Cognitive-Behavioral Therapy for Medication-Resistant Psychosis: A Meta-Analytic Review

• Published in: Psychiatric Services Vol. 65; no. 7; pp. 874 - 880
• Main Authors: Burns, Amy M. N, Erickson, David H, Brenner, Colleen A
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01-07-2014
• Subjects: Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognitive Therapy - methods; Drug Resistance; Humans; Medical sciences; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotic Disorders - therapy; Social psychiatry. Ethnopsychiatry; Treatments; Social environment; Human; Psychosis; Treatment resistance; Cognitive therapy; Treatment; Mental health; Behavior therapy; Review; Public health; Metaanalysis
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.201300213

Patients with schizophrenia often continue to experience disabling positive symptoms, despite adequate trials of medication. In these situations, patients may be prescribed an adjunctive medication, but a more effective choice may be cognitive-behavioral therapy (CBT). This review of 16 published articles from 12 randomized controlled trials found that CBT was associated with robust improvements in the positive symptoms of psychotic disorders. In addition, the improvements were sustained at follow-up, the authors reported.
ObjectiveSupport for cognitive-behavioral therapy (CBT) for psychosis has accumulated, with several reviews and meta-analyses indicating its effectiveness for various intended outcomes in a broad variety of clinical settings. Most of these studies, however, have evaluated CBT provided to the subset of people with schizophrenia who continue to experience positive symptoms despite adequate treatment with antipsychotics. Despite several reviews and meta-analyses, a specific estimate of the effects of CBT for patients with medication-resistant positive symptoms, for whom CBT is frequently used in outpatient clinical settings, is lacking. This meta-analysis examined CBT’s effectiveness among outpatients with medication-resistant psychosis, both on completion of treatment and at follow-up.MethodsSystematic searches (until May 2012) of the Cochrane Collaborative Register of Trials, MEDLINE, PsycINFO, and PubMed were conducted. Sixteen published articles describing 12 randomized controlled trials were used as source data for the meta-analysis. Effect sizes were estimated using the standardized mean difference corrected for bias, Hedges’ g, for positive and general symptoms.ResultsThe trials included a total of 639 individuals, 552 of whom completed the posttreatment assessment (dropout rate of 14%). Overall beneficial effects of CBT were found at posttreatment for positive symptoms (Hedges’ g=.47) and for general symptoms (Hedges’ g=.52). These effects were maintained at follow-up for both positive and general symptoms (Hedges’ g=.41 and .40, respectively).ConclusionsFor patients who continue to exhibit symptoms of psychosis despite adequate trials of medication, CBT for psychosis can confer beneficial effects above and beyond the effects of medication.