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Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis.

Mehl S, Werner D, Lincoln TM - Front Psychol (2015)

Bottom Line: As a consequence, CBTp is recommended by national guidelines for all patients with schizophrenia.When compared with other interventions, there was no significant effect of CBTp at end-of-therapy (k = 8; [Formula: see text] 0.16) and after a follow-up period (k = 5; [Formula: see text]).Comparison between newer studies taking a causal-interventionist approach (k = 4) and first-generation studies showed a difference of 0.33 in mean effect sizes in favor of newer studies at end-of-therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, Philipps-University Marburg Marburg, Germany ; Department of Health and Social Work, Frankfurt University of Applied Science Frankfurt, Germany.

ABSTRACT
Cognitive Behavior Therapy for psychosis (CBTp) is an effective treatment resulting in small to medium effect sizes with regard to changes in positive symptoms and psychopathology. As a consequence, CBTp is recommended by national guidelines for all patients with schizophrenia. However, although CBTp was originally developed as a means to improve delusions, meta-analyses have generally integrated effects for positive symptoms rather than for delusions. Thus, it is still an open question whether CBTp is more effective with regard to change in delusions compared to treatment as usual (TAU) and to other interventions, and whether this effect remains stable over a follow-up period. Moreover, it would be interesting to explore whether newer studies that focus on specific factors involved in the formation and maintenance of delusions (causal-interventionist approach) are more effective than the first generation of CBTp studies. A systematic search of the trial literature identified 19 RCTs that compared CBTp with TAU and/or other interventions and reported delusions as an outcome measure. Meta-analytic integration resulted in a significant small to medium effect size for CBTp in comparison to TAU at end-of-therapy (k = 13; [Formula: see text] 0.27) and after an average follow-up period of 47 weeks (k = 12; [Formula: see text] 0.25). When compared with other interventions, there was no significant effect of CBTp at end-of-therapy (k = 8; [Formula: see text] 0.16) and after a follow-up period (k = 5; [Formula: see text]). Comparison between newer studies taking a causal-interventionist approach (k = 4) and first-generation studies showed a difference of 0.33 in mean effect sizes in favor of newer studies at end-of-therapy. The findings suggest that CBTp is superior to TAU, but is not superior to other interventions, in bringing about a change in delusions, and that this superiority is maintained over the follow-up period. Moreover, interventions that focus on causal factors of delusions seem to be a promising approach to improving interventions for delusions.

No MeSH data available.


Related in: MedlinePlus

Forest plot of effect sizes for the comparison between CBTp and treatment as usual (TAU) at end-of-therapy.
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Figure 2: Forest plot of effect sizes for the comparison between CBTp and treatment as usual (TAU) at end-of-therapy.

Mentions: Results of the comparisons between CBTp vs. TAU (k = 13 studies) at end-of-therapy are depicted in Figure 2 in form of a forest plot. The estimated mean effect size of CBTp was small to medium ( 0.27, SE = 0.10, p = 0.005) with a 95% confidence interval ranging from 0.08 to 0.47. The estimator of the between-study variance revealed an estimate of 0.05 (95% CI: 0.00 to 0.32), the Q-statistic was non-significant (Q = 20.46, df = 12, p = 0.059). The small to medium value of I2 = 42.1% indicates that approximately 42% of the observed variance in effect sizes might be due to heterogeneity. However, one study (Kråkvik et al., 2013) had an especially large influence on the amount of observed heterogeneity. If we exclude this study, the proportion of observed variance due to real differences in effect sizes drops to approximately 12% (I2 = 11,7%).


Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis.

Mehl S, Werner D, Lincoln TM - Front Psychol (2015)

Forest plot of effect sizes for the comparison between CBTp and treatment as usual (TAU) at end-of-therapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4593948&req=5

Figure 2: Forest plot of effect sizes for the comparison between CBTp and treatment as usual (TAU) at end-of-therapy.
Mentions: Results of the comparisons between CBTp vs. TAU (k = 13 studies) at end-of-therapy are depicted in Figure 2 in form of a forest plot. The estimated mean effect size of CBTp was small to medium ( 0.27, SE = 0.10, p = 0.005) with a 95% confidence interval ranging from 0.08 to 0.47. The estimator of the between-study variance revealed an estimate of 0.05 (95% CI: 0.00 to 0.32), the Q-statistic was non-significant (Q = 20.46, df = 12, p = 0.059). The small to medium value of I2 = 42.1% indicates that approximately 42% of the observed variance in effect sizes might be due to heterogeneity. However, one study (Kråkvik et al., 2013) had an especially large influence on the amount of observed heterogeneity. If we exclude this study, the proportion of observed variance due to real differences in effect sizes drops to approximately 12% (I2 = 11,7%).

Bottom Line: As a consequence, CBTp is recommended by national guidelines for all patients with schizophrenia.When compared with other interventions, there was no significant effect of CBTp at end-of-therapy (k = 8; [Formula: see text] 0.16) and after a follow-up period (k = 5; [Formula: see text]).Comparison between newer studies taking a causal-interventionist approach (k = 4) and first-generation studies showed a difference of 0.33 in mean effect sizes in favor of newer studies at end-of-therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, Philipps-University Marburg Marburg, Germany ; Department of Health and Social Work, Frankfurt University of Applied Science Frankfurt, Germany.

ABSTRACT
Cognitive Behavior Therapy for psychosis (CBTp) is an effective treatment resulting in small to medium effect sizes with regard to changes in positive symptoms and psychopathology. As a consequence, CBTp is recommended by national guidelines for all patients with schizophrenia. However, although CBTp was originally developed as a means to improve delusions, meta-analyses have generally integrated effects for positive symptoms rather than for delusions. Thus, it is still an open question whether CBTp is more effective with regard to change in delusions compared to treatment as usual (TAU) and to other interventions, and whether this effect remains stable over a follow-up period. Moreover, it would be interesting to explore whether newer studies that focus on specific factors involved in the formation and maintenance of delusions (causal-interventionist approach) are more effective than the first generation of CBTp studies. A systematic search of the trial literature identified 19 RCTs that compared CBTp with TAU and/or other interventions and reported delusions as an outcome measure. Meta-analytic integration resulted in a significant small to medium effect size for CBTp in comparison to TAU at end-of-therapy (k = 13; [Formula: see text] 0.27) and after an average follow-up period of 47 weeks (k = 12; [Formula: see text] 0.25). When compared with other interventions, there was no significant effect of CBTp at end-of-therapy (k = 8; [Formula: see text] 0.16) and after a follow-up period (k = 5; [Formula: see text]). Comparison between newer studies taking a causal-interventionist approach (k = 4) and first-generation studies showed a difference of 0.33 in mean effect sizes in favor of newer studies at end-of-therapy. The findings suggest that CBTp is superior to TAU, but is not superior to other interventions, in bringing about a change in delusions, and that this superiority is maintained over the follow-up period. Moreover, interventions that focus on causal factors of delusions seem to be a promising approach to improving interventions for delusions.

No MeSH data available.


Related in: MedlinePlus