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. Psychological treatments in schizophrenia: I. meta-analysis of family intervention and cognitive behaviour therapy.
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Background. While there is a growing body of evidence on the efficacy of psychological interventions for schizophrenia, this meta-analysis improves upon previous systematic and meta-analytical reviews by including a wider range of randomized controlled trials and providing comparisons against both standard care and other active interventions. Method. Literature searches identified randomized controlled trials of four types of psychological interventions: family intervention, cognitive behavioural therapy (CBT), social skills training and cognitive remediation. These were then subjected to meta-analysis on a variety of outcome measures. This paper presents results relating to the first two. Results. Family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication compliance. CBT produced higher rates of ‘important improvement’ in mental state and demonstrated positive effects on continuous measures of mental state at follow-up. CBT also seems to be associated with low drop-out rates. Conclusions. Family intervention should be offered to people with schizophrenia who are in contact with carers. CBT may be useful for those with treatment resistant symptoms. Both treatments, in particular CBT, should be further investigated in large trials across a variety of patients, in various settings. The factors mediating treatment success in these interventions should be researched.
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“These findings are consistent with previous studies of acceptance and commitment therapy for psychosis.”
From Acceptance-based Behavior Therapy for Depression With Psychosis (2015) · cites this paper as [60]
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“A recent meta-analysis of mindfulness/acceptance interventions for psychosis showed that these treatments are most effective for distress related to psychosis and negative or affective symptoms.60,61”
From Acceptance-based Behavior Therapy for Depression With Psychosis (2015) · cites this paper as [60]
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Cognitive-Behavioral Therapy for Schizophrenia: A Review
Turkington, D., Dudley, R. E. J., Warman, D. M., & Beck, A. T. (2004) · Journal of Psychiatric Practice · doi:10.1097/00131746-200401000-00002 · Cited by 154
Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J., & Mehta, R. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.bp.105.010884 · Cited by 151
Jackson, H. J., McGorry, P. D., Killackey, E. J., Bendall, S., Allott, K., Dudgeon, P., Gleeson, J., Johnson, T., & Harrigan, S. (2007) · Psychological Medicine · doi:10.1017/s0033291707002061 · Cited by 149
“CBT is clearly supported for chronic treatment-resistant patients (Pilling et al. 2002 ; Zimmerman et al. 2005).”
BackgroundTreating trauma in psychosis with EMDR: A pilot study
van den Berg, D. P. G., & van der Gaag, M. (2011) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2011.09.011 · Cited by 165
“Symptoms decrease as a consequence of treatment (Jones, Cormac, Silveira da Mota Neto, & Campbell, 2010; NICE, 2010; Pilling et al., 2002; Tarrier, 2005).”
BackgroundChien, W. T., Leung, S. F., Yeung, F. K. K., & Wong, W. K. (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s49263 · Cited by 157
“22,23 Although CBT for schizophrenia was mainly designed with an individual treatment, there has been some evidence its group delivery may be more cost-effective.”
Jansen, J. E., Gleeson, J., Bendall, S., Rice, S., & Alvarez-Jimenez, M. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2019.11.016 · Cited by 144
The effectiveness of family therapy and systemic interventions for adult‐focused problems
Carr, A. (2008) · Journal of Family Therapy · doi:10.1111/j.1467-6427.2008.00452.x · Cited by 146
“(2006) conducted a review of three meta-analyses of psychoeducational family therapy (Pharoah et al., 2006; Pilling et al., 2002; Pitschel-Walz et al., 2001) and a new meta-analysis of the thirtyone most methodologically robust available randomized controlled Effectiveness of family therapy for adults 61”
MethodEarly Intervention for Psychosis
Iyer, S. N., Jordan, G., MacDonald, K., Joober, R., & MALLA, A. K. (2015) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000288 · Cited by 146
Religion, Culture and Mental Health
Loewenthal, K. M. (2006) · Cambridge University Press eBooks · doi:10.1017/cbo9780511490125 · Cited by 145
Computerized cognitive remediation improves verbal learning and processing speed in schizophrenia
Sartory, G., Zorn, C., Groetzinger, G., & Windgassen, K. (2004) · Schizophrenia Research · doi:10.1016/j.schres.2004.10.004 · Cited by 145
“In their metaanalysis of the effect of cognitive remediation in schizophrenia, Pilling et al. (2002a,b) concluded that there was no benefit to verbal memory.”
BackgroundResultA Randomized Experimental Investigation of Reasoning Training for People With Delusions
Ross, K., Freeman, D. H., Dunn, G., & Garety, P. A. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbn165 · Cited by 150
Self-citationIntegrated treatment of first-episode psychosis: effect of treatment on family burden
Jeppesen, P., Petersen, L., Thorup, A. A. E., Abel, M.-B., ⊘ehlenschlæger, J., Christensen, T. Ø., Krarup, G., Hemmingsen, R., J⊘rgensen, P., & Nordentoft, M. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.187.48.s85 · Cited by 142
What are the effects of group cognitive behaviour therapy for voices? A randomised control trial
Wykes, T., Hayward, P., Thomas, N., Green, N. H., Surguladze, S., Fannon, D. G., & Landau, S. (2005) · Schizophrenia Research · doi:10.1016/j.schres.2005.03.013 · Cited by 141
“Meta-analyses of individual CBT for the positive symptoms of psychosis support a significant treatment effect (Pilling et al., 2002; Gould et al., 2001) and there would have to be at least 50 unpublished trials to seriously affect this positive benefit (Tarrier and Wykes, 2004).”
BackgroundPERLICK, D. A., Rosenheck, R. A., Clarkin, J. F., Maciejewski, P. K., Sirey, J. A., Struening, E. L., & Link, B. G. (2004) · Psychiatric Services · doi:10.1176/appi.ps.55.9.1029 · Cited by 142
Klingberg, S., Wölwer, W., Engel, C., Wittorf, A., Herrlich, J., Meisner, C., Buchkremer, G., & Wiedemann, G. (2011) · Schizophrenia Bulletin · doi:10.1093/schbul/sbr073 · Cited by 140
Shawyer, F., Farhall, J., Mackinnon, A., Trauer, T., Sims, E., Ratcliff, K., Larner, C., Thomas, N., Castle, D., Mullen, P., et al. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.11.007 · Cited by 137
“, 2007) which are considerably lower than the review on which our power calculation was based (Rector & Beck, 2001) as well as others at the time (e.g., Gould, Mueser, Bolton, Mays, & Goff, 2001; Pilling et al., 2002).”
BackgroundSalisbury, T. T., Killaspy, H. T., Wright, C., Turton, P., White, S. J., Kallert, T. W., Schuster, M., Cervilla, J. A., Brangier, P., Raboch, J., et al. (2009) · BMC Psychiatry · doi:10.1186/1471-244x-9-55 · Cited by 134
“... (including psychoeducation, crisis management work and problem solving) for people with a diagnosis of schizophrenia reduce the risk of relapse (n = 3838, effect size 0.42, CI 0.35, 0.49) [40] and readmission (6-12 month follow-up: n = 3789, effect size 0.22, CI 0.14, 0.29; 18-24 month follow-up: n = 445, effect s…”
BackgroundInfluentialGroup cognitive-behavioural therapy for schizophrenia
Barrowclough, C., Haddock, G., Lobban, F. A., Jones, S. H., Siddle, R., Roberts, C., & Gregg, L. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.021386 · Cited by 130
An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges
Frost, B. G., Tirupati, S., Johnston, S., Turrell, M., Lewin, T. J., Sly, K. A., & Conrad, A. M. (2017) · BMC Psychiatry · doi:10.1186/s12888-016-1164-3 · Cited by 158
“Additional interventions with an evidence base included: motivational interviewing reviewed by [83, 84]; errorless learning [85]; skill building reviewed by [86]; and family interventions reviewed by [87].”
BackgroundPsychiatric rehabilitation today: an overview.
Wulf Rössler, A. (2006) · Europe PMC (PubMed Central) · Cited by 129
Adjunctive psychosocial therapies for the treatment of schizophrenia
Patterson, T. L., & Leeuwenkamp, O. R. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2007.12.468 · Cited by 130
“These findings have been confirmed by metaanalyses (Pfammatter et al., 2006; Pilling et al., 2002; Pitschel-Walz et al., 2001).”
BackgroundResultInfluentialCognitive Behavioral Therapy for Schizophrenia
Rathod, S., Phiri, P., & Kingdon, D. (2010) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.04.009 · Cited by 132
van der Gaag, M. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl027 · Cited by 127
First-Episode Psychosis, Early Intervention, and Outcome: What Have We Learned?
Malla, A., Norman, R., & Joober, R. (2005) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674370505001402 · Cited by 134
Challenges in the Treatment of Major Depressive Disorder With Psychotic Features
Rothschild, A. J. (2013) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt046 · Cited by 133
Chien, W. T., Chan, S. W., & Thompson, D. R. (2006) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.105.008375 · Cited by 125
Two years of continued early treatment for recent‐onset schizophrenia: a randomised controlled study
Gråwe, R. W., Falloon, I. R. H., Widen, J. H., & Skogvoll, E. (2006) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2006.00799.x · Cited by 124
A systematic review and meta-analysis of low intensity CBT for psychosis
Hazell, C. M., Hayward, M., Cavanagh, K., & Strauss, C. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.03.004 · Cited by 120
“A number of meta-analyses demonstrate benefits of cognitive behavioral therapy for psychosis (CBTp) (Gould, Mueser, Bolton, Mays, & Goff, 2001; Jauhar et al., 2014; Pfammatter, 2011; Pilling et al., 2002; Wykes, Steel, Everitt, & Tarrier, 2008; Zimmerman, Favrod, Trieu, & Pomini, 2005).”
Solmi, M., Croatto, G., Piva, G., Rosson, S., Fusar-Poli, P., Rubio, J. M., Carvalho, A. F., Vieta, E., Arango, C., DeTore, N. R., et al. (2023) · Molecular Psychiatry · doi:10.1038/s41380-022-01727-z · Cited by 147
“7 % Pilling 2002a[49] FI-m Mixed 0 2 0 1 0 0 3 5 8 L NA NA Pilling 2002b[77] SST, CRT Mixed 0 0 0 1 0 0 1 3 4 L NA NA Pina 2020[89] Positive psychology interventions TAU 0 0 0 0 0 0 0 7 7 L NA NA Polese 2019[78] CBT TAU 0 1 0 0 1 1 3 10 13 L NA NA Prikken 2018[52] CCDPT Active 0 2 0 0 1 1 4 10 14 M 6 / 24 25.”
Hassan, A. N., & Luca, V. D. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.10.048 · Cited by 121
“CBT has been used to improve the outcome of treatment resistant patients and was found to be effective in improving the mental state and reducing symptom severity (Sensky et al., 2000; Pilling et al., 2002).”
Method
Metadata
- Authors
- PILLING, S., BEBBINGTON, P., KUIPERS, E., GARETY, P., GEDDES, J., ORBACH, G., & MORGAN, C.
- Affiliations
- St Thomas' Hospital (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2002-07
- Volume
- 32
- Issue
- 5
- Pages
- 763-782
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2160436994
- Cited by
- 887
- References
- 62
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 8 · 2023: 13 · 2022: 10 · 2021: 52 · 2020: 29 · 2019: 24 · 2018: 17 · 2017: 20 · 2016: 32 · 2015: 25 · 2014: 37 · 2013: 41 · 2012: 55
- FWCI
- 8.31
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Counseling, Therapy, and Family Dynamics
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- schizophrenia, family intervention, family therapy, cognitive behavioral therapy, social skills training, cognitive remediation, psychotic relapse, hospital readmission, medication adherence, treatment discontinuation, caregivers, treatment-resistant symptoms
- MeSH terms
- Adolescent, Adult, Family Therapy, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Schizophrenia, Schizophrenic Psychology, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic
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