Cognitive behavioural therapy and the psychopathology of schizophrenia: Systematic review and meta-analysis

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Purpose.To examine whether cognitive behaviour therapy (CBT) reduces psychopathology in patients with schizophrenia more effectively than the use of non-cognitive psychotherapies.Method.Systematic review and meta-analysis of the literature was performed. All Randomized Controlled Trials meeting the inclusion criteria were analysed using RevMan software. This design was used to maximize power and study efficacy. Medline, PsycINFO, and Embase were searched using free-text keywords to identify potential papers. Nine were included in the final meta-analysis. Change in psychopathology at the end of therapy was the end point investigated. A random effects model was used to assess the standard mean difference between the CBT and supportive control groups.Results.Meta-analysis of CBT versus supportive therapy did not find significant differences between the therapy groups at the end of treatment in respect of psychopathology. There was no evidence of publication bias. Post hoc power analysis using the Z test ruled out type one error.Conclusions.Theoretically based CBT therapies, although proving effective, may not out perform more accessible and simpler forms of therapy for patients with schizophrenia in reducing psychopathology. Consideration of supportive therapy should be made for patients with psychotic mental disorder.Practitioner PointsCBT may not be the psychotherapeutic treatment of choice to alleviate the phenomenology of Schizophrenia.It may be valuable trialling simple supportive therapies prior to implementing more costly and complex cognitive therapies.This review, like the Cochrane review and others, does not suggest CBT in psychosis is not effective, simply that it dose not outperform supportive therapy in effecting change in phenomenology.

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