AUTHOR=Mehl Stephanie , Werner Dirk , Lincoln Tania M. 

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

JOURNAL=Frontiers in Psychology

VOLUME=6

YEAR=2015

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2015.01450

DOI=10.3389/fpsyg.2015.01450

ISSN=1664-1078

ABSTRACT=<p>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 (<italic>k</italic> = 13; <inline-formula><mml:math id="M1" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover accent="false" class="mml-overline"><mml:mrow><mml:mi>d</mml:mi></mml:mrow><mml:mo accent="true">¯</mml:mo></mml:mover></mml:math></inline-formula> = 0.27). However, the comparison between CBTp and TAU after an average follow-up period of 47 weeks was not statistically significant (<italic>k</italic> = 12, <inline-formula><mml:math id="M2" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover accent="false" class="mml-overline"><mml:mrow><mml:mi>d</mml:mi></mml:mrow><mml:mo accent="true">¯</mml:mo></mml:mover></mml:math></inline-formula> = 0.16). When compared with other interventions, there was no significant effect of CBTp at end-of-therapy (<italic>k</italic> = 8; <inline-formula><mml:math id="M3" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover accent="false" class="mml-overline"><mml:mrow><mml:mi>d</mml:mi></mml:mrow><mml:mo accent="true">¯</mml:mo></mml:mover></mml:math></inline-formula> = 0.16) and after a follow-up period (<italic>k</italic> = 5; <inline-formula><mml:math id="M4" xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mover accent="false" class="mml-overline"><mml:mrow><mml:mi>d</mml:mi></mml:mrow><mml:mo accent="true">¯</mml:mo></mml:mover></mml:math></inline-formula> = −0.04). Comparison between newer studies taking a causal-interventionist approach (<italic>k</italic> = 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 post-therapy in bringing about a change in delusions, but that this change may not be 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.</p>