NICE guidance recommends offering CBT (cognitive behavioural therapy), family therapy and arts therapies for people with schizophrenia:
Offer CBT to all people with schizophrenia. This can be started either during the acute phase or later, including in inpatient settings.
– Taken from 188.8.131.52 in Schizophrenia (CG82). NICE, March 2009.
However, CBT is still not widely available for people with schizophrenia, although the 2009 update of NICE guidance (quoted above) will have helped to improve the level of access that some patients have to this therapy.
A new systematic review from the Cochrane Schizophrenia Group has recently compared the effectiveness of CBT with other psychosocial therapies for people with schizophrenia.
The reviewers conducted a thorough search and included randomised controlled trials of CBT for people with schizophrenia-like illnesses in their analysis. They found 20 trials to include, but many were small studies and of limited quality.
Here’s what they found:
- CBT and other talking therapies were equally effective in treating people with schizophrenia
- Relapses and re-hospitalisation were not reduced with CBT
- CBT was no better at improving mental state
- CBT was no better or worse at managing positive or negative symptoms
- CBT had a lower drop-out rate than drug trials
- CBT offered no advantage in relation to:
- Death by natural causes or suicide
- Coping with anxiety
- Building self-esteem
- Developing insight
- Helping with anger
- Problem behaviours such as violence
The Cochrane reviewers concluded:
Trial-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other (and sometime much less sophisticated) therapies for people with schizophrenia.
The trials are improving in this field, although it’s important to stress that the quality of the evidence included in this review is generally of very low or low quality (according to GRADE recommendations). More research needs to be done before we can confidently recommend CBT over other psychosocial therapies for people with schizophrenia.
Jones C, Hacker D, Cormac I, Meaden A, Irving CB. Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008712. DOI: 10.1002/14651858.CD008712.pub2.