Introduction
Methods
Study design and inclusion criteria
Search strategy
Screening and data extraction
Data analysis
Search strategy for PsycINFO |
1 exp Schizophrenia/ |
2 exp psychosis/ |
3 schizo$.mp |
4 or/1–3 |
5 exp psychotherapy/ or exp Behavior Therapy/ or exp Cognitive Therapy/ or exp PSYCHOANALYSIS/ or exp psychotherapeutic counseling/ or hypnosis/ or free association/ |
6 (abreaction or "acceptance and commitment therapy" or acting out or adlerian or analytical psychotherap$ or anger control or anger management or animal therap$ or art therap$ or assertive$ training or attention training technique or autogenic training or autosuggestion or aversion therap$ or balint group or befriending or behavio?r contracting or behavio?r modification or behavio?r regulation or behavio?r therap$ or bibliotherap$ or biofeedback or body psychotherap$ or brief psychotherap$ or caregiver support or cbt or client cent$ or cognitive behavio?r$ or cognitive intervention$ or cognitive rehabilit$ or cognitive remediation or cognitive technique$ or cognitive therap$ or cognitive treatment$ or colo?r therap$ or compassionate mind training or conjoint therap$ or contingency management or conversational therap$ or conversion therap$ or coping skills or counsel?ing or countertransference or couples therap$ or covert sensitization or crisis intervention or dance therap$ or dialectic$ or eclectic or emotion$ focus$ or emotional freedom technique or encounter group therap$ or existential therap$ or experiential psychotherap$ or exposure therap$ or expressive psychotherap$ or eye movement desensiti?ation or family intervention$ or family therap$ or feminist therap$ or free association or freudian or geriatric psychotherap$ or gestalt therap$ or griefwork or group intervention$ or group psychotherap$ or group therap$ or guided image$ or holistic psychotherap$ or humanistic psychotherap$ or hypnosis or hypnotherap$ or hypnoti?zability or imagery or implosive therap$ or individual psychotherap$ or insight therap$ or integrated psychological therapy or integrative psychotherap$ or integrative therap$ or interpersonal or jungian or kleinian or logotherap$ or marathon group therap$ or marital therap$ or meditation or mental healing or metacognitive therap$ or metacognitive training or milieu therap$ or mindfulness or morita therap$ or multimodal or music therap$ or narrative therap$ or nondirective therap$ or object relations or person cent$ therap$ or personal construct therap$ or persuasion therap$ or pet therap$ or play therap$ or primal therap$ or problem solving or psychoanaly$ or psychodrama or psychodynamic or psychoeducat$ or psychologic$ or psychological therap$ or psychosocial treatment or psychotherap$ or psychotherapeutic counsel$ or psychotherapeutic processes or psychotherapeutic training or psychotherapeutic treatment$ or rational emotive or reality therap$ or reciprocal inhibition or rehabilitat$ or relationship therap$ or relaxation or reminiscence therap$ or rogerian or role play$ or self analys$ or self esteem or sensitivity training or sex therap$ or sleep phase chronotherap$ or social skills education or social skills training or socioenvironmental therap$ or sociotherap$ or solution focused or stress management or support group$ or supportive therap$ or systematic desensiti?ation or systemic therap$ or therapeutic communit$ or transactional analysis or transference or transtheoretical or validation therap$ or (dream$ adj3 analys$) or (support adj3 psycho$)).mp |
7 or/5–6 |
8 ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).mp |
9 (random$ adj5 (assign$ or allocat$)).mp |
10 randomi$.mp |
11 crossover.mp |
12 or/8–11 |
13 4 and 7 and 12 |
Changes from protocol
Results
Characteristics of included studies
Overall study characteristics | Characteristics of patients | |
---|---|---|
Ahuir et al [83] | Country: Spain Study treatments (number of patients): Meta Cognitive Therapy (n = 14), Psychoeducation (n = 14) Trial duration: 8 weeks Treatment setting: group Number of sessions: 8 Study design: open label Risk of bias*: moderate Functioning scale: Personal and Social Performance scale (PSP) | Diagnosis: psychotic disorder (DSM-IV) Baseline severity: Positive and Negative Syndrome Scale (PANSS) positive symptoms 9.85 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Barrowclough et al [39] | Country: UK Study treatments (number of patients): cognitive behavior therapy (CBT) (n = 57), treatment as usual (TAU) (n = 56) Trial duration: 26 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 10.4 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Gender: 82 (73%) men, 31 women (27%) Mean age: 38.83 years Baseline severity: Positive and Negative Syndrome Scale (PANSS) total score: 63.8, positive symptoms 17.4, negative symptoms 14.1; Duration of illness: 13.67 years Only treatment resistant patients included: no |
Bradshaw [40] | Country: not available (author’s affiliation in the USA) Study treatments (number of patients): CBT (n = 12), day treatment program (n = 12) Trial duration: 156 weeks Treatment setting: individual Number of sessions: not available Study design: single blind Risk of bias: high Functioning scale: Role Functioning Scale | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Mean age: 32 years Duration of illness: 11 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Bozzatello et al [84] | Country: Italy Study treatments (number of patients): Art therapy (n = 30), Befriending (n = 32) Trial duration: 24 weeks Treatment setting: group Number of sessions: 24 Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) & Personal and Social Performance scale (PSP) | Diagnosis: schizophrenia spectrum disorder (DSM-V) Setting: outpatients Gender: 29 men, 25 women Mean age: 46.9 years Duration of illness: 18.8 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Cather et al [41] | Country: USA Study treatments (number of patients): CBT (n = 16), psychoeducation (n = 14) Trial duration: 16 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 15 Study design: single blind Risk of bias: high Functioning scale: Social Functioning Scale (SFS) | Diagnosis: schizophrenia or schizoaffective disorder, depressed type (DSM-IV) Setting: outpatients Gender: 17 (57%) men, 13 (43%) women Mean age: 40.4 years Baseline severity: PANSS total score 51.1, positive symptoms factor 13.53, negative symptoms factor 14.32; Duration of illness: 18 years Medication: 100% of CBT arm taking antipsychotics Only treatment resistant patients included: no |
Chadwick et al [42] | Country: UK Study treatments (number of patients): mindfulness (n = 11), wait-list (n = 11) Trial duration: 10 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 10 Study design: open label Risk of bias: high Functioning scale: Clinical Outcomes in Routine Evaluation | Diagnosis: psychotic disorder (criteria not available) Mean age: 41.6 years Duration of illness: 17.7 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Chien and Lee [43] | Country: Hongkong Study treatments (number of patients): mindfulness-based psychoeducation (n = 48), TAU (n = 48) Trial duration: 36 weeks Treatment setting: group Number of sessions: 12 Study design: single blind Risk of bias: high Functioning scale: Specific Levels of Functioning (SLOF) | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 53 (55%) men, 43 (45%) women Mean age: 25.9 years Baseline severity: Brief Psychiatric Rating Scale (BPRS) total score 63.35 Duration of illness: 3.1 years Medication: 84.375% taking antipsychotics Only treatment resistant patients included: no |
Chien and Thompson [44] | Country: Hongkong Study treatments (number of patients): mindfulness-based psychoeducation (n = 36), TAU (n = 35), psychoeducation (n = 36) Trial duration: 27 weeks Treatment setting: group Number of sessions: 12 Study design: single blind Risk of bias: high Functioning scale: Specific Levels of Functioning (SLOF) | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 61 (57%) men, 46 (43%) women Mean age: 25.63 years Baseline severity: BPRS-18 total score 31.40 Duration of illness: 2.6 years Medication: 87.85% taking antipsychotics Only treatment resistant patients included: no |
Chien et al [45] | Country: Hongkong Study treatments (number of patients): mindfulness-based psychoeducation (n = 114), TAU (n = 114), psychoeducation (n = 114) Trial duration: 24 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 12 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning (SLOF) | Diagnosis: schizophrenia and other psychotic disorders (DSM-IV) Setting: outpatients Gender: 216 (63%) men, 126 (37%) women Mean age: 25.63 years Baseline severity: PANSS total score 80.77, positive symptoms 20.23, negative symptoms 19.83 Duration of illness: 2.6 years Medication: 89.77% taking antipsychotics Only treatment resistant patients included: no |
Chien et al [85] | Country: China & Hong Kong Study treatments (number of patients): Mindfulness-based Psychoeducation Group Programme (MPGP) (n = 60), Conventional Psychoeducation Group Programme (CPGP) (n = 60), TAU (n = 60) Trial duration: 24 weeks Treatment setting: group Therapist expertise: experts only Number of sessions:12 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning (SLOF) | Diagnosis: Schizophrenia or its subtypes according to DSM-IV-TR Setting: outpatients Gender: 100 men, 80 women Mean age: 25–28 years Baseline severity: PANSS total score: 94.73, positive symptoms 27.67, negative symptoms 23.6 Duration of illness: 2.1–2.5 years Medication: 51.6% taking first generation antipsychotics, 28.3% taking second generation antipsychotics Only treatment resistant patients included: no |
Crawford et al [46] | Country: UK Study treatments (number of patients): art therapy (n = 140), activity group (n = 140), TAU (n = 137) Trial duration: 52 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 52 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia (clinical diagnosis) Setting: outpatients Gender: 279 (67%) men, 138 (33%) women Mean age: 41 years Baseline severity: PANSS total score 74.08, positive symptoms 17.84, negative symptoms 18.63 Duration of illness: 19.33 years Medication: 96% taking antipsychotics Only treatment resistant patients included: no |
De Jong et al. 2018 | Country: Netherlands Study treatments (number of patients): Metacognitive reflection and insight therapy (MERIT) (n = 35), treatment as usual (TAU) (n = 35) Trial duration: 40 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 40 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) | Diagnosis: Schizophrenia or schizoaffective disorder (DSM-IV-TR) Setting: NA Gender: 49 men, 21 women Mean age: 40 years Baseline severity: PANSS total score: 66.23 Duration of illness: 13.76 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
De Pinho et al. 2020 | Country: Portugal Study treatments (number of patients): Meta Cognitive Training (n = 27), treatment as usual (TAU) (n = 29) Trial duration: 4 weeks Treatment setting: group Therapist expertise: NA Number of sessions: 8 Study design: single blind Risk of bias: low Functioning scale: Personal and Social Performance scale (PSP) | Diagnosis: Schizophrenia (clinical diagnosis) Setting: unclear Gender: 30 men, 26 women Mean age: 50.48 years Baseline severity: NA Duration of illness: NA Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Durham et al [47] | Country: Scotland Study treatments (number of patients): CBT (n = 22), supportive therapy (n = 23), TAU (n = 21) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 20 Study design: single blind Risk of bias: high Functioning scale: Global Assessment Scale (GAS) | Diagnosis: schizophrenia, schizoaffective disorder, delusional disorder (ICD-10 and DSM-IV) Setting: inpatients and outpatients Gender: 45 (68%) men, 21 women (32%) Mean age: 36.3 years Baseline severity: PANSS total score 96.63, PSYRATS total 35.57 Duration of illness: 13 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Farhall et al [48] | Country: Australia Study treatments (number of patients): CBT (n = 45), TAU (n = 49) Trial duration: 52 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 17.05 Study design: open label Risk of bias: high Functioning scale: Life Skills Profile | Diagnosis: schizophrenia, schizoaffective disorder, delusional disorder, or mood disorder with psychotic features (DSM-IV) Setting: outpatients Gender: 54 (59%) men, 38 (41%) women Mean age: 32.85 years Baseline severity: PANSS total score 59.31, positive symptoms 14.63; negative symptoms 14.78 Medication: 90.43% taking antipsychotics Only treatment resistant patients included: no |
Fujii et al [95] | Country: Japan Study treatments (number of patients): Meta Cognitive Training (n = 11), Occupational Therapy (n = 11) Trial duration: 16 weeks Treatment setting: group Therapist expertise: NA Number of sessions: 16 Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: Schizophrenia according to DSM-V Setting: inpatients Gender: 10 men, 7 women Mean age: 54.25 years Baseline severity: PANSS total score 107.8, positive symptoms 25.75; negative symptoms 28.04 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Garety et al [49] (total sample) | Country: UK Study treatments (number of patients): CBT (n = 133), family intervention (n = 28), TAU (n = 140) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 14.3 (CBT), 13.9 (FI) Study design: single blind Risk of bias: moderate Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) | Diagnosis: non-affective psychosis (ICD-10 and DSM-IV) Setting: inpatients and outpatients Gender: 211 (70%) men, 90 (30%) women Mean age: 37.54 years Baseline severity: PANSS total score 65.16, positive symptoms 18.15, negative symptoms 13.27 Duration of illness: 10.8 years Only treatment resistant patients included: no |
Garety et al [49] (sample a) | Country: UK Study treatments (number of patients): CBT (n = 27), family intervention (n = 28), TAU (n = 28) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 13.9 Study design: single blind Risk of bias: moderate Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) | Diagnosis: non-affective psychosis (DSM-IV and ICD–10) Setting: inpatients and outpatients Gender: 60 (72%) men, 23 (28%) women Mean age: 36.4 years Baseline severity: PANSS total score 67.31, positive symptoms 17.16, negative symptoms 15.58 Duration of illness: 11.57 years Only treatment resistant patients included: no |
Garety et al [49] (sample b) | Country: UK Study treatments (number of patients): CBT (n = 106), TAU (n = 112) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 14.3 Study design: single blind Risk of bias: moderate Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) | Diagnosis: non-affective psychosis (DSM-IV and ICD–10) Setting: inpatients and outpatients Gender: 151 (69%) men, 67 (31%) women Mean age: 38.1 years Baseline severity: PANSS total score 64.29, positive symptoms 18.51, negative symptoms 12.38 Duration of illness: 10.4 years Only treatment resistant patients included: no |
Gottlieb et al [50] | Country: USA Study treatments (number of patients): CBT (n = 19), TAU (n = 18) Trial duration: 24 weeks Treatment setting: individual Number of sessions: 10 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning | Diagnosis: schizophrenia, schizoaffective disorder, or psychosis not otherwise specified diagnosis (NA) Setting: outpatients; 23 (62%) men, 14 women (38%) Mean age: 42.04 years Baseline severity: BPRS-24 total score 54.92, Psychotic Symptom Rating Scales (PSYRATS) 53.06, BPRS negative symptoms 6.23 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Granholm et al [51] | Country: USA Study treatments (number of patients): cognitive behavioural social skills training (CBSST) (n = 37), TAU (n = 39) Trial duration: 24 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 24 Study design: single blind Risk of bias: moderate Functioning scale: Independent Living Skills Survey (ILSS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 56 (74%) men, 20 (26%) women Mean age: 53.78 years Baseline severity: PANSS total score 53.37, positive symptoms 12.73, negative symptoms 14.66 Duration of illness: 29.23 years Medication: 87.5% taking antipsychotics Only treatment resistant patients included: no |
Granholm et al [52] | Country: USA Study treatments (number of patients): CBSST (n = 41), goal-focused supportive contact (n = 38) Trial duration: 36 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 30.3 (CBSST), 29.6 (goal-focused supportive contact) Study design: single blind Risk of bias: high Functioning scale: Independent Living Skills Survey (ILSS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 44 (56%) men, 35 (44%) women Mean age: 55 years Baseline severity: PANSS total score 64.63, positive symptoms 18.06 Medication: 94.94% taking antipsychotics Only treatment resistant patients included: no |
Granholm et al [53] | Country: USA Study treatments (number of patients): CBSST(n = 73), goal-focused supportive contact (n = 76) Trial duration: 36 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 12.2 (CBSST), 15.6 (goal-focused supportive contact) Study design: single blind Risk of bias: high Functioning scale: Independent Living Skills Survey (ILSS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 99 (66%) men, 50 (34%) women Mean age: 41.36 years Baseline severity: PANSS total score 72.42, positive symptoms 19.81 Duration of illness: 21.35 years Medication: 97.32% taking antipsychotics Only treatment resistant patients included: no |
Granholm et al [87] | Country: United States of America Study treatments (number of patients): Mobile-assisted CBSST (MA-CBSST) (n = 17), Cognitive-behavioral social skills training (CBSST) (n = 26), device contact-only (DC-only) (n = 14) Trial duration: 24 weeks Treatment setting: group Number of sessions: 24 Study design: single blind Risk of bias: high Functioning scale: Independent Living Skills Survey (ILSS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV-TR) per the Structured Clinical Interview for DSM-IV (SCID-I/P) Setting: outpatients Gender: 47 men, 10 women Mean age: 56.1 years Baseline severity: PANSS total score: 70.64, positive symptoms 18.39 Only treatment resistant patients included: no |
Grant et al [54] | Country: USA Study treatments (number of patients): cognitive therapy (n = 31), standard treatment (n = 29) Treatment setting: individual Trial duration: 18 months Number of sessions: 50.5 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment Scale (GAS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 40 (67%) men, 20 (33%) women Mean age: 38.46 years Baseline severity: Scale for the Assessment of Positive Symptoms (SAPS) score 17.33 Duration of illness: 15.52 years Only treatment resistant patients included: no |
Gurcan et al 2021 | Country: Turkey Study treatments (number of patients): Narrative therapy (n = 14), movie therapy (n = 14) Trial duration: 14 weeks Treatment setting: group Therapist expertise: trainee therapist allowed Number of sessions: 28 Study design: single blind Risk of bias: moderate Functioning scale: Social Functioning Scale (SFS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-V) Setting: outpatients Gender: 71,4% men, 28,6% women Mean age: 40.75 years Baseline severity: PANSS total score: 74.74, positive symptoms 16.06; negative symptoms 20.31 Duration of illness: 18.17 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Haddock et al [55] | Country: UK Study treatments (number of patients): CBT (n = 38), social activity therapy (n = 39) Trial duration: 26 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 17 (CBT), 17.4 (social activity therapy) Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-VI) Setting: inpatients and outpatients Gender: 66 (86%) men, 11 (14%) women Mean age: 34.8 years Baseline severity: PANSS total score 63.81, positive symptoms 27.6, negative symptoms 13.04 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Ishikawa et al 2019 | Country: Japan Study treatments (number of patients): TAU + MCT (Meta Cognitive Training) (n = 24), treatment as usual (TAU) (n = 26) Trial duration: 10 weeks Treatment setting: group Number of sessions: 10 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, schizotypal, and delusional disorders (ICD 10) Setting: inpatients & outpatients Gender: 25 men, 25 women Mean age: 47.5 years Baseline severity: positive symptoms 23.78 Duration of illness: 21.04 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Jenner et al [20] | Country: Netherlands Study treatments (number of patients): hallucination focused integrative treatment (n = 39), TAU (n = 39) Trial duration: 39 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 11 Study design: open label Risk of bias: high Functioning scale: Groningen Social Disabilities Schedule | Diagnosis: non-affective psychosis, including schizophrenia, schizoaffective or psychotic disorder not otherwise specified (DSM-IV) Setting: outpatients Gender: 41 (54%) men, 35 (46%) women Mean age: 36.35 years Baseline severity: PANSS total score 60.2, positive symptoms 16.05, negative symptoms 13.25 Only treatment resistant patients included: no |
Klingberg et al [57] | Country: Germany Study treatments (number of patients): CBT (n = 99), cognitive remediation (n = 99) Trial duration: 36 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 16.6 (CBT), 13.7 (cognitive remediation) Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 87 women (43.94%), 111 men (56.06%) Mean age: 36.9 years Baseline severity: PANSS total score 59.45, positive symptoms 10.5, negative symptoms 18.55 Duration of illness: 12.5 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Kråkvik et al [58] | Country: Norway Study treatments (number of patients): CBT (n = 23), wait-list (n = 22) Trial duration: 26 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 20 Study design: open label Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, schizoaffective disorder, or persistent delusional disorder (ICD-10) Setting: inpatients and outpatients Gender: 29 (64%) men, 16 (36%) women Mean age: 36.36 years Baseline severity: BPRS-24 score 49.49 Duration of illness: 10.9 years Only treatment resistant patients included: no |
Kuipers et al [59] | Country: UK Study treatments (number of patients): CBT and family intervention (n = 32), TAU (n = 27) Trial duration: 39 weeks Number of sessions: not available Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: any functional psychosis (OPCRIT) Setting: outpatients Gender: 45 (76%) men, 14 (24%) women Mean age: 27.8 years Baseline severity: PANSS total score 73.11, positive symptoms 17.39, negative symptoms 16.86 Only treatment resistant patients included: no |
Lee et al [60] | Country: Korea Study treatments (number of patients): group music therapy (n = 12), control (n = 12) Trial duration: 12 weeks Treatment setting: group Number of sessions: 18 Study design: not available Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 25 (75%) men, 5 (25%) women Mean age: 40.55 years Baseline severity: PANSS total score 94.5, positive symptoms 21.25, negative symptoms 23.2 Only treatment resistant patients included: no |
Li et al 2015 | Country: China Study treatments (number of patients): CBT (n = 96), supportive therapy (n = 96) Trial duration: 24 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 15 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) | Diagnosis: schizophrenia (DSM-IV) Setting: inpatients and outpatients Gender: 72 (38%) men, 120 (63%) women Mean age: 31.36 years Baseline severity: PANSS total score 72.6, positive symptoms 23.43, negative symptoms 20.4 Duration of illness: 8.21 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Lincoln et al [62] | Country: Germany Study treatments (number of patients): CBT (n = 40), TAU (n = 40) Trial duration: 38 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 28.9 (CBT), 2 (TAU) Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, schizoaffective disorder, delusional disorder, or brief psychotic disorder (DSM-IV) Setting: outpatients Gender: 45 (56%) men, 35 (44%) women Mean age: 33.15 years Baseline severity: PANSS total score 63.15, positive symptoms 14.95, negative symptoms 14.15 Duration of illness: 10.4 years Medication: 96.25% taking antipsychotics Only treatment resistant patients included: no |
Martin et al [63] | Country: Germany Study treatments (number of patients): dance and movement therapy and body psychotherapy (n = 44), TAU (n = 24) Trial duration: 10 weeks Treatment setting: group Therapist expertise: trainees allowed Number of sessions: 20 Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia spectrum disorder (ICD-10) Setting: outpatients Gender: 36 (53%) men, 32 (47%) women Mean age: 39.8 years Baseline severity: BPRS total score 38.16, SANS 25.03 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Matthews [64] | Country: USA Study treatments (number of patients): psychotherapy (n = 28), TAU (n = 14) Trial duration: 8 weeks Therapist expertise: experts only Number of sessions: 8 Study design: not available Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia (NA) Setting: outpatients Gender: 21 (50%) men, 21 (50%) women Mean age: 24.95 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Montag et al [65] | Country: Germany Study treatments (number of patients): psychodynamic art therapy (n = 29), TAU (n = 29) Trial duration: 6 weeks Number of sessions: 12 Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia (DSM-IV) Setting: inpatients Gender: 38 (72%) men, 15 (28%) women Mean age: 38.1 years Baseline severity: SAPS total score 60.15, Scale for the Assessment of Negative Symptoms (SANS) 45.6 Duration of illness: 12.6 years Only treatment resistant patients included: no |
Morrison et al [66] | Country: UK Study treatments (number of patients): cognitive therapy (n = 37), TAU (n = 37) Trial duration: 39 weeks Therapist expertise: experts only Number of sessions: 13.3 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) | Diagnosis: schizophrenia, schizoaffective disorder, or delusional disorder; diagnostic uncertainty in early phases of psychosis (Early intervention for psychosis service) (ICD-10 or PANSS) Gender: 39 (53%) men, 35 (47%) women Mean age: 31.32 years Baseline severity: PANSS total score 71.76, positive symptoms 20.98, negative symptoms 14.52; Medication: 0% taking antipsychotics Only treatment resistant patients included: no |
Morrison et al [90] | Country: United Kingdom Study treatments (number of patients): cognitive behavior therapy (CBT) (n = 242), treatment as usual (TAU) (n = 245) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: only expert therapists Number of sessions: 26 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) | Diagnosis: schizophrenia, schizoaffective disorder, or delusional disorder, or criteria for an Early Intervention for Psychosis service to allow for diagnostic uncertainty in early phases (ICD-10) Setting: inpatients and outpatients Gender: 349 men, 138 women Mean age: 42.5 years Baseline severity: PANSS total score: 83.05; positive symptoms 24.95; negative symptoms 19.35 Duration of illness: 19 years Medication: 91% taking antipsychotics Only treatment resistant patients included: yes |
Naeem et al [67] | Country: Canada Study treatments (number of patients): CBT (n = 18), TAU (n = 15) Trial duration: 16 weeks Treatment setting: individual Number of sessions: 14 Study design: single blind Risk of bias: low Functioning scale: (World Health Organization Disability Assessment Schedule) WHODAS 2.0 | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 17 (52%) men, 16 (48%) women Mean age: 40.45 years Baseline severity: PANSS total score 50.24, positive symptoms 13.54, negative symptoms 12.18 Only treatment resistant patients included: no |
Ochoa et al [68] | Country: Spain Study treatments (number of patients): metacognitive training (n = 65), psychoeducation (n = 57) Trial duration: 8 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 5.53 (metacognitive training), 4.95 (psychoeducation) Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, psychotic disorder not otherwise specified, delusional disorder, schizoaffective disorder, brief psychotic disorder, or schizophreniform disorder (DSM-IV-TR) Setting: outpatients Gender: 85 (70%) men, 37 (30%) women Mean age: 27.59 years Baseline severity: PANSS total score 54.33, positive symptoms 12.22, negative symptoms 14.63 Duration of illness: 2.29 years Only treatment resistant patients included: no |
Ozdemir and Budak 2022 | Country: Turkey Study treatments (number of patients): mindfulness-based stress reduction (MBSR) (n = 50), psychoeducation group (n = 50), control group (n = 56) Trial duration: 8 weeks Treatment setting: group Therapist expertise: only expert therapists Number of sessions: 8 Study design: open label Risk of bias: high Functioning scale: Functional Remission of General Schizophrenia (FROGS) scale | Diagnosis: schizophrenia (DSM-V) Setting: outpatients Gender: 106 men, 31 women Mean age: 43.77 years Duration of illness: 16.36 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Palma et al [22] | Country: Spain Study treatments (number of patients): Cognitive-Motivational Therapy (PIPE) (n = 35), Routine Care (n = 27) Trial duration: 52 weeks Treatment setting: individual & family Therapist expertise: expert only Number of sessions: 34 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: initial phase of schizophrenia (DSM-IV) Setting: inpatients & outpatients Gender: 46 men, 16 women Mean age: 25.5 years Baseline severity: PANSS total score: 104, positive symptoms 38,8, negative symptoms 30,7 Duration of illness: 1 year Only treatment resistant patients included: no |
Penadés et al [69] | Country: Spain Study treatments (number of patients): CBT (n = 20), cognitive remediation (n = 20) Trial duration: 16 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 40 Study design: single blind Risk of bias: moderate Functioning scale: Life Skills Profile | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 23 men (57.5%), 17 women (42.5%) Mean age: 35.1 years Baseline severity: PANSS score 66.99, positive symptoms 11.27, negative symptoms 20.17 Duration of illness: 13.8 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Penn et al [70] | Country: USA Study treatments: CBT (n = 32), supportive therapy (n = 33) Trial duration: 12 weeks Treatment setting: group Number of sessions: 8.3 Study design: single blind Risk of bias: low Functioning scale: Social Functioning Scale (SFS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 33 (51%) men, 32 (49%) women Mean age: 40.65 years Baseline severity: PANSS total score 61.75, positive symptoms 17.55, negative symptoms 13.9 Duration of illness: 15.4 years Only treatment resistant patients included: no |
Pos et al [92] | Country: Netherlands Study treatments (number of patients): CBTsa (Social Activation) (n = 49), TAU (n = 50) Trial duration: 12 weeks Treatment setting: group & individual Therapist expertise: experts only Number of sessions: 14 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia or a related disorder with onset of their first psychotic episode 4 years prior to inclusion (DSM-IV-TR) Setting: inpatients & outpatients Gender: male 80, female 19 Mean age: 25.43 years Baseline severity: NA Duration of illness: NA Medication: 91.7% taking antipsychotics Only treatment resistant patients included: no |
Pot-Kolder et al [26] | Country: Netherlands Study treatments (number of patients): virtual-reality exposure therapy for psychosis (n = 58), wait-list (n = 58) Trial duration: 12 weeks Number of sessions: 16 Study design: single blind Risk of bias: low Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) | Diagnosis: psychotic disorder (DSM-IV) Gender: 82 (71%) men, 34 (29%) women Mean age: 38 years Duration of illness: 14.1 years Medication: 95.5% taking antipsychotics Only treatment resistant patients included: no |
Richardson et al [72] | Country: UK Study treatments (number of patients): art therapy (n = 43), TAU (n = 47) Trial duration: 12 weeks Treatment setting: group Number of sessions: 12 Study design: open label Risk of bias: high Functioning scale: Social Functioning Scale (SFS) | Diagnosis: chronic schizophrenia (NA) Setting: outpatients Gender: 59 (66%) men, 31 (34%) women Mean age: 41.17 years Baseline severity: BPRS total score 15.57, SANS 8.44 Only treatment resistant patients included: no |
Schrank et al [73] | Country: UK Study treatments (number of patients): group psychotherapy (n = 47), TAU (n = 47) Trial duration: 11 weeks Treatment setting: group Number of sessions: 7 Study design: open label Risk of bias: high Functioning scale: Health of the Nation Outcome Scale | Diagnosis: diagnosis of psychosis defined as schizophrenia and other psychoses including schizoaffective and delusional disorder but not depressive psychosis or psychosis due to substance misuse (clinical diagnosis) Setting: inpatients and outpatients Gender: 56 (60%) men, 38 (40%) women Mean age: 42.5 years Baseline severity: BPRS-18 total score 32.14 Duration of illness: 13.5 years Only treatment resistant patients included: no |
Shawyer et al [74] | Country: Australia Study treatments (number of patients): CBT (n = 21), befriending (n = 22) Trial duration: 15 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 14.3 (CBT), 14.4 (Befriending) Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia or related condition (DSM-IV) Gender: 24 (56%) men, 19 (44%) women Mean age: 39.8 years Baseline severity: PANSS total score 62.89, positive symptoms 15.99, negative symptoms 14.15 Duration of illness: 14.71 years Only treatment resistant patients included: no |
Shawyer et al [75] | Country: Australia Study treatments (number of patients): acceptance and commitment therapy (n = 49), befriending (n = 47) Trial duration: 13 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 7 Study design: single blind Risk of bias: low Functioning scale: Social Functioning Scale (SFS) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV-TR) Setting: outpatients Gender: 59 (61%) men, 37 (39%) women Mean age: 34.3 years Baseline severity: PANSS total score 78.25, positive symptoms 21.8, negative symptoms 18 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Startup et al [76] | Country: UK Study treatments (number of patients): CBT (n = 47), TAU (n = 43) Trial duration: 26 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 12.9 Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, schizophreniform, schizoaffective (DSM-IV) Setting: inpatients Gender: 68 (76%) men, 22 (24%) women Mean age: 30.8 years Baseline severity: BPRS-16 total score 45.75, SAPS positive symptoms 10.7, SANS negative symptoms 8.9; Duration of illness: 6.95 years Only treatment resistant patients included: no |
Talwar et al [77] | Country: UK Study treatments (number of patients): music therapy (n = 33), TAU (n = 48) Trial duration: 12 weeks Treatment setting: individual Number of sessions: 8 Study design: single blind Risk of bias: low Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, or schizophrenia-like psychoses (ICD-10) Setting: inpatients Gender: 60 (74%) men, 21 (26%) women Mean age: 37.36 years Baseline severity: PANSS total score 71.72, positive symptoms 16.36, negative symptoms 19.20 Only treatment resistant patients included: no |
Tarrier et al [78] | Country: UK Study treatments: CBT (n = 25), TAU (n = 24) Trial duration: 16 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 24 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder or psychotic disorder not otherwise specified (DSM-IV) Gender: 31 (63%) men, 18 (37%) women Mean age: 34.9 years Baseline severity: PANSS total score 60.12, positive symptoms 15.44, negative symptoms 13.29 Medication: 100% taking antipsychotics O Only treatment resistant patients included: no |
Valencia et al]. [79] | Country: Mexico Study treatments (number of patients): music therapy (n = 18), psychosocial therapy (n = 18), multiple therapies (n = 18) Trial duration: 26 weeks Number of sessions: 44 (MT), 44 (PST), 108 (MultipleT) Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 33 (77%) men, 10 (23%) women Mean age: 30.5 years Duration of illness: 8.13 years Medication: 100% taking antipsychotics Only treatment resistant patients included: yes |
van der Gaag et al [80] | Country: Netherlands Study treatments (number of patients): CBT (n = 110), TAU (n = 106) Treatment setting: individual Trial duration: 26 weeks Number of sessions: 13 Study design: single blind Risk of bias: high Functioning scale: Social Functioning Scale (SFS) | Country: schizophrenia or schizoaffective disorder (DSM-IV-TR) Gender: 153 (71%) men, 63 (29%) women Mean age: 36.99 years Baseline severity: PANSS total score 69.3, PSYRATS total 31.35 Duration of illness: 10.58 years Only treatment resistant patients included: no |
Wang et al [81] | Country: Hong Kong Study treatments (number of patients): mindfulness-based psychoeducation (n = 46), psychoeducation (n = 46), TAU (n = 46) Trial duration: 26 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 12 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning (SLOF) | Diagnosis: schizophrenia or its subtypes (DSM-IV-TR) Setting: outpatients Gender: 72 (52%) men, 66 (48%) women Mean age: 24.3 years Baseline severity: PANSS total score 87.93, positive symptoms 26.57, negative symptoms 18.3 Duration of illness: 2.03 years Medication: 85.51% taking antipsychotics Only treatment resistant patients included: no |
Wykes et al [82] | Country: UK Study treatments (number of patients): CBT (n = 45), TAU (n = 40) Trial duration: 10 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 7 Study design: open label Risk of bias: high Functioning scale: Social Behaviour Schedule | Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 50 (59%) men, 35 (41%) women Mean age: 39.7 years Baseline severity: PSYRATS hallucination score 27.95 Only treatment resistant patients included: no |
Yildiz et al. [93] | Country: Turkey Study treatments (number of patients): Psychosocial Skills Training (PST) (n = 10), Meta Cognitive Training (MCT) (n = 10) Trial duration: 20 weeks Treatment setting: group Therapist expertise: only expert Number of sessions: 40 Study design: single blind Risk of bias*: moderate Functioning scale: Global Assessment of Functioning (GAF) | Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 13 men, 7 women Mean age: 35.25 years Baseline severity: PANSS total score: 81.85 Duration of illness: 13.4 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
Acceptance and commitment therapy (ACT) | A manualized cognitive behavior therapy (Hayes et al. 2003, p. 79) that focuses more on the patient’s relation to distressing symptoms than on the symptoms themselves. It encourages patients to be mindful of and accept instead of try and avoid negative experiences, such as distressing voices. At the same time, it is a goal to take value-guided action to enable positive change in spite of the difficulties the patients face1 |
Activity group ( inactive control) | Activity groups are used as control groups in the trial Crawford and colleagues conducted. They aim to control for potential effects of the group setting also used in group art therapy. Lead by a group facilitator, the patients engage together in different activities varying from watching films to visiting local cafés. Psychological techniques as well as art materials are not employed2 |
Art therapy | In art therapy, patients express their inner experience spontaneously and freely in a creative process using different art materials. Then, they get the possibility to share and discuss their pictures helped by interventions of an art therapist2,3 |
Befriending ( inactive control) | A manualized treatment designed to control for the therapist’s attention and the patient’s treatment expectancy. It includes conversation about everyday topics and, if conversation is too difficult to attain, neutral activities that do not provoke fear or negative emotions. For talking about symptoms and problems, the patient is referred to the treating clinician4 |
Cognitive-behavioral social skills training ( CBT) | An intervention integrating cognitive behavioral techniques and strategies from social skills training to help patients challenge their thoughts, ask for help in an appropriate way and problem-solve, tailored to the specific needs of patients suffering from schizophrenia5 |
Cognitive behavior therapy (CBT) | A widely spread therapy approach aimed at changing thought processes and behavior. Initially, a stable therapeutic relationship is to be built. The following treatment includes identifying dysfunctional cognitive and behavioral patterns, setting distinct and reachable therapy goals together and replacing dysfunctional patterns step by step with healthier ones. CBT for psychosis focusses especially on dealing with disturbing hallucinations and delusional thoughts as well as the identification of negative belief systems and the development of healthy coping strategies6 |
Cognitive remediation | Applying the principles of errorless learning and immediate positive feedback, executive functioning, attention and memory are trained using techniques for structuring of information, verbalization and self-instruction7 |
Cognitive therapy ( CBT) | An individualized goal-directed therapy approach aiming to motivate the patient to work on realistic long- and short-term goals. Dysfunctional believes are replaced by more functional ones using cognitive and behavioral strategies. Techniques introduced and practiced during the sessions are consolidated with homework for the patient to do between the sessions8 |
Creative therapy | This term summarizes therapies that give patients the possibility to express themselves in a creative way, for example through art, music or body movement. For more detailed information about the treatments that are considered creative therapy, see their descriptions in this table |
Dance and movement therapy and body psychotherapy | See movement therapy |
Day treatment program ( TAU) | A psychiatric service provided for a longer period of time to persons with serious and chronic psychiatric conditions. It entails medication management and different group interventions9 |
Family intervention | An intervention that aims at improving communication and problem-solving skills in the families of schizophrenic patients. There are psychoeducational elements to enable a better understanding of the patients. On top of that, the patient and the relatives get the possibility to discuss and resolve conflicts with the help of a professional and work through difficult emotions that arise as a consequence of the disease10 |
Goal-focused supportive contact ( inactive control) | Designed to control for frequency and amount of contact to the therapist and other group members, this intervention gives patients the opportunity to formulate goals and work on them through group discussion without specific therapist guidance11 |
Hallucination focused integrative treatment | This is a combination treatment containing psychoeducational, cognitive-behavioral, coping-oriented as well as family interventions and rehabilitative elements added to antipsychotic medication. The main purpose is to cope better with hallucinations12 |
Inactive control | This term is utilized for any treatment that serves as a control condition regarding non-specific factors such as the therapist’s attention, for example “activity group”, “befriending”, “social activity therapy” or “supportive counselling” which are also described in this table13 |
Integrated therapies | Under this term, treatments that combine multiple fundamentally different therapeutic strategies, for example music therapy, family intervention or behavioral therapy, are subsumed |
Metacognitive training | A structured group intervention aimed at dismantling cognitive biases that contribute to psychotic exacerbations. There are multiple modules with different specific targets such as showing the importance of collecting enough information before making assumptions, strengthening theory of mind or also handling affective symptoms14 |
Metacognitive reflection and insight therapy (MERIT) ( metacognitive training) | This therapy aims to stimulate the four metacognition elements (self-reflectivity, understanding the other’s mind, decentration, and mastery) and focuses on adjusting level of metacognition of the patient during the session rather than providing a step-by-step intervention28 |
Mindfulness | A third-wave cognitive and experiential approach aimed at enabling a different pattern of relating to psychotic experiences such as thoughts, images and hallucinations. Core element are guided meditation sessions in which patients are motivated to focus on bodily sensations and their breath and bring a gentle attention to distressing symptoms. The aim is not to eliminate distressing sensations, but to alleviate distress that is generated by dysfunctional ways of relating to them. Mindfulness meditation integrated with discussion in a cognitive frame is believed to bring about metacognitive insights that enhance the process of relating more functionally to psychotic experiences15,16 |
Mindfulness-based psychoeducation ( mindfulness) | Its aim is to increase the patient’s comprehension of schizophrenia and their illness insight as well as helping them to manage and accept their symptoms. Patients are taught to recognize and respond in a less-involved way to their emotions, cognitions and perceptions instead of seeing them as exact representations of reality17 |
Movement therapy | Movement therapy is a therapy form that aims at alleviating psychotic symptoms using body-oriented exercises. These can focus on perception of sensation on the one hand as well as on an active and expressive bodily movement on the other hand. Feeling and moving the body are used to enable the patients to develop a more embodied sense of self, a broader range of communicative behaviors and a more differentiated understanding and expression of their emotions18 |
Movie therapy ( inactive control) | A therapy that screens the 2–3-min videos on different topics showing the people interact each other and reflecting certain emotion theme such as basic emotions (fear and happiness) and complex emotions (jealousy, disappointment, etc.). This movie therapy allows the patients to follow three stages which first the video sections are watched without interruption and the group therapist will ask the patient how they interpret the scenes. In the second stage, the group therapist will pause the video sections to allow the patients to collect the social clues such as place, time, facial expressions, voice tones, etc. Finally, the patients discuss the social clues they have picked up29 |
Music therapy | An intervention that uses music to tackle psychotic symptoms. It can take place either individually or in a group setting. Usually, patients are encouraged to express themselves spontaneously by improvising on musical instruments. Therapeutic interventions can entail accompanying the patients’ music, helping them to vary the course of the music and interpreting the music together through discussion19 |
Narrative therapy | Narrative therapy is an intervention that helps patients to collect their life events, experiences, and memories, as well as understand other people’s thoughts and feelings to gain new insights and perspectives. There are four stages during the sessions. At the first stage, the patients will share their stories without interruption after the group therapist reviewed the narrative before the session begins. The second and third stage will be about responding to the narrative by asking several questions and it is also important to ask the patient’s emotions during the event and ensure that the patient feel accepted of what other people might have thought and felt. The last stage aims to gain an insight and perspective from other patients29 |
PIPE (Psychoeducation, CBT, motivational intervention) | This is a combination therapy consisting of psychoeducation, individual CBT & family cognitive-motivational therapy. The aims to treat the patient’s ideas and hallucination and to ensure the family can adapt to the illness and provide the optimal support and environment for the sake of patient’s recovery30 |
Psychotherapy not further specified | A therapy is considered not specified, if no further information is given about the specific form of psychological treatment, for example in the study undertaken by Matthews in 1981, where it was only mentioned that the patients received “psychotherapy”, but no details were given |
Positive psychotherapy | Using different exercises, patients shall be encouraged to make positive experiences, enhance their personal strengths and interpersonal relationships and get a more meaningful perspective on their lives20 |
Psychodynamic therapy | Patients get the opportunity to describe the narratives of their lives. By doing so, they can make sense of the timing and nature of the illness and how it is related to strong and unbearable affects in their past personal history. Furthermore, transference phenomena in the therapeutic relationship can be described and worked through24 |
Psychoeducation | Psychoeducation is meant to teach patients about different aspects of their disease and its management. Topics vary from explanation models of disease development to the rationale for medication and different coping strategies as well as noticing and understanding warning signs for relapses21 |
Psychosocial therapy | Psychosocial therapy is an intervention based on social skills training with the aim to give patients behavioral alternatives that enrich their existing behavioral strategies. The focus lies on five areas: occupation, economical aspects and relationships with friends, partners and family22 |
Social activity therapy ( inactive control) | Social activity therapy has the goal to support patients in finding activities they like doing and taking steps to actually engage in them23 |
Standard treatment ( TAU) | See “Treatment as usual” |
Supportive therapy | In supportive therapy, a safe environment is created in which patients can talk about their problems24. The therapists support the patients emotionally without giving symptom specific interventions. More importance is given to non-specific therapeutic factors such as empathic attitude and creating a reliable therapeutic alliance25 |
Third-wave cognitive behavioral therapy | If described as waves, the first wave of CBT consists in the strictly behavioral approach and the second is characterized by the implementation of a cognitive model. In the current third wave, an emphasis is put on metacognition and how the patient relates to thoughts and emotions. Examples for third-wave therapies are dialectical behavior therapy, acceptance and commitment therapy (ACT), mindfulness-based treatments, metacognitive therapy and several others27 |
Treatment as usual (TAU) | Patients assigned to this group get the usual psychiatric care. What it exactly entails depends on the local guidelines. Usually, patients are offered medication and regular visits to doctors and nurses to talk about current issues13 |
Virtual-reality exposure therapy for psychosis ( CBT) | A cognitive behavior therapy using a virtual-reality environment for exposure exercises for fear and paranoia provoking social situations26 |
Wait-list | If patients get assigned to the wait-list, this means that they get informed that there is a possible treatment, but they cannot yet engage in it. They can only get that specific treatment after waiting some weeks13 |
Risk-of-bias assessment
All psychological interventions compared to all control conditions (primary analysis)
Certainty assessment | No of patients | Effect | Certainty | Importance | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
No of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Psychological interventions | Control conditions | Relative (95% CI) | Absolute (95% CI) | ||
Functioning | ||||||||||||
58 | Randomized trials | Seriousa | Seriousb | Not serious | Not serious | Publication bias strongly suspectedc | 2323 | 2725 | – | SMD 0.37 SD lower (0.49 lower to 0.25 lower) | ⨁◯◯◯ Very low |
Groups of psychological interventions and specific psychological interventions compared to control conditions
CBT versus control
Third-wave cognitive behavior therapies versus control
Creative therapies versus control
Integrated therapies versus control
Other therapies versus control
Subgroup analyses
Treatment setting: individual versus group
Therapist expertise: trainee therapist allowed vs only expert therapists
Metaregression analyses
Moderator | Coefficient | 95% CI | Z value | P value |
---|---|---|---|---|
Number of sessions | 0.0047 | – 0.0071; 0.0164 | 0.7811 | 0.4347 |
Study duration | – 0.0063 | – 0.0136; 0.0010 | – 1.6950 | 0.0901 |
Mean age | 0.0222 | 0.0060; 0.0383 | 2.6892 | 0.0072 |
Male percentage | 0.0077 | – 0.0031; 0.0184 | 1.3930 | 0.1636 |
Baseline severity | – 0.0080 | – 0.0182; 0.0022 | – 1.5364 | 0.1244 |