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Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor.
Til Wykes1, Craig Steel, Brian Everitt
1Department of Psychology, Institute of Psychiatry, King's College London, London, UK. t.wykes@iop.kcl.ac.uk
Schizophrenia Bulletin
|October 27, 2007
Summary
Cognitive behavior therapy for psychosis (CBTp) benefits positive symptoms, but trial methodology impacts results. Rigorous studies show benefit, though less pronounced. Methodological rigor is crucial for accurate CBTp evidence.
Area of Science:
- Psychiatry
- Clinical Psychology
- Psychotherapy Research
Background:
- Cognitive behavior therapy for psychosis (CBTp) is a preferred therapy in the US and UK.
- Recent advances have expanded CBTp targets and delivery methods, including group settings.
- This study examines the effectiveness of CBTp across various symptoms and methodologies.
Purpose of the Study:
- To determine the effect sizes of CBTp trials for targeted and nontargeted symptoms.
- To investigate the impact of different modes of action and methodological rigor on CBTp outcomes.
- To analyze the influence of trial methodology on reported effect sizes.
Main Methods:
- A meta-analysis of 34 publicly available CBTp trials was conducted.
- The Clinical Trial Assessment Measure (CTAM) was used to evaluate methodological rigor.
- Effect sizes were calculated for various symptom domains and overall functioning.
Main Results:
- CBTp showed beneficial effects for target symptoms (ES=0.400), positive symptoms (ES=0.35-0.44), functioning, mood, and social anxiety.
- No significant effect was observed for hopelessness.
- Trials with unblinded raters exhibited inflated effect sizes (50%-100%). Rigorous trials showed a smaller, but significant, benefit (ES=0.223).
Conclusions:
- CBTp is effective for positive symptoms, consistent with prior meta-analyses.
- Psychological treatment trials risk inflated effect sizes if group allocation is not masked.
- Future evidence synthesis for psychological treatments must prioritize methodological rigor and detail.
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