Abstract
Functioning is recognized as a key treatment goal in alleviating the burden of schizophrenia. Psychological interventions can play an important role in improving functioning in this population, but the evidence on their efficacy is limited. We therefore aimed to evaluate the effect of psychological interventions in functioning for patients with schizophrenia. To conduct this systematic review and meta-analysis, we searched for published and unpublished randomized controlled trials (RCTs) in EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and the Study register of the Cochrane Schizophrenia Group. The outcome functioning was measured with validated scales. We performed random-effects pairwise meta-analysis to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs). We included 58 RCTs (5048 participants). Psychological interventions analyzed together (SMD = – 0.37, 95% CI – 0.49 to – 0.25), cognitive behavioral therapy (30 RCTs, SMD = – 0.26, 95% CI – 0.39 to – 0.12), and third wave cognitive-behavioral therapies (15 RCTs, SMD = – 0.60, 95% CI – 0.83 to – 0.37) were superior to control in improving functioning, while creative therapies (8 RCTs, SMD = 0.01, 95% CI – 0.38 to 0.39), integrated therapies (4 RCTs, SMD = – 0.21, 95% CI – 1.20 to 0.78) and other therapies (4 RCTs, SMD = – 0.74, 95% CI – 1.52 to 0.04) did not show a benefit. Psychological interventions, in particular cognitive behavioral therapy and third wave cognitive behavioral therapies, have shown a therapeutic effect on functioning. The confidence in the estimate was evaluated as very low due to risk of bias, heterogeneity and possible publication bias.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Schizophrenia is a severe mental disorder with relevant consequences for the individual and society, being ranked as one of the most debilitating disorders worldwide [2]. The disease burden for patients, relatives and society is dramatic [3, 4].
Since the first symptoms of schizophrenia typically appear in the age between 20 and 30 years, this has big impact on the life-perspectives of the young adult patients, who often do not complete their education, have difficulties in finding an occupation as well as to form relationships [1]. It is estimated that 80–90% of patients are unemployed [5]. These high rates of loss of productivity and unemployment lead to high costs for the society; with estimated total costs of more than 93 billion Euros per year, schizophrenia is among the most expensive illnesses in the EU [4].
To support patients and their families to face such challenges, it is important to address not only the symptoms of the disorder, but also the functioning of the individuals and their ability to be active members of the society. The concept of functioning is not limited to employment and economical contribution, but includes social behavior, participation and activities of daily living and self-care [6]. These aspects are included in most of the rating scales to measure functioning such as Global Assessment of Functioning (GAF) [7], Personal and Social Performance scale (PSP) [8], or the Social Functioning Scale (SFS) [9].
The importance of functioning as a therapeutic goal in schizophrenia is recognized in the scientific community [10], as well as explicitly expressed in clinical guidelines from National Institute for Care and Health Excellence (NICE) [11], Scottish Intercollegiate Guidelines Network (SIGN) [12], German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) [13] and other national and international guidelines.
Nevertheless, the evidence on the effects of psychological interventions on functioning in schizophrenia is very limited, and mostly focused on cognitive behavioral therapy (CBT). A network meta-analysis investigating psychological interventions in the acute phase of schizophrenia found that, on 53 included studies, 40 were focused on CBT, and only 20 had measured functioning [14]. Laws et al. conducted a meta-analysis investigating the effects of CBT on functioning, distress and quality of life [15]. Based on 25 RCTs, they found an SMD of 0.25 (95% CI 0.14–0.33) for CBT compared to control conditions [treatment as usual (TAU) or other psychological interventions]. Two Cochrane reviews by Jones et al. investigated the effects of CBT compared to TAU and compared to other psychosocial interventions and considered functioning among other outcomes. However, they provided effects for each rating scale separately and for different time points separately, resulting in analyses that include very few studies each and do not inform on the general picture [10, 16].
The evidence on other psychological interventions such as creative therapies is limited to Cochrane reviews that investigated their effect in many outcomes, but present only scattered data, separating data measured with different rating scales and at different time points [17, 18].
Randomized controlled trials have been conducted investigating other therapeutic approaches, such as third-wave cognitive therapies. After a first wave of strictly behavioral approaches, and a second characterized by the implementation of a cognitive model, the third wave of cognitive behavioral therapies includes interventions in which an emphasis is put on metacognition and how the patient relates to thoughts and emotions, such as acceptance and commitment therapy (ACT), mindfulness-based treatments and metacognitive training [19]. Integrated approaches, combining multiple fundamentally different therapeutic strategies, have been also developed and investigated [20,21,22].
A network meta-analysis investigated the effects of different psychological interventions in patients with schizophrenia, but was focused on patients in the acute phase, which presented positive symptoms [14]. When investigating functioning, it is important to consider also chronic patients and patients with predominant or prominent negative symptoms; in the present analysis, we included all subgroups of patients with schizophrenia.
Specific therapeutic approaches have shown different effects in patients with schizophrenia, so that it is meaningful to investigate them separately [14, 23]. On the other side, an overall picture about the efficacy of psychological interventions is missing from the literature.
The aim of the present systematic review and meta-analysis of randomized clinical trials is to provide a comprehensive overview about the efficacy of psychological interventions in improving functioning in patients with schizophrenia regardless of the comparator, time point and rating scale used. In this way, we want to answer the research question: are psychological interventions efficacious for improving functioning in patients with schizophrenia?
Methods
Study design and inclusion criteria
The methods of the present work were adapted from the protocol, which was registered in PROSPERO with the number CRD42017067795 and published in a peer-reviewed journal [24]. The methods have been developed according to the PRISMA statement [25]. We included studies conducted in adults with a diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, with no restrictions on setting, gender or ethnicity. We excluded studies that, based on their inclusion criteria, recruited only patients with concomitant somatic or psychiatric comorbidity, or only patients with first episode psychosis. Studies were included if at least 80% of the participants had schizophrenia or related disorders (schizoaffective disorder, schizophreniform disorder, delusional disorder or non-affective psychotic disorder). We included studies regardless of the diagnostic criteria used.
Studies investigating psychological interventions were included. We considered for inclusion the interventions described in the list of psychological therapies of the Cochrane Common Mental Disorders Group (CCMD) (formerly Cochrane Collaboration Depression, Anxiety and Neurosis Group [CCDAN]) [26], such as cognitive behavioral therapy, acceptance and commitment therapy, mindfulness, art therapy and music therapy. Psychosocial and community interventions such as case management or assertive community treatment were not included, as well as family interventions. The psychological intervention was usually provided in addition to the standard care, which typically includes medication with antipsychotics [27]. We accepted as comparator another psychological intervention, inactive control, defined as interventions intended to control for non-specific aspects of the therapy (for example activity groups, befriending), treatment as usual (TAU) and waiting list.
Studies were included in the analysis if they provided data for functioning measured with a validated rating scale, such as the Global Assessment of Functioning (GAF) scale or the Social Functioning Scale (SFS) [9, 28].
Search strategy
We searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Library, World Health Organization’s International Clinical Trials Registry Platform and ClinicalTrials.gov for RCTs published up to January 2020 and the Study register of the Cochrane Schizophrenia Group from January 2020 up to September 2021, investigating the efficacy of psychological interventions in people with schizophrenia [29]. No time limit on how old the articles could be and no language restrictions were applied (Table 1).
Screening and data extraction
Two reviewers among IB, SW, CR and FS screened independently all abstracts (first phase) and full texts (second phase) identified in the search for eligibility. Results of the update search from January 2018 to September 2021 were screened by IB; NHS independently re-inspected 25% of these results, to ensure reliability of selection. Disagreements were resolved by discussion, and in case of doubt, the full paper was retrieved for further inspection. Two of IB, SW, CR, FS and NHS extracted relevant data independently in a Microsoft Access database explicitly created for this study and assessed the different domains of risk of bias using the Cochrane Risk of Bias tool [30]. We also rated an overall risk of bias for each study, following the approach described by Furukawa et al. [31]. Disagreements were resolved by discussion, by involving the senior author and, in case of need, by asking the study authors. Authors of the studies were contacted via e-mail and asked if they could provide additional data relevant for the analysis.
Data analysis
We performed random-effects pairwise meta-analyses using Review Manager version 5.3 and R Studio version 1.3.959, package meta [32, 33]. We calculated standardized mean differences (SMDs) and 95% confidence intervals (CIs). We planned different levels of analysis: (i) all psychological interventions compared to all control conditions (primary analysis); (ii) groups of psychological interventions compared to control conditions (e.g., third wave cognitive behavioral therapy, creative therapies); (iii) specific psychological interventions considered separately. The decision which studies to consider for each treatment comparison was made by two independent reviewers and then discussed, not solely based on the name the study authors gave to the intervention, but based on the description, they provided about the treatment and control conditions (Table 3).
Effect sizes are described according to Cohen, considering an effect size of 0.20 small, 0.50 moderate and 0.80 large [34].
We evaluated heterogeneity using I2, and considered heterogeneity probably not important for an I2 of up to 40%, moderate for an I2 from 30 to 60%, substantial for an I2 from 50 to 90% and considerable if over 75% according to the Cochrane Handbook for Systematic Reviews [35].
To explore potential sources for heterogeneity, we conducted subgroup and meta-regression analyses for the primary analysis, for the following potential effect modifiers: treatment setting (individual vs group), therapist expertise (trainee therapist allowed vs only expert therapists), treatment duration, age, percentage males, number of sessions, and baseline severity. Sensitivity analyses were conducted excluding studies that did not employ a blind outcome assessor, studies with researcher’s allegiance, studies focused on treatment resistant patients and studies with high overall risk of bias [31]. Subgroup, meta-regression and sensitivity analyses were considered only exploratory; therefore, we did not adjust for multiple hypotheses testing.
For the primary analysis, we assessed small trial effect, potentially associated with publication bias, by visual inspection of the funnel plot and by applying Egger’s test for funnel plot asymmetry [36]. The trim-and-fill method by Duval and Tweedie was used to give an estimate of the effect size after correcting for publication bias [37].
For the primary analysis, we assessed confidence in the estimate with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [38].
Changes from protocol
Participants. For the present review, it was not required that patients have current positive symptoms. Studies focused on patients with predominant negative symptoms were not excluded.
Interventions with a primary aim different from positive symptoms were not excluded. The present review focuses on the outcome functioning. Pairwise meta-analyses were performed as data analysis method, and the GRADE approach was used to evaluate the confidence in the estimate [38].
Results
Characteristics of included studies
The search identified 28,420 records, of which 3570 were considered eligible and retrieved in full. 253 studies met the inclusion criteria, of which 58 had usable data and were included in the meta-analysis [22, 39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95]. The study selection process is illustrated in Fig. 1, and the included studies are described in Table 2.
The different psychological interventions investigated in the studies are described in detail in Table 3.
Risk-of-bias assessment
Six, 25 and 27 studies were judged to be at low, moderate and high overall risk of bias, respectively (Table 2).
Concerning random sequence generation, the risk of bias was low in 40 (69%) studies; concerning allocation concealment, it was low in 25 (43%) studies; concerning blinding of participants and personnel, the risk of bias was never low; concerning blinding of outcome assessment in 29 (50%) studies; concerning attrition bias in 15 (26%) studies; concerning selective reporting in 15 (26%) studies; concerning researchers’ allegiance in 12 (21%) studies; and in 53 (91%) studies concerning other bias (Fig. 2).
All psychological interventions compared to all control conditions (primary analysis)
58 studies with 5048 participants provided data for this analysis. Psychological treatments were associated with a greater improvement in participants’ functioning scores in comparison to control conditions (SMD = – 0.37, 95% CI – 0.49 to – 0.25), with substantial heterogeneity (I2 = 76%) (Fig. 3). The confidence in the estimate assessed with the GRADE approach was judged to be very low, due to the presence of studies at high risk of bias, substantial heterogeneity and suspected publication bias (Table 4).
Groups of psychological interventions and specific psychological interventions compared to control conditions
CBT versus control
30 studies with 2657 participants provided data for this analysis. Overall, CBT was associated with a greater improvement in functioning (SMD = – 0.26, 95% CI – 0.39 to – 0.12), with substantial heterogeneity (I2 = 62%) (Fig. 4). The benefit was clear in comparison with TAU (SMD = – 0.36, 95% CI – 0.55 to – 0.16), supportive therapy (SMD = – 0.26, 95% CI – 0.50 to – 0.01) and psychoeducation (SMD = – 0.95, 95% CI – 1.74 to – 0.16), while for the comparisons with inactive control, cognitive remediation, wait-list, family intervention and psychodynamic therapy, the confidence intervals include the possibility of no difference.
Third-wave cognitive behavior therapies versus control
15 studies with 1391 participants were included in this analysis. Third-wave CBT interventions were associated with an improvement in functioning (SMD = – 0.60, 95% CI – 0.83 to – 0.37), with substantial heterogeneity (I2 = 73%) (Fig. 5).
Of these, seven studies investigated mindfulness (SMD = – 0.72, 95% CI – 0.98 to – 0.46), one study investigated ACT (SMD = 0.05, 95% CI – 0.35 to 0.45) and seven studies investigated metacognitive training (SMD = – 0.47, 95% CI – 0.92 to – 0.02).
Creative therapies versus control
In this analysis, eight studies on art therapy, music therapy and movement therapy provided data for 750 participants. No difference was found between creative therapies and the control group (SMD = 0.01, 95% CI – 0.38 to 0.39), with considerable heterogeneity (I2 = 81) (Fig. 5).
Four studies investigated art therapy (SMD = – 0.04, 95% CI – 0.27 to 0.36), three studies music therapy (SMD = – 0.60, 95% CI – 2.21 to 1.01) and one study movement therapy (SMD = – 0.04, 95% CI – 0.54 to 0.46).
Integrated therapies versus control
Four studies with 182 participants were included for this comparison. No difference between integrated therapies and control group was found (SMD = – 0.21, 95% CI – 1.20 to 0.78), with considerable heterogeneity (I2 = 88%) (Fig. 5).
Two studies investigated CBT combined with family intervention (SMD = – 1.15, 95% CI – 2.14 to – 0.15), one study hallucination focused integrated treatment (SMD = 0.58, 95% CI – 1.09 to – 0.08) and one study multiple therapies (SMD = 0.95, 95% CI – 0.90 to 2.81).
Other therapies versus control
Among other therapies, we included positive psychotherapy, psychosocial therapy, narrative therapy and not further specified psychotherapy. Based on four studies with 197 participants, these interventions were not associated with an improvement in functioning (SMD = – 0.74, 95% CI – 1.52 to 0.04), with considerable heterogeneity (I2 = 82%) (Fig. 5).
One study investigated positive psychotherapy (SMD = 0.08, 95% CI – 0.34 to 0.51), one study investigated psychosocial therapy (SMD = – 1.87, 95% CI – 2.64 to – 1.10), one study psychotherapy, without further specification (SMD = -0.69, 95% CI – 1.35 to – 0.03), and one study narrative therapy (SMD = 0.17, 95% CI – 0.57 to 0.91).
Subgroup analyses
Treatment setting: individual versus group
In 28 studies, the psychological intervention was delivered in a group setting (SMD = – 0.38, 95% CI – 0.57 to – 0.20, I2 = 78%) and in 25 studies in an individual setting (SMD = – 0.31, 95% CI – 0.48 to – 0.14, I2 = 70%).
Test for subgroup difference did not find a difference between these two subgroups (p = 0.56).
Therapist expertise: trainee therapist allowed vs only expert therapists
In 32 studies, only expert therapists conducted therapy (SMD = – 0.39, 95% CI – 0.55 to – 0.22, I2 = 79%), in seven studies’ therapists in training conducted treatment, as well (SMD = – 0.16, 95% CI – 0.34 to 0.03, I2 = 17%). Test for subgroup difference did not find a difference between these two subgroups (p = 0.07).
Metaregression analyses
The effect of psychological interventions on functioning was not found to be associated with number of sessions (p = 0.4347), study duration (p = 0.0901), male percentage (p = 0.1636), or baseline severity (p = 0.1244).
Age was found to have a role in moderating treatment effect on functioning, with a possible bigger treatment effect for younger patients (p = 0.0072) (Table 5).
Sensitivity analyses
Excluding 14 open label studies did not substantially change the results of the analysis (SMD = – 0.38, CI – 0.52 to – 0.25). Heterogeneity remained similar to the original analysis (I2 = 77%).
Excluding 34 studies with high researcher allegiance, the confidence interval includes the possibility of no difference between the psychological interventions and the control condition (SMD = – 0.21, CI – 0.42 to 0.00). Heterogeneity remained similar compared to the original analysis (I2 = 75%).
Excluding 27 studies with high overall risk of bias did not change the results of the analysis substantially (SMD = – 0.44, CI – 0.58 to – 0.25). Heterogeneity remained similar (I2 = 79%).
Excluding 11 studies focused on treatment resistant patients led to a slight decrease of effect size (SMD = – 0.42, CI – 0.60 to – 0.27). Heterogeneity remained similar (I2 = 80%).
Publication bias
Visual inspection of the funnel plot reveals some asymmetry, suggesting that small studies favoring the control condition could have remained unpublished (Fig. 6a). Egger’s test for funnel plot asymmetry confirmed this (p = 0.0097) [36]. By applying the trim-and-fill method by Duval and Tweedie 16 studies were added to the funnel plot (represented in white in Fig. 6b) confidence intervals included the possibility of no effect (SMD = – 0.13, 95% CI – 0.27 to 0.01) [37].
Discussion
Summary of main results
We conducted the first systematic review and meta-analysis investigating the effect of psychological interventions for functioning in patients with schizophrenia. After a thorough literature search, we were able to include 58 studies with usable outcome data.
We found that psychological interventions overall showed a benefit in improving functioning compared to control conditions. According to Cohen (0.2 = small, 0.5 = medium, 0.8 = large effect size), this effect size can be considered small to medium [34]. CBT compared to any control condition had also a small effect in improving functioning, third-wave CBT interventions produced a medium benefit. Creative therapies, integrated therapies and other therapies were not associated with an improvement in functioning.
Discussion in light of previous literature
In a previous network meta-analysis by our group focused on acute patients with positive symptoms, we found an effect of – 0.25 (95% CI – 0.48 to – 0.03) indicating a benefit for CBT compared to treatment as usual [14], while in the present work on the general population of patients with schizophrenia, the effect of CBT vs TAU was larger ( – 0.43). It can be argued that, after acute symptoms of schizophrenia are treated, patients are more receptive for interventions aimed at improving functioning. Results of Bighelli et al. on CBT compared with supportive therapy, family intervention, inactive control and wait-list are in line with the ones of the present work, not showing a difference between these interventions [14]. It must be noted, however, that evidence for these interventions is based on only 1–2 studies each.
Our results are also in line with the findings of Laws et al. that found an effect of 0.25 (95% CI 0.10–0.39) showing a benefit for CBT compared with control conditions [15].
Contradicting the findings of the present meta-analysis, Jones found no evidence supporting the use of CBT for functioning in people with schizophrenia [10]. This conclusion is, however, strongly affected by the different analysis that the authors conducted, analyzing different rating scales and different time points separately, so that our results cannot be compared with the ones of the Cochrane review.
In the present analysis, findings on mindfulness, metacognitive training, hallucination focused integrated treatment and psychosocial therapy are promising, but based only on a small number of trials. A recent review focused on metacognitive training, including randomized and non-randomized evidence, found a similar effect on functioning (SMD 0.41, 95% CI 0.12 to 0–69) [96].
Results of subgroup, meta-regression and sensitivity analyses did not find a role for the investigated variables in moderating the effect of psychological interventions on functioning, with exception of a possible moderating role for age (with bigger treatment effects associated with younger patients) and for researchers’ allegiance.
Younger patients might be more open for change and to engage in a psychotherapy. A systematic review reported larger effect sizes for psychotherapy in young adults with depression (up to 24 years) than in older adults [97].
Excluding studies that were conducted by the same authors who developed the treatment manual, the effect of the interventions on functioning was not so clear anymore, suggesting that effects might be inflated by allegiance of the authors to the investigated interventions. It must be noted that heterogeneity remained high in all subgroup analysis, confirming that the variables investigated in the subgroup analyses did not account for heterogeneity. A possible further explanation for heterogeneity in the investigated studies could be the use of different control conditions, that we pooled together. A network meta-analysis approach could help to disentangle this issue, analyzing also control conditions as different nodes of the network.
Limitations
First, the pooling of different rating scales is a problematic issue. As the concept of functioning developed through the years, the rating scales changed as well, including and giving a focus on different aspects like living skills, disability, social and occupational role [1, 6]. Moreover, some scales, such as the Global Assessment Scale (GAS), include psychopathology and some do not, for example the Social and Occupational Functioning Assessment Scale (SOFAS) [98, 99]. To account for this difficulty, we decided to include only published scales, for which it is possible to check the original reference and therefore description and metric properties, and we applied a statistical correction, by calculating SMDs. Still, many of the comparisons present a considerable heterogeneity, and one of the possible causes could be the use of different rating scales. On the contrary, the strategy in Cochrane reviews is to keep every measure separate, but paying the price of losing the overall picture [10, 16]. An ideal solution does not exist; an agreement on one functioning measure would make research results more comparable. Currently, in the Diagnostic and Statistical Manual 5, the American Psychiatric Association suggests using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. [100]
Second, pooling and classifying psychological treatments are not straightforward. We adopted a transparent approach, classifying the interventions according to the description given in each study, and presenting the assumptions made in Table 3. We also present different level of analyses for treatment grouped and taken singularly, so that an appraisal of the evidence is provided also independently from our classification of the psychological interventions.
Third, of 253 studies that met our eligibility criteria, only 58 reported data on functioning as an outcome. Most of all, there was scarcity of evidence for interventions other than CBT, and for some interventions, the evidence is based on few studies only. Results need therefore to be interpreted with caution.
A further limitation of the current analysis, and of studies on psychological interventions in patients with schizophrenia in general, is that participants of the studies are generally also receiving antipsychotic medication. Insufficient details on the medication were provided in the studies, so that it was not possible to disentangle the effect of psychological and pharmacological therapy. Randomization ensures that the observed effect sizes refer to the presence of the psychological intervention.
Finally, the certainty of the evidence was evaluated as very low with the GRADE approach. This evaluation is motivated by three aspects; (i) the studies providing data are mostly at overall moderate or high risk of bias; (ii) there was substantial heterogeneity. This may be due to the fact that we analyzed the results of studies with different duration together. The meta-regression analysis investigating the role of study duration was of borderline significance, so this aspect remains unclear; (iii) the results are potentially affected by small study effect, that can be associated with publication bias. Even if we conducted a thorough literature search, including study registries and gray literature, it is possible that some small studies favoring the control condition remained unpublished and were not possible to detect.
Implications for future research and practice
Despite limitations, the present data suggest that psychological interventions can improve functioning in people with schizophrenia. In particular, CBT and third-wave CBT interventions seem to have a positive effect on functioning.
To increase the amount of evidence on other treatments, future trials investigating psychological interventions for schizophrenia should address functioning among outcomes, not only psychopathology.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Code availability
R codes used for analysis of the present work are available from the corresponding author on reasonable request.
References
Wallis SM (2022) Effects of psychological treatments on functioning in people with schizophrenia: systematic review and meta-analysis. Doctoral dissertation, Technical University of Munich. https://mediatum.ub.tum.de/1616544
Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019. A systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England) 396(10258):1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
McGrath J, Saha S, Chant D, Welham J (2008) Schizophrenia: A concise overview of incidence, prevalence, and mortality. Schizophr Bull 30(1):67–76. https://doi.org/10.1093/epirev/mxn001
Olesen J, Gustavsson A, Svensson M, Wittchen H-U, Jönsson B (2012) The economic cost of brain disorders in Europe. Eur J Neurol 19(1):155–162. https://doi.org/10.1111/j.1468-1331.2011.03590.x
Marwaha S, Johnson S (2004) Schizophrenia and employment - a review. Soc Psychiatry Psychiatr Epidemiol 39(5):337–349. https://doi.org/10.1007/s00127-004-0762-4
Wancata J, Kapfhammer H-P, Schüssler G, Fleischhacker WW (2007) Sozialpsychiatrie: essentieller Bestandteil der Psychiatrie [Social psychiatry: Essential part of psychiatry]. Psychiat Psychother 3(2):58–64. https://doi.org/10.1007/s11326-007-0048-z
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd ed., rev., Washington, DC
Morosini P-L, Magliano L, Brambilla L, Ugolini S, Pioli R (2000) Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social funtioning. Acta Psychiatr Scand 101(4):323–329. https://doi.org/10.1034/j.1600-0447.2000.101004323.x
Birchwood M, Smith J, Cochrane R, Wetton S, Copestake S (1990) The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry 157:853–859. https://doi.org/10.1192/bjp.157.6.853
Jones C, Hacker D, Meaden A, Cormac I, Irving CB, Xia J, Zhao S, Shi C, Chen J (2018) Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia. Cochrane Database System Rev. https://doi.org/10.1002/14651858.CD008712.pub3
National Institute for Health and Care Excellence (2014) Psychosis and schizophrenia in adults: prevention and management (NICE guideline CG178). http://www.nice.org.uk/guidance/cg178
Scottish Intercollegiate Guidelines Network (2013) Management of Schizophrenia. (SIGN 131). SIGN
Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde S3-Leitlinie Schizophrenie [Guideline for schizophrenia] (Abbreviated version)
Bighelli I, Salanti G, Huhn M, Schneider-Thoma J, Krause M, Reitmeir C, Wallis S, Schwermann F, Pitschel-Walz G, Barbui C, Furukawa TA, Leucht S (2018) Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta-analysis. World Psychiatry 17(3):316–329. https://doi.org/10.1002/wps.20577
Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S (2018) Cognitive behavioural therapy for schizophrenia - outcomes for functioning, distress and quality of life: A meta-analysis. BMC Psychol 6(1):32. https://doi.org/10.1186/s40359-018-0243-2
Jones C, Hacker D, Xia J, Meaden A, Irving CB, Zhao S, Chen J, Shi C (2018) Cognitive behavioural therapy plus standard care versus standard care for people with schizophrenia. Cochrane Database System Rev. https://doi.org/10.1002/14651858.CD007964.pub2
Xia J, Merinder LB, Belgamwar MR (2011) Psychoeducation for schizophrenia. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002831.pub2
Geretsegger M, Mössler KA, Bieleninik Ł, Chen X-J, Heldal TO, Gold C (2017) Music therapy for people with schizophrenia and schizophrenia-like disorders. The Cochrane database of systematic reviews 5:CD004025. https://doi.org/10.1002/14651858.CD004025.pub4
Hayes SC, Hofmann SG (2017) The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry 16(3):245–246. https://doi.org/10.1002/wps.20442
Jenner JA, Nienhuis FJ, Wiersma D, van de Willige G (2004) Hallucination focused integrative treatment: A randomized controlled trial. Schizophr Bull 30(1):133–145. https://doi.org/10.1093/oxfordjournals.schbul.a007058
Valencia M, Murow E, Rascon ML (2006) Comparación de tres modalidades de intervención en esquizofrenia: terapia psicosocial, musicoterapia y terapias múltiples [Comparison of three types of treatment for schizophrenia: Psychosocial therapy, music therapy, and multiple therapies]. Revista Latinoamericana de Psicologia 38(3):535–549
Palma C, Farriols N, Frías A, Cañete J, Gomis O, Fernández M, Alonso I, Signo S (2019) Randomized controlled trial of cognitive-motivational therapy program (PIPE) for the initial phase of schizophrenia: Maintenance of efficacy at 5-year follow up✰. Psychiatry Res 273:586–594. https://doi.org/10.1016/j.psychres.2019.01.084
Bighelli I, Rodolico A, García-Mieres H, Pitschel-Walz G, Hansen W-P, Schneider-Thoma J, Siafis S, Wu H, Wang D, Salanti G, Furukawa TA, Barbui C, Leucht S (2021) Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry 8(11):969–980. https://doi.org/10.1016/S2215-0366(21)00243-1
Bighelli I, Salanti G, Reitmeir C, Wallis S, Barbui C, Furukawa TA, Leucht S (2017) Psychological interventions for positive symptoms in schizophrenia: protocol for a network meta-analysis of randomised controlled trials. PROSPERO
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement. An updated guideline for reporting systematic reviews. BMJ (Clinical Research ed.) 372:n71. https://doi.org/10.1136/bmj.n71
The Cochrane Collaboration Depression, Anxiety and Neurosis Group (2013) CCDAN topic list: Intervention – Psychological therapies. https://cmd.cochrane.org/sites/cmd.cochrane.org/files/public/uploads/CCDAN%20topics%20list_psychological%20therapies%20for%20website.pdf
National Institute for Health and Clinical Excellence (Great Britain) (2014) Psychosis and schizophrenia in adults. Treatment and management. National Institute for Health and Clinical Excellence (NICE), London
Hall RC (1995) Global assessment of functioning. Psychosomatics 36(3):267–275. https://doi.org/10.1016/S0033-3182(95)71666-8
Shokraneh F, Adams CE (2020) Cochrane Schizophrenia Group’s study-based register of randomized controlled trials: development and content analysis. Schizophrenia Bulletin Open. https://doi.org/10.1093/schizbullopen/sgaa061
Higgins JPT, Altman DG, Sterne JAC (Ed) (Cochrane, 2017) Assessing risk of bias in included studies. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (Ed), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017)
Furukawa TA, Salanti G, Atkinson LZ, Leucht S, Ruhe HG, Turner EH, Chaimani A, Ogawa Y, Takeshima N, Hayasaka Y, Imai H, Shinohara K, Suganuma A, Watanabe N, Stockton S, Geddes JR, Cipriani A (2016) Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2015-010919
Review Manager (RevMan) (Version 5.3). The Cochrane Collaboration
RStudio: Integrated Development for R (Version 1.3.959)
Cohen J (1988) Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates.
(2021) Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021), www.training.cochrane.org/handbook
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629
Duval S, Tweedie R (2000) A nonparametric, “Trim and Fill” method of accounting for publication bias in meta-analysis. J Am Stat Assoc 95(449):89–98. https://doi.org/10.1080/01621459.2000.10473905
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD
Barrowclough C, Haddock G, Lobban F, Jones S, Siddle R, Roberts C, Gregg L (2006) Group cognitive-behavioural therapy for schizophrenia. Randomised controlled trial. British J Psychiatry 189:527–532. https://doi.org/10.1192/bjp.bp.106.021386
Bradshaw W (2000) Integrating cognitive-behavioral psychotherapy for persons with schizophrenia into a psychiatric rehabilitation program. Results of a three year trial. Commun Mental Health J 36(5):491–500. https://doi.org/10.1023/a:1001911730268
Cather C, Penn D, Otto MW, Yovel I, Mueser KT, Goff DC (2005) A pilot study of functional Cognitive Behavioral Therapy (fCBT) for schizophrenia. Schizophr Res 74(2–3):201–209. https://doi.org/10.1016/j.schres.2004.05.002
Chadwick P, Hughes S, Russell D, Russell I, Dagnan D (2009) Mindfulness groups for distressing voices and paranoia. A replication and randomized feasibility trial. Behav Cogn Psychother 37(4):403–412. https://doi.org/10.1017/S1352465809990166
Chien WT, Lee IY (2013) The mindfulness-based psychoeducation program for Chinese patients with schizophrenia. Psychiatr Serv 64(4):376–379. https://doi.org/10.1176/appi.ps.002092012
Chien WT, Thompson DR (2014) Effects of a mindfulness-based psychoeducation programme for Chinese patients with schizophrenia. 2-year follow-up. British J Psychiatry 205(1):52–59. https://doi.org/10.1192/bjp.bp.113.134635
Chien WT, Bressington D, Yip A, Karatzias T (2017) An international multi-site, randomized controlled trial of a mindfulness-based psychoeducation group programme for people with schizophrenia. Psychol Med 47(12):2081–2096. https://doi.org/10.1017/S0033291717000526
Crawford MJ, Killaspy H, Barnes TR, Barrett B, Byford S, Clayton K, Dinsmore J, Floyd S, Hoadley A, Johnson T, Kalaitzaki E, King M, Leurent B, Maratos A, O'Neill FA, Osborn D, Patterson S, Soteriou T, Tyrer P, Waller D (2012) Group art therapy as an adjunctive treatment for people with schizophrenia. A randomised controlled trial (MATISSE). Health Technol Assessm (Winchester, England) 16(8):iii–iv, 1–76. https://doi.org/10.3310/hta16080
Durham RC, Guthrie M, Morton RV, Reid DA, Treliving LR, Fowler D, Macdonald RR (2003) Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. Results to 3-month follow-up. British J Psychiatry 182:303–311. https://doi.org/10.1192/bjp.182.4.303
Farhall J, Freeman NC, Shawyer F, Trauer T (2009) An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis. Br J Clin Psychol 48(1):47–62. https://doi.org/10.1111/j.2044-8260.2009.tb00456.x
Garety PA, Fowler DG, Freeman D, Bebbington P, Dunn G, Kuipers E (2008) Cognitive–behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis. Randomised controlled trial. British J Psychiatry 192(6):412–423. https://doi.org/10.1192/bjp.bp.107.043570
Gottlieb JD, Gidugu V, Maru M, Tepper MC, Davis MJ, Greenwold J, Barron RA, Chiko BP, Mueser KT (2017) Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis. Psychiatr Rehabil J 40(3):283–292. https://doi.org/10.1037/prj0000258
Granholm E, McQuaid JR, McClure FS, Auslander LA, Perivoliotis D, Pedrelli P, Patterson T, Jeste DV (2005) A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry 162(3):520–529. https://doi.org/10.1176/appi.ajp.162.3.520
Granholm E, Holden J, Link PC, McQuaid JR, Jeste DV (2013) Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia. Defeatist performance attitudes and functional outcome. Am J Geriatric Psychiatry 21(3):251–262. https://doi.org/10.1016/j.jagp.2012.10.014
Granholm E, Holden J, Link PC, McQuaid JR (2014) Randomized clinical trial of cognitive behavioral social skills training for schizophrenia. Improvement in functioning and experiential negative symptoms. J Consult Clin Psychol 82(6):1173–1185. https://doi.org/10.1037/a0037098
Grant PM, Huh GA, Perivoliotis D, Stolar NM, Beck AT (2012) Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry 69(2):121–127. https://doi.org/10.1001/archgenpsychiatry.2011.129
Haddock G, Barrowclough C, Shaw JJ, Dunn G, Novaco RW, Tarrier N (2009) Cognitive-behavioural therapy v. social activity therapy for people with psychosis and a history of violence. Randomised controlled trial. British J Psychiatry 194(2):152–157. https://doi.org/10.1192/bjp.bp.107.039859
Jenner JA, Nienhuis FJ, Wiersma D, van de Willige G (2004) Hallucination focused integrative treatment. A randomized controlled trial. Schizophr Bull 30(1):133–145. https://doi.org/10.1093/oxfordjournals.schbul.a007058
Klingberg S, Wölwer W, Engel C, Wittorf A, Herrlich J, Meisner C, Buchkremer G, Wiedemann G (2011) Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy. Results of the randomized clinical TONES study. Schizophr Bull 37(Suppl 2):S98-110. https://doi.org/10.1093/schbul/sbr073
Kråkvik B, Gråwe RW, Hagen R, Stiles TC (2013) Cognitive behaviour therapy for psychotic symptoms. A randomized controlled effectiveness trial. Behav Cogn Psychother 41(5):511–524. https://doi.org/10.1017/S1352465813000258
Kuipers E, Holloway F, Rabe-Hesketh S, Tennakoon L (2004) An RCT of early intervention in psychosis. Croydon outreach and assertive support team (COAST). Soc Psychiatry Psychiatric Epidemiol 39(5):358–363. https://doi.org/10.1007/s00127-004-0754-4
Lee H-J, Lee D-B, Park M-C, Lee S-Y (2014) The effect of group music therapy on the social function and interpersonal relationship in outpatients with schizophrenia. J Korean Neuropsychiatr Assoc 53(1):40. https://doi.org/10.4306/jknpa.2014.53.1.40
Li Z-J, Guo Z-H, Wang N, Xu Z-Y, Qu Y, Wang X-Q, Sun J, Yan L-Q, Ng RMK, Turkington D, Kingdon D (2015) Cognitive-behavioural therapy for patients with schizophrenia. A multicentre randomized controlled trial in Beijing, China. Psychol Med 45(9):1893–1905. https://doi.org/10.1017/S0033291714002992
Lincoln TM, Ziegler M, Mehl S, Kesting M-L, Lüllmann E, Westermann S, Rief W (2012) Moving from efficacy to effectiveness in cognitive behavioral therapy for psychosis. A randomized clinical practice trial. J Consult Clin Psychol 80(4):674–686. https://doi.org/10.1037/a0028665
Martin LAL, Koch SC, Hirjak D, Fuchs T (2016) Overcoming disembodiment. The effect of movement therapy on negative symptoms in schizophrenia-a multicenter randomized controlled trial. Front Psychol 7:483. https://doi.org/10.3389/fpsyg.2016.00483
Matthews JG (1981) The process and outcome of therapy of outpatient schizophrenics by A and B therapists: Does psychotherapy add to the effects of psychopharmacotherapy? [Doctoral dissertation], Auburn University
Montag C, Haase L, Seidel D, Bayerl M, Gallinat J, Herrmann U, Dannecker K (2014) A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes. Feasibility, impact on symptoms and mentalising capacity. PLoS ONE 9(11):e112348. https://doi.org/10.1371/journal.pone.0112348
Morrison AP, Turkington D, Pyle M, Spencer H, Brabban A, Dunn G, Christodoulides T, Dudley R, Chapman N, Callcott P, Grace T, Lumley V, Drage L, Tully S, Irving K, Cummings A, Byrne R, Davies LM, Hutton P (2014) Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs. A single-blind randomised controlled trial. Lancet (London, England) 383(9926):1395–1403. https://doi.org/10.1016/S0140-6736(13)62246-1
Naeem F, Johal R, McKenna C, Rathod S, Ayub M, Lecomte T, Husain N, Kingdon D, Farooq S (2016) Cognitive Behavior Therapy for psychosis based Guided Self-help (CBTp-GSH) delivered by frontline mental health professionals. Results of a feasibility study. Schizophrenia Res 173(1–2):69–74. https://doi.org/10.1016/j.schres.2016.03.003
Ochoa S, Lopez-Carrilero R, Barrigon ML, Pousa E, Barajas A, Lorente-Rovira E, Gonzalez-Higueras F, Grasa E, Ruiz-Delgado I, Cid J, Birules I, Esteban-Pinos I, Casanas R, Luengo A, Torres-Hernandez P, Corripio I, Montes-Gamez M, Beltran M, de Apraiz A, Dominguez-Sanchez L, Sanchez E, Llacer B, Pelaez T, Bogas JL, Moritz S (2017) Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis. Psychol Med. https://doi.org/10.1017/S0033291716003421
Penadés R, Catalán R, Salamero M, Boget T, Puig O, Guarch J, Gastó C (2006) Cognitive remediation therapy for outpatients with chronic schizophrenia. A controlled and randomized study. Schizophrenia Res 87(1–3):323–331. https://doi.org/10.1016/j.schres.2006.04.019
Penn DL, Meyer PS, Evans E, Wirth RJ, Cai K, Burchinal M (2009) A randomized controlled trial of group cognitive-behavioral therapy vs enhanced supportive therapy for auditory hallucinations. Schizophrenia Res 109(1–3):52–59. https://doi.org/10.1016/j.schres.2008.12.009
Pot-Kolder RMCA, Geraets CNW, Veling W, van Beilen M, Staring ABP, Gijsman HJ, Delespaul PAEG, van der Gaag M (2018) Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders A single-blind randomised controlled trial. Lancet Psychiatry 5(3):217–226. https://doi.org/10.1016/S2215-0366(18)30053-1
Richardson P, Jones K, Evans C, Stevens P, Rowe A (2007) Exploratory RCT of art therapy as an adjunctive treatment in schizophrenia. J Ment Health 16(4):483–491. https://doi.org/10.1080/09638230701483111
Schrank B, Brownell T, Jakaite Z, Larkin C, Pesola F, Riches S, Tylee A, Slade M (2016) Evaluation of a positive psychotherapy group intervention for people with psychosis Pilot randomised controlled trial. Epidemiol Psychiatric Sci 25(3):235–246. https://doi.org/10.1017/S2045796015000141
Shawyer F, Farhall J, Mackinnon A, Trauer T, Sims E, Ratcliff K, Larner C, Thomas N, Castle D, Mullen P, Copolov D (2012) A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behav Res Ther 50(2):110–121. https://doi.org/10.1016/j.brat.2011.11.007
Shawyer F, Farhall J, Thomas N, Hayes SC, Gallop R, Copolov D, Castle DJ (2016) Acceptance and commitment therapy for psychosis. Randomised controlled trial. British J Psychiatry 210(2):140–148. https://doi.org/10.1192/bjp.bp.116.182865
Startup M, Jackson MC, Bendix S (2004) North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders. Outcomes at 6 and 12 months. Psychol Med 34(3):413–422. https://doi.org/10.1017/S0033291703001211
Talwar N, Crawford MJ, Maratos A, Nur U, McDermott O, Procter S (2006) Music therapy for in-patients with schizophrenia. Exploratory randomised controlled trial. British J Psychiatry 189:405–409. https://doi.org/10.1192/bjp.bp.105.015073
Tarrier N, Kelly J, Maqsood S, Snelson N, Maxwell J, Law H, Dunn G, Gooding P (2014) The cognitive behavioural prevention of suicide in psychosis. A clinical trial. Schizophrenia Res 156(2–3):204–210. https://doi.org/10.1016/j.schres.2014.04.029
Valencia M, Murow E, Rascon ML (2006) Comparación de tres modalidades de intervención en esquizofrenia: terapia psicosocial, musicoterapia y terapias multiples. [Comparison of three types of treatment for schizophrenia: Psychosocial therapy, music therapy, and multiple therapies]. Revista Latinoamericana de Psicologia 38(3):535–549
van der Gaag M, Stant AD, Wolters KJK, Buskens E, Wiersma D (2011) Cognitive-behavioural therapy for persistent and recurrent psychosis in people with schizophrenia-spectrum disorder. Cost-effectiveness analysis. British J Psychiatry 198(1):59–65. https://doi.org/10.1192/bjp.bp.109.071522
Wang L-Q, Chien WT, Yip LK, Karatzias T (2016) A randomized controlled trial of a mindfulness-based intervention program for people with schizophrenia. 6-month follow-up. Neuropsychiatr Dis Treat 12:3097–3110. https://doi.org/10.2147/NDT.S123239
Wykes T, Hayward P, Thomas N, Green N, Surguladze S, Fannon D, Landau S (2005) What are the effects of group cognitive behaviour therapy for voices? A randomised control trial. Schizophr Res 77(2–3):201–210. https://doi.org/10.1016/j.schres.2005.03.013
Ahuir M, Cabezas Á, Miñano MJ, Algora MJ, Estrada F, Solé M, Gutiérrez-Zotes A, Tost M, Barbero JD, Montalvo I, Sánchez-Gistau V, Monreal JA, Vilella E, Palao D, Labad J (2018) Improvement in cognitive biases after group psychoeducation and metacognitive training in recent-onset psychosis: A randomized crossover clinical trial. Psychiatry Res 270:720–723. https://doi.org/10.1016/j.psychres.2018.10.066
Bozzatello P, Bellino S, de Marzi G, Macrì A, Piterà R, Montemagni C, Rocca P (2019) Effectiveness of psychosocial treatments on symptoms and functional domains in schizophrenia spectrum disorders: a prospective study in a real-world setting. Disabil Rehabil 41(23):2799–2806. https://doi.org/10.1080/09638288.2018.1480666
Chien WT, Cheng HY, McMaster TW, Yip ALK, Wong JCL (2019) Effectiveness of a mindfulness-based psychoeducation group programme for early-stage schizophrenia: An 18-month randomised controlled trial. Schizophr Res 212:140–149. https://doi.org/10.1016/j.schres.2019.07.053
Jong S de, van Donkersgoed RJM, Timmerman ME, Rot M aan het, Wunderink L, Arends J, van der Gaag M, Aleman A, Lysaker PH, Pijnenborg GHM (2019) Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychol Med 49(2):303–313. https://doi.org/10.1017/S0033291718000855
Granholm E, Holden JL, Dwyer K, Link P (2020) Mobile-assisted cognitive-behavioral social skills training in older adults with schizophrenia. J Behav Cogn Ther 30(1):13–21. https://doi.org/10.1016/j.jbct.2020.03.006
Gürcan MB, Yildiz M, Patir K, Demir Y (2021) The effects of narrative and movie therapy on the theory of mind and social functioning of patients with schizophrenia. Noro Psikiyatri Arsivi 58(2):108–114. https://doi.org/10.29399/npa.27291
Ishikawa R, Ishigaki T, Shimada T, Tanoue H, Yoshinaga N, Oribe N, Morimoto T, Matsumoto T, Hosono M (2020) The efficacy of extended metacognitive training for psychosis: A randomized controlled trial. Schizophr Res 215:399–407. https://doi.org/10.1016/j.schres.2019.08.006
Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe SE, French P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TRE, Davies L, Kingdon D, Aydinlar S, Courtley J, Douglas-Bailey M, Graves E, Holden N, Hutton J, Hutton P, Irving S, Jackson C, Lebert T, Mander H, McCartney L, Munro-Clark T, Murphy EK, Spanswick M, Steele A, Tip L, Tully S (2018) Cognitive behavioural therapy in clozapine-resistant schizophrenia (FOCUS): an assessor-blinded, randomised controlled trial. Lancet Psychiatry 5(8):633–643. https://doi.org/10.1016/S2215-0366(18)30184-6
Özdemir AA, Kavak Budak F (2022) The effects of mindfulness-based stress reduction training on hope, psychological well-being, and functional recovery in patients with schizophrenia. Clin Nurs Res 31(2):183–193. https://doi.org/10.1177/10547738211039069
Pos K, Franke N, Smit F, Wijnen BFM, Staring ABP, van der Gaag M, Meijer C, de Haan L, Velthorst E, Schirmbeck F (2019) Cognitive behavioral therapy for social activation in recent-onset psychosis: Randomized controlled trial. J Consult Clin Psychol 87(2):151–160. https://doi.org/10.1037/ccp0000362
Yildiz M, Özaslan Z, İncedere A, Kircali A, Kiras F, İpçi K (2019) The effect of psychosocial skills training and metacognitive training on social and cognitive functioning in schizophrenia. Noro Psikiyatri Arsivi 56(2):139–143. https://doi.org/10.29399/npa.23095
de Pinho LMG, Da Sequeira CAC, Sampaio FMC, Rocha NB, Ozaslan Z, Ferre-Grau C (2021) Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: A randomized controlled trial. J Adv Nurs 77(2):999–1012. https://doi.org/10.1111/jan.14627
Fujii K, Kobayashi M, Funasaka K, Kurokawa S, Hamagami K (2021) Effectiveness of metacognitive training for long-term hospitalized patients with schizophrenia: a pilot study with a crossover design. Asian J Occupat Therapy 17(1):45–52
Penney D, Sauvé G, Mendelson D, Thibaudeau É, Moritz S, Lepage M (2022) Immediate and sustained outcomes and moderators associated with metacognitive training for psychosis: a systematic review and meta-analysis. JAMA Psychiat 79(5):417–429. https://doi.org/10.1001/jamapsychiatry.2022.0277
Cuijpers P, Karyotaki E, Eckshtain D, Ng MY, Corteselli KA, Noma H, Quero S, Weisz JR (2020) Psychotherapy for depression across different age groups: a systematic review and meta-analysis. JAMA Psychiat 77(7):694–702. https://doi.org/10.1001/jamapsychiatry.2020.0164
Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch General Psychiatry 33(6):766–771. https://doi.org/10.1001/archpsyc.1976.01770060086012
Goldman HH, Skodol AE, Lave TR (1992) Revising axis V for DSM-IV: A review of measures of social functioning. Am J Psychiatry. https://doi.org/10.1176/ajp.149.9.1148
Association AP (2013) Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association
Acknowledgements
This work was part of the doctoral dissertation of Sofia Wallis [1]. Part of the data were collected during a project funded by the European Union’s Horizon 2020 Research and Innovation Programme, Marie Skłodowska-Curie (701717). The funder had no role in study design, data collection, analysis, or interpretation, writing of the report or decision to submit the paper for publication.
Funding
Open Access funding enabled and organized by Projekt DEAL. Part of the data were collected during a project funded by the European Union’s Horizon 2020 Research and Innovation Programme, Marie Skłodowska-Curie (701717). The funder had no role in study design, data collection, analysis, or interpretation, writing of the report or decision to submit the paper for publication.
Author information
Authors and Affiliations
Contributions
SW, IB and SL designed the study; IB set up the database; SW, IB, FS, CR and NHS screened the literature search, acquired reports of the relevant trials, identified multiple publications of individual studies, selected included studies and extracted data; SW performed the statistical analyses with input from IB; SW interpreted the data with input from IB and SL; IB and SW wrote the draft and the final version of the manuscript. The present work was part of SW’s doctoral dissertation [1]
Corresponding author
Ethics declarations
Conflict of interest
In the past 3 years, SL has received honoraria for service as a consultant or adviser and/or for lectures from Angelini, Böhringer Ingelheim, Geodon & Richter, Janssen, Johnson&Johnson, Lundbeck, LTS Lohmann, MSD, Otsuka, Recordati, SanofiAventis, Sandoz, Sunovion, TEVA, ROVI and EISAI. IB, SW, CR, FS and NHS declare no competing interests.
Ethics approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Bighelli, I., Wallis, S., Reitmeir, C. et al. Effects of psychological treatments on functioning in people with Schizophrenia: a systematic review and meta-analysis of randomized controlled trials. Eur Arch Psychiatry Clin Neurosci 273, 779–810 (2023). https://doi.org/10.1007/s00406-022-01526-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-022-01526-1