Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis
Open accessAbstract
Psychological treatments are increasingly regarded as useful interventions for schizophrenia. However, a comprehensive evaluation of the available evidence is lacking and the benefit of psychological interventions for patients with current positive symptoms is still debated. The present study aimed to evaluate the efficacy, acceptability and tolerability of psychological treatments for positive symptoms of schizophrenia by applying a network meta‐analysis approach, that can integrate direct and indirect comparisons. We searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Library, World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov for randomized controlled trials of psychological treatments for positive symptoms of schizophrenia, published up to January 10, 2018. We included studies on adults with a diagnosis of schizophrenia or a related disorder presenting positive symptoms. The primary outcome was change in positive symptoms measured with validated rating scales. We included 53 randomized controlled trials of seven psychological interventions, for a total of 4,068 participants receiving the psychological treatment as add‐on to antipsychotics. On average, patients were moderately ill at baseline. The network meta‐analysis showed that cognitive behavioural therapy (40 studies) reduced positive symptoms more than inactive control (standardized mean difference, SMD=−0.29; 95% CI: –0.55 to −0.03), treatment as usual (SMD=−0.30; 95% CI: –0.45 to −0.14) and supportive therapy (SMD=−0.47; 95% CI: –0.91 to −0.03). Cognitive behavioural therapy was associated with a higher dropout rate compared with treatment as usual (risk ratio, RR=0.74; 95% CI: 0.58 to 0.95). Confidence in the estimates ranged from moderate to very low. The other treatments contributed to the network with a lower number of studies. Results were overall consistent in sensitivity analyses controlling for several factors, including the role of researchers’ allegiance and blinding of outcome assessor. Cognitive behavior therapy seems to be effective on positive symptoms in moderately ill patients with schizophrenia, with effect sizes in the lower to medium range, depending on the control condition.
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Even in patients who respond well to traditional treatments, some continue to experience residual symptoms and/or risk of future relapse.
“Furthermore, even in those who respond well to traditional treatments, some continue to experience residual symptoms, and/or a risk of future relapse [35,36,38].”
From Exercise as Medicine for Mental and Substance Use Disorders: A Meta-review of the Benefits for Neuropsychiatric and Cognitive Outcomes (2020) · cites this paper as [38]
The Discussion (page unavailable) says trial participants generally continued antipsychotic medication while receiving interventions for positive symptoms, supporting the point that symptoms can persist during traditional treatment. It does not establish that these patients had responded well to that treatment. The Secondary outcomes section (page unavailable) says very few relapse data were available, so it does not substantiate the relapse-risk part of the claim. (LLM, conf=0.80)
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- Authors
- Bighelli, I., Salanti, G., Huhn, M., Schneider‐Thoma, J., Krause, M., Reitmeir, C., Wallis, S., Schwermann, F., Pitschel‐Walz, G., Barbui, C., Furukawa, T. A., & Leucht, S.
- Affiliations
- TUM Klinikum (DE)
- University of Bern (CH)
- University of Verona (IT)
- Kyoto University (JP)
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2018-09-07
- Volume
- 17
- Issue
- 3
- Pages
- 316-329
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6127754
- OpenAlex
- W2890749013
- Semantic Scholar
- 5bbf1121158fd524ebf7b6536b565c6773be0b80
- Cited by
- 199
- References
- 81
- Citations by year
- 2026: 22 · 2025: 31 · 2024: 32 · 2023: 26 · 2022: 28 · 2021: 19 · 2020: 16 · 2019: 20 · 2018: 5
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Funders
- Horizon 2020 Framework Programme
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, positive symptoms, psychological intervention, cognitive behavioral therapy, supportive therapy, antipsychotic augmentation, treatment efficacy, dropout rates
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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