [系统化认知干预对首发精神分裂症患者 康复效果的临床观察]. Hebei Medical Journal 2010;32:417-8.
Zha 2015 {published data only}
    1. Zha W. The effect of cognitive insight therapy on medication compliance of patients with schizophrenia [认知领悟治疗对精神分裂症患者服药依从性的影响]. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine 2015;25:26-7.
Zhang 1999 {published data only}
    1. Zhang Z, Yao S. Controlled study on the role of cognitive psychotherapy in the remission of paranoid schizophrenia [认知治疗对偏执型精神分裂症患者]. Chinese Mental Health Journal 1999;13:174-5.
Zhang 2014 {published data only}
    1. Zhang Y. The effect of cognitive behavioral intervention on medication compliance of hospitalized vagrant patients with mental illness during the recovery period [认知行为干预对恢复期住院流浪精神病患者服药依从性的影响]. Medical Journal of Chinese People's Health 2014;26:117-8.
Zhang 2015a {published data only}
    1. Zhang J. The clinical experience of cognitive correction in the treatment of schizophrenia [认知矫正治疗精神分裂症的临床体会]. Modern diagnosis and treatment 2015;26:2054-5.
Zhang 2015b {published data only}
    1. Zhang Y. Effect of cognitive behavior on coping style in patients with schizophrenia [认知 行为治疗对精神分裂症患者应对方式的影响]. World Latest Medicine Information 2015;13:63.
Zhang 2015c {published data only}
    1. Zhang H. Nursing observation on cognitive psychotherapy of psychotic patients in rehabilitation period [康复期精神病患者认知心理治疗的护理观察]. World Latest Medicine Information 2015;15:191-4.
Zhao 2014 {published data only}
    1. Zhao S, Wang J. A comparative study of cognitive behavioral therapy in the rehabilitation of patients with chronic schizophrenia [认知行为治疗对慢性精神分裂症患者康复疗效的对照研究]. Chinese Disability Medicine 2014;22:209-10.

References to studies awaiting assessment

Brenner 1987 {published data only}
    1. Brenner HD, Hodel B, Kube G, Roder V. Cognitive therapy with schizophrenics: analysis of the problem and experimental results. Nervenarzt 1987;58:72-83. - PubMed
Chung 2001 {published data only}
    1. Chung YC, Kim JH, Eun HB, Hwang IK. Effect of cognitive-behavioral therapy on the delusion in schizophrenic patients. Journal of the Korean Neuropsychiatric Association 2001;40:63-71.
Classen 1993 {published data only}
    1. Classen W, Krajewski C, Boesken S. Cognitive and social processes during art (AT) or cognitive (CT) therapy and a simultaneous CT + AT therapy in schizophrenics. Verhaltenstherapie 1993;Suppl 1:A45.
    1. Classen W, Krajewski C, Boesken S. Comparison of art and cognitive therapy (IPT) with simultaneous cognitive and art therapy for schizophrenic patients regarding the change of cognitive processes. Pharmacopsychiatry 1993;26:171.
Klingberg 2001 {published data only}
    1. Klingberg S, Wiedemann G, Buchkremer G. Cognitive-behavioural therapy for schizophrenic patients – design and preliminary results of a randomised effectiveness trial. Zeitschrift Für Klinische Psychologie Und Psychotherapie 2001;30:259-67.
Kraemer 1987 {published data only}
    1. Kraemer S, Sulz KH, Schmid R, Lassle R. Cognitive therapy of schizophrenic patients: a control study. Nervenarzt 1987;58:84-90. - PubMed
McLeod 2007 {published data only}
    1. McLeod T, Morris M, Birchwood M, Dovey A. Cognitive behavioural therapy group work with voice hearers. Part 1. British Journal of Nursing 2007;16:248-52. - PubMed
    1. McLeod T, Morris M, Birchwood M, Dovey A. Cognitive behavioural therapy group work with voice hearers. Part 2. British Journal of Nursing 2007;16:292-5. - PubMed
Shafiei 2011 {published data only}
    1. Shafiei Amiri M, Ahmadi Gatab T, Babakhani N. The efficacy of cognitive-behavior group therapy and social skill trainings on reduction of negative symptoms of schizophrenic patients. European Psychiatry 2011;26(Suppl 2):1327.

References to ongoing studies

IRCT 20180817040818N {published data only}
    1. IRCT 20180817040818N. The effect of cognitive-behavioral group training of self-care skills on positive, negative symptoms, general psychopathology and self-care in patients with schizophrenia. en.irct.ir/trial/47632 (first received 25 July 2020). [IRANIAN REGISTRY OF CLINICAL TRIAL: IRCT20180817040818N2]
NCT04144075 {unpublished data only}
    1. NCT04144075. Application of a mindfulness and self-compassion program in patients with schizophrenia. Randomized controlled trial (ACAMP2020). clinicaltrials.gov/ct2/show/NCT04144075 (first received 30 October 2019). [CLINICALTRIALS.GOV: NCT04144075]

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