This is not the most recent version of the article. View current version (13 APR 2011)
Intervention Review
Cognitive behaviour therapy for schizophrenia
Editorial Group: Cochrane Schizophrenia Group
Published Online: 20 JAN 2010
Assessed as up-to-date: 18 JUL 2004
DOI: 10.1002/14651858.CD000524.pub2
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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- Published Online: 20 JAN 2010
This is not the most recent version of the article.View current version (13 Apr 2011)
Abstract
Background
Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person's feelings and patterns of thinking which underpin distress.
Objectives
To review the effects of CBT for people with schizophrenia when compared to standard care, specific medication, other therapies and no intervention.
Search strategy
This 2004 update built on past work by searching the Cochrane Schizophrenia Groups' Register of Trials (January 2004). We inspected all references of the selected articles for further relevant trials.
Selection criteria
All relevant clinical randomised trials of cognitive behaviour therapy for people with schizophrenia-like illnesses.
Data collection and analysis
Studies were reliably selected and assessed for methodological quality. Two reviewers, working independently, extracted data. We analysed dichotomous data on an intention-to-treat basis and continuous data with 65% completion rate are presented. Where possible, for dichotomous outcomes, we estimated a relative risk (RR) with the 95% confidence interval (CI) along with the number needed to treat/harm (NNT/H).
Main results
30 papers described 19 trials. CBT plus standard care did not reduce relapse and readmission compared with standard care (long term 4 RCTs, n=357, RR 0.8 CI 0.5 to 1.5), but did decrease the risk of staying in hospital (1 RCT, n=62, RR 0.5 CI 0.3 to 0.9, NNT 4 CI 3 to 15). CBT helped mental state over the medium term (2 RCTs, n=123, RR No meaningful improvement 0.7 CI 0.6 to 0.9, NNT 4 CI 3 to 9) but after one year the difference was gone (3 RCTs, n=211, RR 0.95 CI 0.6 to 1.5). Continuous measures of mental state (BDI, BPRS, CPRS, MADRS, PAS) do not demonstrate a consistent effect.
When compared with supportive psychotherapy, CBT had no effect on relapse (1 RCT, n=59, RR medium term 0.6 CI 0.2 to 2; 2 RCTs, n=83, RR long term 1.1 CI 0.5 to 2.4). This also applies to the outcome of 'No clinically meaningful improvements in mental state' over the same time periods (1 RCT, n=59, RR medium term 0.8 CI 0.6 to 1.1; 2 RCT, n=100, RR long term 0.9 CI 0.8 to 1.1).
When CBT was combined with a psychoeducational approach there was no significant reduction of readmission rates relative to standard care alone (1 RCT, n=91, RR 0.9 CI 0.6 to 1.4).
Authors' conclusions
CBT is a promising but under evaluated intervention. Currently, trial-based data supporting the wide use of CBT for people with schizophrenia or other psychotic illnesses are far from conclusive. More trials are justified, especially in comparison with a lower grade supportive approach. These trials should be designed to be both clinically meaningful and widely applicable.
Plain language summary
Cognitive behaviour therapy for schizophrenia
Cognitive behavioural therapy (CBT) is one of the talking therapies that is suggested to be of value to people with schizophrenia. This review suggests that it may well be of value, at least in the short term. Cognitive behavioural therapy should be further evaluated in various clinical settings and comparing effects for both expert and less skilled practitioners.