CBT is no better than other psychosocial therapies for people with schizophrenia, according to new Cochrane review

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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 1.3.4.1 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.

Links

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.

Core interventions in the treatment and management of schizophrenia in primary and secondary care (update), CG82 (PDF). NICE, Mar 2009.

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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