Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-14T23:21:55.184Z Has data issue: false hasContentIssue false
  • English
  • Français

Adapted cognitive–behavioural therapy required for targeting negative symptoms in schizophrenia: meta-analysis and meta-regression

Published online by Cambridge University Press:  22 May 2014

E. Velthorst ,
M. Koeter ,
M. van der Gaag ,
D. H. Nieman ,
A.-K. J. Fett ,
F. Smit ,
A. B. P. Staring ,
C. Meijer  and
L. de Haan
E. Velthorst*
Affiliation:
Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
M. Koeter
Affiliation:
Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands Program for Mood Disorders, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands
M. van der Gaag
Affiliation:
Parnassia Psychiatric Institute, The Hague, The Netherlands Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
D. H. Nieman
Affiliation:
Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
A.-K. J. Fett
Affiliation:
Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands Department of Educational Neuroscience, Faculty of Psychology and Education, VU University of Amsterdam, Amsterdam, The Netherlands Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
F. Smit
Affiliation:
Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
A. B. P. Staring
Affiliation:
Altrecht Psychiatric Institute, Utrecht, The Netherlands
C. Meijer
Affiliation:
Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
L. de Haan
Affiliation:
Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
*
*Address for correspondence: E. Velthorst, Academic Medical Center, Department of Early Psychosis, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There is an increasing interest in cognitive–behavioural therapy (CBT) interventions targeting negative symptoms in schizophrenia. To date, CBT trials primarily focused on positive symptoms and investigated change in negative symptoms only as a secondary outcome. To enhance insight into factors contributing to improvement of negative symptoms, and to identify subgroups of patients that may benefit most from CBT directed at ameliorating negative symptoms, we reviewed all available evidence on these outcomes.

Method

A systematic search of the literature was conducted in PsychInfo, PubMed and the Cochrane register to identify randomized controlled trials reporting on the impact of CBT interventions on negative symptoms in schizophrenia. Random-effects meta-analyses were performed on end-of-treatment, short-term and long-term changes in negative symptoms.

Results

A total of 35 publications covering 30 trials in 2312 patients, published between 1993 and 2013, were included. Our results showed studies’ pooled effect on symptom alleviation to be small [Hedges’ g = 0.093, 95% confidence interval (CI) −0.028 to 0.214, p = 0.130] and heterogeneous (Q = 73.067, degrees of freedom = 29, p < 0.001, τ2 = 0.081, I2 = 60.31) in studies with negative symptoms as a secondary outcome. Similar results were found for studies focused on negative symptom reduction (Hedges’ g = 0.157, 95% CI −0.10 to 0.409, p = 0.225). Meta-regression revealed that stronger treatment effects were associated with earlier year of publication, lower study quality and with CBT provided individually (as compared with group-based).

Conclusions

The co-occurring beneficial effect of conventional CBT on negative symptoms found in older studies was not supported by more recent studies. It is now necessary to further disentangle effective treatment ingredients of older studies in order to guide the development of future CBT interventions aimed at negative symptom reduction.

Keywords

Cognitive–behavioural therapypsychosisrandomized controlled trials
Type
Review Articles
Information
Psychological Medicine , Volume 45 , Issue 3 , February 2015 , pp. 453 - 465
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arango, C, Garibaldi, G, Marder, SR (2013). Pharmacological approaches to treating negative symptoms: a review of clinical trials. Schizophrenia Research 150, 346–352.Google Scholar
Baker, A, Bucci, S, Lewin, TJ, Kay-Lambkin, F, Constable, PM, Carr, VJ (2006). Cognitive–behavioural therapy for substance use disorders in people with psychotic disorders: randomised controlled trial. British Journal of Psychiatry 188, 439–448.Google Scholar
Barrowclough, C, Haddock, G, Lobban, F, Jones, S, Siddle, R, Roberts, C, Gregg, L (2006). Group cognitive–behavioural therapy for schizophrenia. Randomised controlled trial. British Journal of Psychiatry 189, 527–532.CrossRefGoogle ScholarPubMed
Barrowclough, C, Haddock, G, Tarrier, N, Lewis, SW, Moring, J, O'Brien, R, Schofield, N, McGovern, J (2001). Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry 158, 1706–1713.Google Scholar
Bechdolf, A, Knost, B, Kuntermann, C, Schiller, S, Klosterkötter, J, Hambrecht, M, Pukrop, R (2004). A randomized comparison of group cognitive–behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatrica Scandinavica 110, 21–28.Google Scholar
Begg, CB, Mazumdar, M (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088–1101.Google Scholar
Blanchard, JJ, Kring, AM, Horan, WP, Gur, R (2011). Toward the next generation of negative symptom assessments: the collaboration to advance negative symptom assessment in schizophrenia. Schizophrenia Bulletin 37, 291–299.Google Scholar
Borenstein, M, Hedges, LV, Higgins, JPT, Rothstein, HR (2009). Introduction to Meta-Analysis. Wiley: Chichester.Google Scholar
Cather, C, Penn, D, Otto, MW, Yovel, I, Mueser, KT, Goff, DC (2005). A pilot study of functional cognitive behavioral therapy (fCBT) for schizophrenia. Schizophrenia Research 74, 201–209.Google Scholar
Daniels, L (1998). A group cognitive–behavioral and process-oriented approach to treating the social impairment and negative symptoms associated with chronic mental illness. Journal of Psychotherapy Practice and Research 7, 167–176.Google ScholarPubMed
Duval, S, Tweedie, R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463.CrossRefGoogle ScholarPubMed
Farhall, J, Freeman, NC, Shawyer, F, Trauer, T (2009). An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis. British Journal of Clinical Psychology 48, 47–62.Google Scholar
Gard, DE, Kring, AM, Gard, MG, Horan, WP, Green, MF (2007). Anhedonia in schizophrenia: distinctions between anticipatory and consummatory pleasure. Schizophrenia Research 93, 253–260.Google Scholar
Garety, PA, Fowler, DG, Freeman, D, Bebbington, P, Dunn, G, Kuipers, E (2008). Cognitive–behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. British Journal of Psychiatry 192, 412–423.Google Scholar
Gaudiano, BA, Herbert, JD (2006). Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy: pilot results. Behaviour Research and Therapy 44, 415–437.Google Scholar
Granholm, E, Ben-Zeev, D, Link, PC (2009). Social disinterest attitudes and group cognitive–behavioral social skills training for functional disability in schizophrenia. Schizophrenia Bulletin 35, 874–883.Google Scholar
Granholm, E, Holden, J, Link, PC, McQuaid, JR, Jeste, DV (2013). Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: defeatist performance attitudes and functional outcome. American Journal of Geriatric Psychiatry 21, 251–262.Google Scholar
Granholm, E, McQuaid, JR, McClure, FS, Auslander, LA, Perivoliotis, D, Pedrelli, P, Patterson, T, Jeste, DV (2005). A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. American Journal of Psychiatry 162, 520–529.Google Scholar
Granholm, E, McQuaid, JR, McClure, FS, Link, PC, Perivoliotis, D, Gottlieb, JD, Patterson, TL, Jeste, DV (2007). Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. Journal of Clinical Psychiatry 68, 730–737.Google Scholar
Grant, PM, Beck, AT (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin 35, 798–806.Google Scholar
Grant, PM, Huh, GA, Perivoliotis, D, Stolar, NM, Beck, AT (2012). Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry 69, 121–127.CrossRefGoogle ScholarPubMed
Gumley, A, O'Grady, M, McNay, L, Reilly, J, Power, KG, Norrie, J (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychological Medicine 33, 419–431.Google Scholar
Hall, PL, Tarrier, N (2003). The cognitive–behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behaviour Research and Therapy 41, 317–332.Google Scholar
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. BMJ (Clinical Research Ed.) 327, 557–560.Google Scholar
Hjorthoj, CR, Fohlmann, A, Larsen, AM, Gluud, C, Arendt, M, Nordentoft, M (2013). Specialized psychosocial treatment plus treatment as usual (TAU) versus TAU for patients with cannabis use disorder and psychosis: the CapOpus randomized trial. Psychological Medicine 43, 1499–1510.Google Scholar
Jackson, HJ, McGorry, PD, Killackey, E, Bendall, S, Allott, K, Dudgeon, P, Gleeson, J, Johnson, T, Harrigan, S (2008). Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus befriending for first-episode psychosis: The ACE project. Psychological Medicine 38, 725–735.Google Scholar
Jauhar, S, McKenna, PJ, Radua, J, Fung, E, Salvador, R, Laws, KR (2014). Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry 204, 20–29.Google Scholar
Jones, C, Hacker, D, Cormac, I, Meaden, A, Irving, CB (2012). Cognitive behavior therapy versus other psychosocial treatments for schizophrenia. Schizophrenia Bulletin 38, 908–910.Google Scholar
Kircanski, K, Mazur, H, Gotlib, IH (2013). Behavioral activation system moderates self-referent processing following recovery from depression. Psychological Medicine 43, 1909–1919.Google Scholar
Kirkpatrick, B, Castle, D, Murray, RM, Carpenter, WT Jr (2000). Risk factors for the deficit syndrome of schizophrenia. Schizophrenia Bulletin 26, 233–242.Google Scholar
Kirkpatrick, B, Strauss, GP, Nguyen, L, Fischer, BA, Daniel, DG, Cienfuegos, A, Marder, SR (2011). The Brief Negative Symptom Scale: psychometric properties. Schizophrenia Bulletin 37, 300–305.Google Scholar
Klingberg, S, Herrlich, J, Wiedemann, G, Wolwer, W, Meisner, C, Engel, C, Jakobi-Malterre, UE, Buchkremer, G, Wittorf, A (2012). Adverse effects of cognitive behavioral therapy and cognitive remediation in schizophrenia: results of the Treatment of Negative Symptoms study. Journal of Nervous and Mental Disease 200, 569–576.Google Scholar
Krakvik, B, Grawe, RW, Hagen, R, Stiles, TC (2013). Cognitive behaviour therapy for psychotic symptoms: a randomized controlled effectiveness trial. Behavioural and Cognitive Psychotherapy 41, 511–524.Google Scholar
Lecomte, T, Leclerc, C, Corbiere, M, Wykes, T, Wallace, CJ, Spidel, A (2008). Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. Journal of Nervous and Mental Disease 196, 866–875.Google Scholar
Lecomte, T, Leclerc, C, Wykes, T (2012). Group CBT for early psychosis – are there still benefits one year later? International Journal of Group Psychotherapy 62, 309–321.CrossRefGoogle ScholarPubMed
Leucht, S, Corves, C, Arbter, D, Engel, RR, Li, C, Davis, JM (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 373, 31–41.Google Scholar
Lewis, S, Tarrier, N, Haddock, G, Bentall, R, Kinderman, P, Kingdon, D, Siddle, R, Drake, R, Everitt, J, Leadley, K, Benn, A, Grazebrook, K, Haley, C, Akhtar, S, Davies, L, Palmer, S, Faragher, B, Dunn, G (2002). Randomised controlled trial of cognitive–behavioural therapy in early schizophrenia: acute-phase outcomes. British Journal of Psychiatry. Supplement 43, s91–s97.Google Scholar
Liemburg, E, Castelein, S, Stewart, R, van der Gaag, M, Aleman, A, Knegtering, H, Genetic Risk and Outcome of Psychosis (GROUP) Investigators (2013). Two subdomains of negative symptoms in psychotic disorders: established and confirmed in two large cohorts. Journal of Psychiatric Research 47, 718–725.Google Scholar
Lincoln, TM, Ziegler, M, Mehl, S, Kesting, ML, Lullmann, E, Westermann, S, Rief, W (2012). Moving from efficacy to effectiveness in cognitive behavioral therapy for psychosis: a randomized clinical practice trial. Journal of Consulting and Clinical Psychology 80, 674–686.Google Scholar
Madigan, K, Brennan, D, Lawlor, E, Turner, N, Kinsella, A, O'Connor, JJ, Russell, V, Waddington, JL, O'Callaghan, E (2013). A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness. Schizophrenia Research 143, 138–142.Google Scholar
National Institute for Clinical Excellence (2009). Schizophrenia. Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (Update). National Institute for Clinical Excellence: London.Google Scholar
Oorschot, M, Lataster, T, Thewissen, V, Lardinois, M, Wichers, M, van Os, J, Delespaul, P, Myin-Germeys, I (2013). Emotional experience in negative symptoms of schizophrenia – no evidence for a generalized hedonic deficit. Schizophrenia Bulletin 39, 217–225.Google Scholar
Penn, DL, Meyer, PS, Evans, E, Wirth, RJ, Cai, K, Burchinal, M (2009). A randomized controlled trial of group cognitive–behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophrenia Research 109, 52–59.Google Scholar
Peters, E, Landau, S, McCrone, P, Cooke, M, Fisher, P, Steel, C, Evans, R, Carswell, K, Dawson, K, Williams, S, Howard, A, Kuipers, E (2010). A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatrica Scandinavica 122, 302–318.Google Scholar
Pinto, A, La Pia, S, Mennella, R, Giorgio, D, DeSimone, L (1999). Cognitive–behavioral therapy and clozapine for clients with treatment-refractory schizophrenia. Psychiatric Services (Washington, D.C.) 50, 901–904.Google Scholar
Rathod, S, Phiri, P, Harris, S, Underwood, C, Thagadur, M, Padmanabi, U, Kingdon, D (2013). Cognitive behaviour therapy for psychosis can be adapted for minority ethnic groups: a randomised controlled trial. Schizophrenia Research 143, 319–326.Google Scholar
Rector, NA, Seeman, MV, Segal, ZV (2003). Cognitive therapy for schizophrenia: a preliminary randomized controlled trial. Schizophrenia Research 63, 1–11.Google Scholar
Saksa, JR, Cohen, SJ, Srihari, VH, Woods, SW (2009). Cognitive behavior therapy for early psychosis: a comprehensive review of individual vs. group treatment studies. International Journal of Group Psychotherapy 59, 357–383.CrossRefGoogle ScholarPubMed
Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, O'Carroll, M, Barnes, TR (2000). A randomized controlled trial of cognitive–behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry 57, 165–172.Google Scholar
Shawyer, F, Farhall, J, Mackinnon, A, Trauer, T, Sims, E, Ratcliff, K, Larner, C, Thomas, N, Castle, D, Mullen, P, Copolov, D (2012). A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behaviour Research and Therapy 50, 110–121.CrossRefGoogle ScholarPubMed
Staring, AB, Ter Huurne, MA, van der Gaag, M (2013). Cognitive behavioral therapy for negative symptoms (CBT-n) in psychotic disorders: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry 44, 300–306.Google Scholar
Startup, M, Jackson, MC, Bendix, S (2004). North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: outcomes at 6 and 12 months. Psychological Medicine 34, 413–422.Google Scholar
Sterk, B, Winter van Rossum, I, Muis, M, de Haan, L (2013). Priorities, satisfaction and treatment goals in psychosis patients: an online consumer's survey. Pharmacopsychiatry 46, 88–93.Google Scholar
Strauss, GP, Horan, WP, Kirkpatrick, B, Fischer, BA, Keller, WR, Miski, P, Buchanan, RW, Green, MF, Carpenter, WT Jr (2013). Deconstructing negative symptoms of schizophrenia: avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome. Journal of Psychiatric Research 47, 783–790.Google Scholar
Tarrier, N, Sommerfield, C, Pilgrim, H, Humphreys, L (1999). Cognitive therapy or imaginal exposure in the treatment of post-traumatic stress disorder. Twelve-month follow-up. British Journal of Psychiatry 175, 571–575.Google Scholar
Tarrier, N, Wykes, T (2004). Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? Behaviour Research and Therapy 42, 1377–1401.CrossRefGoogle ScholarPubMed
Tarrier, N, Yusupoff, L, Kinney, C, McCarthy, E, Gledhill, A, Haddock, G, Morris, J (1998). Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ (Clinical Research Ed.) 317, 303–307.CrossRefGoogle ScholarPubMed
Turkington, D, Sensky, T, Scott, J, Barnes, TR, Nur, U, Siddle, R, Hammond, K, Samarasekara, N, Kingdon, D (2008). A randomized controlled trial of cognitive–behavior therapy for persistent symptoms in schizophrenia: a five-year follow-up. Schizophrenia Research 98, 1–7.Google Scholar
Valmaggia, LR, van der Gaag, M, Tarrier, N, Pijnenborg, M, Slooff, CJ (2005). Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. Randomised controlled trial. British Journal of Psychiatry 186, 324–330.CrossRefGoogle ScholarPubMed
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523–537.Google Scholar
Supplementary material: File

Velthorst Supplementary Material

Table S1

Download Velthorst Supplementary Material(File)
File 62 KB