A systematic scoping review of psychological therapies for psychosis within acute psychiatric in-patient settings
Open accessAbstract
Background: People with psychotic disorders account for most acute admissions to psychiatric wards. Psychological therapies are a treatment adjunct to standard medication and nursing care, but the evidence base for such therapies within in-patient settings is unclear. Aims: To conduct a systematic scoping review of the current evidence base for psychological therapies for psychosis delivered within acute in-patient settings (PROSPERO: CRD42015025623). Method: All study designs, and therapy models, were eligible for inclusion in the review. We searched PubMed, PsycINFO, EThOS, ProQuest, conference abstracts and trial registries. Results: We found 65 studies that met criteria for inclusion in the review, 21 of which were randomised controlled trials (RCTs). The majority of studies evaluated cognitive–behavioural interventions. Quality was variable across all study types. The RCTs were mostly small ( n <25 in the treatment arm), and many had methodological limitations including poorly described randomisation methods, inadequate allocation concealment and non-masked outcome assessments. We found studies used a wide range of different outcome measures, and relatively few studies reported affective symptoms or recovery-based outcomes. Many studies described adaptations to treatment delivery within in-patient settings, including increased frequency of sessions, briefer interventions and use of single-session formats. Conclusions: Based on these findings, there is a clear need to improve methodological rigour within in-patient research. Interpretation of the current evidence base is challenging given the wide range of different therapies, outcome measures and models of delivery described in the literature. Declaration of interest: None.
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Recent systematic reviews and meta-analyses found third-wave therapies superior to guideline-recommended second-wave CBTp for acute psychiatric inpatients with psychosis.
“However, recent systematic reviews and meta-analyses investigating treatment effects for acute psychiatric inpatients with psychosis revealed an outcome superiority of third-wave therapies (5–7) over guideline-recommended second-wave cognitive behavioral therapy for psychosis (CBTp) (3, 4).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [7]
The Discussion (‘Adapting therapy protocols for in-patient settings’; page unavailable) says this was a scoping review, not a synthesis of efficacy data, and that it cannot draw firm conclusions about which interventions are most efficacious. The Results (‘Current state of evidence base’; page unavailable) note an increase in third-wave therapy studies, but do not report their superiority over CBTp. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredMost studies of ACT and Metacognitive Therapy for psychosis were conceptualized for individual therapy and/or outpatients, and most available concepts remain rather unsuitable and demanding for group inpatient settings.
“However, most studies were either conceptualized for individual therapy and/or outpatients (5–7) with most available concepts still rather unsuitable and demanding for group inpatient settings.”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [7]
The Discussion (Therapy delivery; page unavailable) describes practical and methodological challenges for inpatient groups, and the Discussion (Adapting therapy protocols for in-patient settings; page unavailable) says most reviewed therapies were adapted for inpatient delivery. But the Results (Review Question 4; page unavailable) report group therapy more often than individual therapy (27 versus 19 studies). The review does not establish that most ACT or metacognitive-therapy studies were designed for individual or outpatient care, or that most concepts are unsuitable for inpatient groups. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMEBASp is a low-threshold transdiagnostic and modularized group therapy that focuses on symptom and distress reduction and responds to a central priority of health care services to develop, test and offer effective and needs-oriented care for acute inpatients with psychosis.
“MEBASp is a low-threshold transdiagnostic and modularized group therapy that focuses on symptom and distress reduction and responds to a central priority of health care services to develop, test and offer effective and needs-oriented care for acute inpatients with psychosis (5–7).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [7]
Split into 2 atoms — 1 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
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 Jacobsen et al., 2018
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 Jacobsen 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 Jacobsen et al., 2018
Evidence is based on a small number of RCTs with heterogeneous study conditions and methodological shortcomings.
“Until now, evidence is based on a small number of randomized controlled trials (RCTs) with relatively heterogeneous study conditions and methodological shortcomings (5–7).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [7]
CBTp is recommended in the outpatient clinic in Sweden and internationally.
“CBTp is recommended in the outpatient clinic in Sweden (Socialstyrelsen, 2018) and internationally (Jacobsen et al., 2018; National Institute for Health and Care Excellence [NICE], 2014).”
From Acceptance and Commitment Therapy for inpatients with psychosis –an acceptability and feasibility single case AB designed study (2022) · cites this paper as Jacobsen et al., 2018
A total sample size of N=50 was determined conservatively, reflecting recommendations of n=12-28 participants per study arm in pilot trials.
“A total sample size of N = 50 participants was determined conservatively, reflecting recommendations of n = 12-28 participants per study arm in pilot trials.46,47”
From Yoga-Based Group Intervention for Inpatients with Schizophrenia Spectrum Disorders—Feasibility, Acceptability, and Preliminary Outcomes of a Rater-Blinded Randomized Controlled Trial. (2026) · cites this paper as [46]
The Results section (Review Question 2; page unavailable) reports that 10 of 19 published RCTs had fewer than 25 people in the treatment arm. It does not give a recommended pilot-trial sample size of 12–28 per arm or explain a decision to recruit 50 participants. Searches for those numbers and for pilot-trial sample-size recommendations found no supporting passage. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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- Authors
- Jacobsen, P., Hodkinson, K., Peters, E., & Chadwick, P.
- Affiliations
- King's College London (GB)
- Webster Vienna Private University (AT)
- Corresponding author
- Jacobsen, Pamela
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2018-06-26
- Volume
- 213
- Issue
- 2
- Pages
- 490-497
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC6054872
- OpenAlex
- W2810565381
- Cited by
- 49
- References
- 75
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 12 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 7 · 2019: 3 · 2018: 1
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- www.cambridge.org/core/terms (unspecified)
- Locations
- The British Journal of Psychiatry (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Research Portal (King's College London) (acceptedVersion, public-domain)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Pure (University of Bath) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (DRF-2014-07-003)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- psychosis, psychotherapy, cognitive-behavioural intervention, adjunct treatment, methodological quality, outcome measures, single-session intervention
- MeSH terms
- Hospitalization, Humans, Psychotic Disorders, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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