Objective:Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Method:Electronic databases were searched up to June 2009 using variants of the key words “cognitive,” “training,” “remediation,” “clinical trial,” and “schizophrenia.” Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted th...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2010.10060855

A Meta-Analysis of Cognitive Remediation for Schizophrenia: Methodology and Effect Sizes

BACKGROUND: Guidance in the United States and United Kingdom has included cognitive behavior therapy for psychosis (CBTp) as a preferred therapy. But recent advances have widened the CBTp targets to other symptoms and have different methods of provision, eg, in groups. AIM: To explore the effect sizes of current CBTp trials including targeted and nontargeted symptoms, modes of action, and effect of methodological rigor. METHOD: Thirty-four CBTp trials with data in the public domain were used as source data for a meta-analysis and investigation of the effects of trial methodology using the Clinical Trial Assessment Measure (CTAM). RESULTS: There were overall beneficial effects for the target symptom (33 studies; effect size = 0.400 [95% confidence interval [CI] = 0.252, 0.548]) as well as significant effects for positive symptoms (32 studies), negative symptoms (23 studies), functioning (15 studies), mood (13 studies), and social anxiety (2 studies) with effects ranging from 0.35 to 0.44. However, there was no effect on hopelessness. Improvements in one domain were correlated with improvements in others. Trials in which raters were aware of group allocation had an inflated effect size of approximately 50%-100%. But rigorous CBTp studies showed benefit (estimated effect size = 0.223; 95% CI = 0.017, 0.428) although the lower end of the CI should be noted. Secondary outcomes (eg, negative symptoms) were also affected such that in the group of methodologically adequate studies the effect sizes were not significant. CONCLUSIONS: As in other meta-analyses, CBTp had beneficial effect on positive symptoms. However, psychological treatment trials that make no attempt to mask the group allocation are likely to have inflated effect sizes. Evidence considered for psychological treatment guidance should take into account specific methodological detail.

http://www.reading.ac.uk/web/files/psychology/paper_4.pdf

Cognitive Behavior Therapy for Schizophrenia: Effect Sizes, Clinical Models, and Methodological Rigor

Schizophrenia, “just the facts” 4. Clinical features and conceptualization

Background. While there is a growing body of evidence on the efficacy of psychological interventions for schizophrenia, this meta-analysis improves upon previous systematic and meta-analytical reviews by including a wider range of randomized controlled trials and providing comparisons against both standard care and other active interventions. 

Method. Literature searches identified randomized controlled trials of four types of psychological interventions: family intervention, cognitive behavioural therapy (CBT), social skills training and cognitive remediation. These were then subjected to meta-analysis on a variety of outcome measures. This paper presents results relating to the first two.

Results. Family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication compliance. CBT produced higher rates of 'important improvement' in mental state and demonstrated positive effects on continuous measures of mental state at follow-up. CBT also seems to be associated with low drop-out rates.

Conclusions. Family intervention should be offered to people with schizophrenia who are in contact with carers. CBT may be useful for those with treatment resistant symptoms. Both treatments, in particular CBT, should be further investigated in large trials across a variety of patients, in various settings. The factors mediating treatment success in these interventions should be researched.

/pdf/psychological-treatments-in-schizophrenia-i-meta-analysis-of-4uma3ynsqp.pdf

Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy

Since publication of the original Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations in 1998, considerable scientific advances have occurred in our knowledge about how to help persons with schizophrenia. Today an even stronger body of research supports the scientific basis of treatment. This evidence, taken in its entirety, points to the value of treatment approaches combining medications with psychosocial treatments, including psychological interventions, family interventions, supported employment, assertive community treatment, and skills training. The most significant advances lie in the increased options for pharmacotherapy, with the introduction of second generation antipsychotic medications, and greater confidence and specificity in the application of psychosocial interventions. Currently available treatment technologies, when appropriately applied and accessible, should provide most patients with significant relief from psychotic symptoms and improved opportunities to lead more fulfilling lives in the community. Nonetheless, major challenges remain, including the need for (1) better knowledge about the underlying etiologies of the neurocognitive impairments and deficit symptoms that account for much of the disability still associated with schizophrenia; (2) treatments that more directly address functional impairments and that promote recovery; and (3) approaches that facilitate access to scientifically based treatments for patients, the vast majority of whom currently do not have such access.

The Schizophrenia Patient Outcomes Research Team (PORT): Updated Treatment Recommendations 2003

Background Cognitive—behavioural therapy (CBT) improves persistent psychotic symptoms.

Aims To test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia.

Method A 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM—IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded.

Results Linear regression over 70 days showed predicted trends towards faster improvement in the CBT group.

Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBT v . routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v . supportive counselling for auditory hallucinations score.

Conclusions CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.

/pdf/randomised-controlled-trial-of-cognitive-behavioural-therapy-1ufxrqmbcb.pdf

Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes.

Background The initial phase of a trial of cognitive-behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.

Aims To testthe hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.

Method This was an18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.

Results There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre-treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBTand supportive counselling. Medication dosage and compliance did not explain group differences.

Conclusions Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction.

/pdf/cognitive-behavioural-therapy-in-first-episode-and-early-5c2exd5sai.pdf

Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial

The evolution of symptoms in the early course of non-affective psychosis.

Are insight measures related to other symptoms in first episode schizophrenia

Summary statistics, showing mean outcomescores by scheduled visit, are shown in Ta-ble 3. Results of the main intention-to-treatregression analysis for the data at 70 daysare shown in Table 4. The main effect, at-tributable to the routine care shared by allthree treatment groups, is very large over s94Table 3 Observedmeanscoresforprimaryoutcomevariablesby treatmentgroupObservedmean scoresforprimaryoutcomevariablesby treatmentgroup VisitVisit Observed Observed MeanMean s.d.s.d. MinimumMinimum MaximumMaximumPANSStotalscoreCBTBasBaseelliinnee 101 87.4787.47 17.64 17.64 5454 129 129225 53370.8370.83 14.80 14.80 4646 110 110334 43367.6567.65 17.13 17.13 3636 119 119443 37761.65 11 1717.8.855 3838 111 111555 5226868..1122 21.3821.38 3636 123 123667 78861.7361.73 19.69 19.69 18 11218 112SupportivecounsellingBasBaseelliinnee 110606 8989.22.22 1177.5.533 4949 131311224 47774.6674.66 1717.0.055 4343 121 121334 4776868..1177 16.7916.79 39 10539 105443 33367.8267.82 17.99 17.99 3838 110 110556 64467.2567.25 18.52 18.52 3636 109 109667 71159.9659.96 16.39 16.39 37 11937 119Routine careRoutinecareBasBaseelliinnee 102 87.0187.01 16.81 16.81 52 14152 141225 58872.5072.50 16.38 16.38 4848 120 120335 5007700.28.28 18.3818.38 4040 126 126443 3777272..1111 19.0219.02 4242 107 107555 5997070..1155 21.4621.46 4040 133 133666 6006464..3388 16.7916.79 4242 115 115PANSSpositivesub-scalescoreCBTBasBaseelliinnee 101 23.54 4.93 14 36225 53317.04 4.76 883 344334 4331155.28.28 44..8787 662 288443 37713.19

Cliff Haley

Papers

Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes.

Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial

The evolution of symptoms in the early course of non-affective psychosis.

Are insight measures related to other symptoms in first episode schizophrenia

early schizophrenia: acute-phase outcomes Randomised controlled trial of cognitive—behavioural therapy in