Psychological therapy for inpatients receiving acute mental health care: A systematic review and meta‐analysis of controlled trials
Open accessAbstract
OBJECTIVES: The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates. METHOD: A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms 'inpatient', 'psychological therapy', and 'acute'. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses. RESULTS: Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant. CONCLUSIONS: The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format, and intensity of brief psychological therapy is required to achieve sustained benefits. PRACTITIONER POINTS: Clinical implications: This review provides the first meta-analytical synthesis of brief psychological therapy delivered in acute psychiatric inpatient settings. This review suggests that brief psychological therapy may be associated with reduced emotional distress and readmissions. LIMITATIONS: The evidence in this review is of limited quality. The type, format, and intensity of brief psychological therapy required to achieve sustained benefits are yet to be established.
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Both recent systematic reviews concluded that psychological interventions show promise in this setting but there needs to be a standardised approach to the delivery and evaluation of interventions.
“Both concluded that psychological interventions show promise in this setting but there needs to be a standardised approach to the delivery and evaluation of interventions.”
From A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis (2020) · cites this paper as Paterson et al., 2018
The Conclusions report improvements associated with psychological therapy for acute psychiatric inpatients and call for more rigorous trials to establish the effective type, format and intensity of therapy. The paper does not specifically call for a standardised approach to delivering and evaluating interventions; its recommendations are for better-quality trials and further study of therapy components. (LLM, conf=0.82)
Experimental — accuracy not yet measuredResults from RCTs are not fully generalizable to clinical practice.
“Due to various methodological aspects (e.g. often less severely ill patients who suffer from one defined disorder), results from RCTs are not fully generalizable to clinical practice (Paterson et al., 2018).”
From A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders (2021) · cites this paper as Paterson et al., 2018
The Introduction says single-blind RCT findings in acute inpatient mental health care may have limited external validity because very unwell patients may not participate or may be excluded. That supports the concern about generalizability, but the paper treats it as a possibility in this setting, not an established limitation of RCTs generally. Its Method says no restriction was placed on diagnosis, so it does not support the example of patients having one defined disorder. (LLM, conf=0.86)
Experimental — accuracy not yet measuredRandomised controlled trials (RCTs) of psychological therapies for psychosis with the acute inpatient population so far appears to be limited.
“Randomised controlled trials (RCTs) of psychological therapies for psychosis with the acute inpatient population so far appears to be limited.”
From A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis (2020) · cites this paper as Paterson et al., 2018
Six further studies were identified from the four examined review papers, and one identified from already included study references.
“Six further studies were identified from the four examined review papers (Paterson et al., 2018, Whittington et al., in prep, Wykes et al., 2008, Jacobsen et al., 2018), and one identified from already included study references.”
From A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis (2020) · cites this paper as Paterson et al., 2018
Two recent systematic reviews have been conducted of inpatient psychological interventions; one scoping review, and one systematic review and meta-analysis of both randomised and non-randomised studies.
“Two recent systematic reviews have been conducted of inpatient psychological interventions; one scoping review (Jacobsen et al., 2018), and one systematic review and meta-analysis of both randomised and non-randomised studies (Paterson et al., 2018).”
From A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis (2020) · cites this paper as Paterson et al., 2018
The large and stable improvements in depressive symptoms across both therapy conditions are comparable to those of the effectiveness trial of ACT for inpatients by Benoy et al., 2019 and larger than those effect sizes reported in the most recently published meta-analysis of psychotherapy for inpatients.
“The large and stable improvements in depressive symptoms across both therapy conditions are comparable to those of the effectiveness trial of ACT for inpatients by Benoy et al., 2019 and larger than those effect sizes reported in the most recently published meta-analysis of psychotherapy for inpatients (Paterson et al., 2018; Schefft et al., 2019).”
From A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders (2021) · cites this paper as Paterson et al., 2018
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“In summary, most research on ACT has been performed with RCTs. Due to various methodological aspects (e.g. often less severely ill patients who suffer from one defined disorder), results from RCTs are not fully generalizable to clinical practice (Paterson et al., 2018).”
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- Authors
- Paterson, C., Karatzias, T., Dickson, A., Harper, S., Dougall, N., & Hutton, P.
- Affiliations
- Edinburgh Napier University (GB)
- NHS Lothian (GB)
- Glasgow Caledonian University (GB)
- Corresponding author
- Paterson, Charlotte
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2018-04-16
- Volume
- 57
- Issue
- 4
- Pages
- 453-472
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W2802226128
- Cited by
- 69
- References
- 17
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 12 · 2023: 8 · 2022: 13 · 2021: 10 · 2020: 8 · 2019: 1 · 2018: 4
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline (Glasgow Caledonian University) (acceptedVersion, other-oa)
- ResearchOnline (submittedVersion, other-oa)
- Research Output (Edinburgh Napier University) (submittedVersion, cc-by)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- psychotherapy, acute psychiatric inpatients, psychotic symptoms, hospital readmission, depression, anxiety, emotional distress, internal validity, generalizability, treatment effectiveness
- MeSH terms
- Adult, Anxiety, Depression, Humans, Inpatients, Mental Health, Psychotherapy, Single-Blind Method, Controlled Clinical Trials as Topic
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