Skip to main content
×
×
Home

Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

  • Danyael Lutgens (a1), Genevieve Gariepy (a2) and Ashok Malla (a3)
Abstract
Background

Negative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.

Aims

To conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.

Method

We searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.

Results

A total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive–behavioural therapy (pooled SMD –0.34, 95% CI –0.55 to –0.12), skills-based training (pooled SMD –0.44, 95% CI –0.77 to –0.10), exercise (pooled SMD –0.36, 95% CI –0.71 to –0.01), and music treatments (pooled SMD –0.58, 95% CI –0.82 to –0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD –0.38, 95% CI –0.53 to –0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.

Conclusions

Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis
      Available formats
      ×
Copyright
Corresponding author
Ashok Malla, Department of Psychiatry, Douglas Mental Health University Institute, ACCESS-Canada Pavilion, 6625 LaSalle Boulevard, Montréal, Quebec, H4H 1R3, Canada. Email: ashok.malla@mcgill.ca
Footnotes
Hide All

Declaration of interest

None

Footnotes
References
Hide All
1 Ho, BC, Nopoulos, P, Flaum, M, Arndt, S, Andreasen, NC. Two-year outcome in first-episode schizophrenia: predictive value of symptoms for quality of life. Am J Psychiatry 1998; 155: 1196–201.
2 Rabinowitz, J, Levine, SZ, Garibaldi, G, Bugarski-Kirola, D, Berardo, CG, Kapur, S. Negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: analysis of CATIE data. Schizophr Res 2012; 137: 147–50.
3 Jordan, G, Lutgens, D, Joober, R, Lepage, M, Iyer, SN, Malla, A. The relative contribution of cognition and symptomatic remission to functional outcome following treatment of a first episode of psychosis. Clin Psychiatry 2014; 75: e55672.
4 Carpenter, WT, Heinrichs, DW Wagman, AMI. Deficit and nondeficit forms of schizophrenia – the concept. Am J Psychiatry 1988; 145: 578–83.
5 Malla, AK, Takhar, JJ, Norman, RM, Manchanda, R, Cortese, L, Haricharan, R, et al. Negative symptoms in first episode non-affective psychosis. Acta Psychiatr Scand 2002; 105: 431–9.
6 Kirkpatrick, B, Buchanan, RW, Ross, DE, Carpenter, WT Jr. A separate disease within the syndrome of schizophrenia. Arch Gen Psychiatry 2001; 58: 165–71.
7 Buchanan, RW. Persistent negative symptoms in schizophrenia: an overview. Schizophr Bull 2007; 33: 1013–22.
8 Arango, C, Garibaldi, G, Marder, SR. Pharmacological approaches to treating negative symptoms: a review of clinical trials. Schizophr Res 2013; 150: 346–52.
9 Buchanan, RW, Kreyenbuhl, J, Kelly, DL, Noel, JM, Boggs, DL, Fischer, BA, et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2010; 36: 7193.
10 National Collaborating Centre for Mental Health. Schizophrenia-Core Interventions in the Treatment and Management of Schizophrenia in Primary Care. NICE, 2002.
11 Pilling, S, Bebbington, P, Kuipers, E, Garety, P, Geddes, J, Orbach, G, et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 2002; 32: 763–82.
12 Vancampfort, D, Probst, M, Helvik Skjaerven, L, Catalán-Matamoros, D, Lundvik-Gyllensten, A, Gómez-Conesa, A, et al. Systematic review of the benefits of physical therapy within a multidisciplinary care approach for people with schizophrenia. Phys Ther 2012; 92: 1123.
13 Jauhar, S, McKenna, PJ, Radua, J, Fung, E, Salvador, R, Laws, KR. Cognitive–behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry 2014; 204: 20–9.
14 Bird, V, Premkumar, P, Kendall, T, Whittington, C, Mitchell, J, Kuipers, E. Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 2010; 197: 350–6.
15 Fusar-Poli, P, Papanastasiou, E, Stahl, D, Rocchetti, M, Carpenter, WT, Shergill, S, et al. Treatments of negative symptoms in schizophrenia: meta-analysis of 168 randomized placebo-controlled trials. Schizophr Bull 2015; 41: 892–9.
16 Elis, O, Caponigro, JM, Kring, AM. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clin Psychol Rev 2013; 33: 914–28.
17 Evidence Partners. DistillerSR. Evidence Partners, 2011.
18 Pai, M, McCulloch, M, Gorman, JD, Pai, N, Enanoria, W, Kennedy, G, et al. Systematic reviews and meta-analyses: an illustrated, step-by-step guide. Natl Med J India 2003; 17: 8695.
19 Guyatt, G, Rennie, D. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, Vol 706. AMA Press, 2002.
20 Centre for Reviews and Dissemination. Undertaking Systematic Reviews of Research on Effectiveness: CRD's Guidance for Carrying Out or commissioning Reviews. NHS Centre for Reviews and Dissemination, 2001
21 Higgins, JP, Green, S. Cochrane Handbook for Systematic Reviews of Interventions, Vol 5. Wiley Online Library, 2008.
22 Sedgwick, P, Marston, L. Meta-analyses: standardised mean differences. BMJ 2013. 347: f7257.
23 Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–9.
24 Farhall, J, Freeman, NC, Shawyer, F, Trauer, T. An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis. Br J Clin Psychol 2009; 48: 4762.
25 Granholm, E, Holden, J, Link, PC, McQuaid, JR. Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: improvement in functioning and experiential negative symptoms. J Consult Clin Psychol 2014; 82: 1173–85.
26 Gumley, A, O'Grady, M, McNay, L, Reilly, J, Power, K, Norrie, J. Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychol Med 2003; 33: 419–31.
27 Jackson, H, McGorry, PD, Killackey, E, Bendall, S, Allott, K, Dudgeon, P. Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus befriending for first-episode psychosis: the ACE project. Psychol Med 2008; 38: 725–35.
28 Klingberg, S, Wittorf, A, Fischer, A, Jakob-Deters, K, Buchkremer, G, Wiedemann, G. Evaluation of a cognitive behaviourally oriented service for relapse prevention in schizophrenia. Acta Psychiatr Scand 2010; 121: 340–50.
29 Klingberg, S, Wölwer, W, Engel, C, Wittorf, A, Herrlich, J, Meisner, C, et al. Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study. Schizophr Bull 2011; 37 (suppl 2): S98110.
30 Morrison, AP, Turkington, D, Pyle, M, Spencer, H, Brabban, A, Dunn, G, et al. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. Lancet 2014; 383: 1395–403.
31 Sensky, T, Turkington, D, Kingdon, D, Scott, JL, Scott, J, Siddle, R, et al. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry 2000; 57: 165–72.
32 Turkington, D, Kingdon, D, Rathod, S, Hammond, K, Pelton, J, Mehta, R. Outcomes of an effectiveness trial of cognitive–behavioural intervention by mental health nurses in schizophrenia. Br J Psychiatry 2006; 189: 3640.
33 Turkington, D, Kingdon, D. Cognitive–behavioural techniques for general psychiatrists in the management of patients with psychoses. Br J Psychiatry 2000; 177: 101–6.
34 Malik, N, Kingdon, D, Pelton, J, Mehta, R, Turkington, D. Effectiveness of brief cognitive-behavioral therapy for schizophrenia delivered by mental health nurses: relapse and recovery at 24 months. J Clin Psychiatry 2009; 70: 201–7.
35 Barrowclough, C, Haddock, G, Lobban, F, Jones, S, Siddle, R, Roberts, C, et al. Group cognitive–behavioural therapy for schizophrenia. Br J Psychiatry 2006; 189: 527–32.
36 Cather, C, Penn, D, Otto, MW, Yovel, I, Mueser, KT, Goff, DC. A pilot study of functional cognitive behavioral therapy (fCBT) for schizophrenia. Schizophr Res 2005; 74: 201–9.
37 Drury, V, Birchwood, M, Cochrane, R, Macmillan, F. Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. Br J Psychiatry 1996; 169: 593601.
38 Drury, V, Birchwood, M, Cochrane, R. Cognitive therapy and recovery from acute psychosis: a controlled trial. Br J Psychiatry 2000; 177: 814.
39 Grant, PM, Huh, GA, Perivoliotis, D, Stolar, NM, Beck, AT. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch Gen Psychiatry 2012; 69: 121–7.
40 Hall, PL, Tarrier, N. The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behav Res Therapy 2003; 41: 317–32.
41 Kråkvik, B, Gråwe, RW, Hagen, R, Stiles, TC. Cognitive behaviour therapy for psychotic symptoms: a randomized controlled effectiveness trial. Behav Cogn Psychother 2013; 41: 511–24.
42 Leclerc, C, Lesage, AD, Ricard, N, Lecomte, T, Cyr, M. Assessment of a new rehabilitative coping skills module for persons with schizophrenia. Am J Orthopsychiatry 2000; 70: 380–8.
43 Lecomte, T, Leclerc, C, Wykes, T. Group CBT for early psychosis—are there still benefits one year later? Int J Group Psychother 2012; 62: 309–21.
44 Lecomte, T, Leclerc, C, Corbière, M, Wykes, T, Wallace, CJ, Spidel, A. Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. J Nerv Ment Dis 2008; 196: 866–75.
45 Li, ZJ, Guo, ZH, Wang, N, Xu, ZY, Qu, Y, Wang, XQ, et al. Cognitive–behavioural therapy for patients with schizophrenia: a multicentre randomized controlled trial in Beijing, China. Psychol Med 2015; 45: 1893–905.
46 Lincoln, TM, Ziegler, M, Mehl, S, Kesting, ML, Lüllmann, E, Westermann, S, et al. Moving from efficacy to effectiveness in cognitive behavioral therapy for psychosis: a randomized clinical practice trial. J Consult Clin Psychol 2012; 80: 674–86.
47 Naeem, F, Saeed, S, Irfan, M, Kiran, T, Mehmood, N, Gul, M, et al. Brief culturally adapted CBT for psychosis (CaCBTp): a randomized controlled trial from a low income country. Schizophr Res 2015; 164: 143–8.
48 Peters, E, Landau, S, McCrone, P, Cooke, M, Fisher, P, Steel, C, et al. A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatr Scand 2010; 122: 302–18.
49 Rector, NA, Seeman, MV, Segal, ZV. Cognitive therapy for schizophrenia: a preliminary randomized controlled trial. Schizophr Res 2003; 63: 111.
50 Startup, M, Jackson, MC, Evans, KE, Bendix, S. North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: two-year follow-up and economic evaluation. Psychol Med 2005; 35: 1307–16.
51 Tarrier, N, Lewis, S, Haddock, G, Bentall, R, Drake, R, Kinderman, P, et al. Cognitive–behavioural therapy in first-episode and early schizophrenia. Br J Psychiatry 2004; 184: 231–9.
52 Tarrier, N, Kinney, C, McCarthy, E, Humphreys, L, Wittkowski, A, Morris, J. Two-year follow-up of cognitive–behavioral therapy and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia. J Consult Clin Psychol 2000; 68: 917–22.
53 Valmaggia, LR, van der Gaag, M, Tarrier, N, Pijnenborg, M, Slooff, CJ. Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication. Randomised controlled trial. Br J Psychiatry 2005; 186: 324–30.
54 Turkington, D, Sensky, T, Scott, J, Barnes, TR, Nur, U, Siddle, R, et al. A randomized controlled trial of cognitive-behavior therapy for persistent symptoms in schizophrenia: a five-year follow-up. Schizophr Res 2008; 98: 17.
55 Bartels, SJ, Pratt, SI, Mueser, KT, Forester, BP, Wolfe, R, Cather, C, et al. Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. Am J Geriatr Psychiatry 2014; 22: 1251–61.
56 Valencia, M, Rascon, ML, Juarez, F, Murow, E. A psychosocial skills training approach in Mexican out-patients with schizophrenia. Psychol Med 2007; 37: 1393–402.
57 Roberts, DL, Combs, DR, Willoughby, M, Mintz, J, Gibson, C, Rupp, B, et al. A randomized, controlled trial of Social Cognition and Interaction Training (SCIT) for outpatients with schizophrenia spectrum disorders. Br J Clin Psychol 2014; 53: 281–98.
58 Horan, WP, Rassovsky, Y, Kern, RS, Lee, J, Wynn, JK, Green, MF. Further support for the role of dysfunctional attitudes in models of real-world functioning in schizophrenia. J Psychiatr Res 2010; 44: 499505.
59 Hayes, RL, Halford, WK, Varghese, FT. Social skills training with chronic schizophrenic patients: effects on negative symptoms and community functioning. Behav Ther 1995; 26: 433–49.
60 Li, F, Wang, M. A behavioural training programme for chronic schizophrenic patients: a three-month randomised controlled trial in Beijing. Br J Psychiatry 1994; 165 (suppl 24): 32–7.
61 Dobson, DJ, McDougall, G, Busheikin, J, Aldous, J. Effects of social skills training and social milieu treatment on symptoms of schizophrenia. Psychiatr Serv 1995; 46: 376–80.
62 Xiang, Y, Weng, Y, Li, W, Gao, L, Chen, G, Xie, L, et al. Training patients with schizophrenia with the community re-entry module. Social Psychiatry Psychiatr Epidemiol 2006; 41: 464–9.
63 Lin, EC, Chan, CH, Shao, WC, Lin, MF, Shiau, S, Mueser, KT, et al. A randomized controlled trial of an adapted illness management and recovery program for people with schizophrenia awaiting discharge from a psychiatric hospital. Psychiatr Rehab J 2013; 36: 243–9.
64 Gil-Sanz, D, Diego-Lorenzo, M, Bengochea-Seco, R, Arrieta-Rodríguez, M, Lastra-Martínez, I, Sánchez-Calleja, R, et al. Efficacy of a social cognition training program for schizophrenic patients: a pilot study. Span J Psychol 2009; 12: 184–91.
65 Rus-Calafell, M, Gutiérrez-Maldonado, J, Ortega-Bravo, M, Ribas-Sabaté, J, Caqueo-Urízar, A, et al. A brief cognitive–behavioural social skills training for stabilised outpatients with schizophrenia: a preliminary study. Schizophr Res 2013; 143: 327–36.
66 Cook, S, Chambers, E, Coleman, JH. Occupational therapy for people with psychotic conditions in community settings: a pilot randomized controlled trial. Clin Rehab 2009; 23: 4052.
67 Tatsumi, E, Yotsumoto, K, Nakamae, T, Hashimoto, T. Effects of occupational therapy on hospitalized chronic schizophrenia patients with severe negative symptoms. Kobe J Med Sci 2011; 57: E14554.
68 Foruzandeh, N, Parvin, N. Occupational therapy for inpatients with chronic schizophrenia: a pilot randomized controlled trial. Japan J Nurs Sci 2013; 10: 136–41.
69 Hansen, JP, Østergaard, B, Nordentoft, M, Hounsgaard, L. Cognitive adaptation training combined with assertive community treatment: A randomised longitudinal trial. Schizophr Res 2012; 135: 105111.
70 Quee, PJ, Stiekema, AP, Wigman, JT, Schneider, H, van der Meer, L, Maples, NJ, et al. Improving functional outcomes for schizophrenia patients in the Netherlands using cognitive adaptation training as a nursing intervention – a pilot study. Schizophr Res 2014; 158: 120–5.
71 Bio, DS, Gattaz, WF. Vocational rehabilitation improves cognition and negative symptoms in schizophrenia. Schizophr Res 2011; 126: 265–9.
72 Farreny, A, Aguado, J, Ochoa, S, Huerta-Ramos, E, Marsà, F, López-Carrilero, R, et al. REPYFLEC cognitive remediation group training in schizophrenia: looking for an integrative approach. Schizophr Res 2012; 142: 137–44.
73 Cella, M, Reeder, C, Wykes, T. It is all in the factors: effects of cognitive remediation on symptom dimensions. Schizophr Res 2014; 156: 60–2.
74 Penadés, R, Catalán, R, Salamero, M, Boget, T, Puig, O, Guarch, J, et al. Cognitive remediation therapy for outpatients with chronic schizophrenia: a controlled and randomized study. Schizophr Res 2006; 87: 323–31.
75 Sánchez, P, Peña, J, Bengoetxea, E, Ojeda, N, Elizagárate, E, Ezcurra, J, et al. Improvements in negative symptoms and functional outcome after a new generation cognitive remediation program: a randomized controlled trial. Schizophr Bull 2014; 40: 707–15.
76 Gharaeipour, M, Scott, B. Effects of cognitive remediation on neurocognitive functions and psychiatric symptoms in schizophrenia inpatients. Schizophr Res 2012; 142: 165–70.
77 Østergaard Christensen, T, Vesterager, L, Krarup, G, Olsen, BB, Melau, M, Gluud, C. Cognitive remediation combined with an early intervention service in first episode psychosis. Acta Psychiatr Scand 2014; 130: 300–10.
78 Vita, A, De Peri, L, Barlati, S, Cacciani, P, Deste, G, Poli, R, et al. Effectiveness of different modalities of cognitive remediation on symptomatological, neuropsychological, and functional outcome domains in schizophrenia: a prospective study in a real-world setting. Schizophr Res 2011; 133: 223–31.
79 Tan, S, Zou, Y, Wykes, T, Reeder, C, Zhu, X, Yang, F, et al. Group cognitive remediation therapy for chronic schizophrenia: a randomized controlled trial. Neurosci Lett 2016; 626: 106–11.
80 Holzer, L, Urben, S, Pihet, S, Jaugey, L. A randomized controlled trial of the effectiveness of computer-assisted cognitive remediation (CACR) program in adolescents with psychosis or at high risk of psychosis: short-term and long-term outcomes. Neuropsychiatr Enfance Adolesc 2012; 60: 71.
81 Ahmed, AO, Hunter, KM, Goodrum, NM, Batten, NJ, Birgenheir, D, Hardison, E, et al. A randomized study of cognitive remediation for forensic and mental health patients with schizophrenia. J Psychiatr Res 2015; 68: 818.
82 Bellucci, DM, Glaberman, K, Haslam, N. Computer-assisted cognitive rehabilitation reduces negative symptoms in the severely mentally ill. Schizophr Res 2003; 59: 225–32.
83 Nemoto, T, Yamazawa, R, Kobayashi, H, Fujita, N, Chino, B, Fujii, C, et al. Cognitive training for divergent thinking in schizophrenia: a pilot study. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33: 1533–6.
84 Twamley, EW, Vella, L, Burton, CZ, Heaton, RK, Jeste, DV. Compensatory cognitive training for psychosis: effects in a randomized controlled trial. J Clin Psychiatry 2012; 73: 1212–9.
85 Mueller, DR, Schmidt, SJ, Roder, V. One-year randomized controlled trial and follow-up of integrated neurocognitive therapy for schizophrenia outpatients. Schizophr Bull 2015; 41: 604–16.
86 Eack, SM, Mesholam-Gately, RI, Greenwald, DP, Hogarty, SS, Keshavan, MS. Negative symptom improvement during cognitive rehabilitation: results from a 2-year trial of cognitive enhancement therapy. Psychiatry Res 2013; 209: 21–6.
87 Vauth, R, Corrigan, PW, Clauss, M, Dietl, M, Dreher-Rudolph, M, Stieglitz, RD, et al. Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophr Bull 2005; 31: 5566.
88 Ho, RT, Au Yeung, FS, Lo, PH, Law, KY, Wong, KO, Cheung, IK, et al. Tai-chi for residential patients with schizophrenia on movement coordination, negative symptoms, and functioning: a pilot randomized controlled trial. Evid Based Complement Alternat Med 2012; 2012: 923–5.
89 Ikai, S, Suzuki, T, Uchida, H, Saruta, J, Tsukinoki, K, Fujii, Y, et al. Effects of weekly one-hour Hatha yoga therapy on resilience and stress levels in patients with schizophrenia-spectrum disorders: an eight-week randomized controlled trial. J Altern Complement Med 2014; 20: 823–30.
90 Visceglia, E, Lewis, S. Yoga therapy as an adjunctive treatment for schizophrenia: a randomized, controlled pilot study. J Altern Complement Med 2011; 17: 601–7.
91 Acil, A, Dogan, S, Dogan, O. The effects of physical exercises to mental state and quality of life in patients with schizophrenia. J Psychiatr Ment Health Nurs 2008; 15: 808–15.
92 Manjunath, RB, Varambally, S, Thirthalli, J, Basavaraddi, IV, Gangadhar, BN. Efficacy of yoga as an add-on treatment for in-patients with functional psychotic disorder. Indian J Psychiatry 2013; 55 (suppl 3): 374–8.
93 Scheewe, TW, Backx, FJG, Takken, T, Jörg, F, van Strater, ACP, Kroes, AG, et al. Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial. Acta Psychiatr Scand 2013; 127: 464–73.
94 Varambally, S, Gangadhar, BN, Thirthalli, J, Jagannathan, A, Kumar, S, Venkatasubramanian, G, et al. Therapeutic efficacy of add-on yogasana intervention in stabilized outpatient schizophrenia: randomized controlled comparison with exercise and waitlist. Indian J Psychiatry 2012; 54: 227–32.
95 Loh, SY, Abdullah, A, Abu Bakar, AK, Thambu, M, Nik Jaafar, NR. Structured walking and chronic institutionalized schizophrenia inmates: a pilot rct study on quality of life. Glob J Health Sci 2015; 8: 238–48.
96 Kaltsatou, A, Kouidi, E, Fountoulakis, K, Sipka, C, Theochari, V, Kandylis, D, et al. Effects of exercise training with traditional dancing on functional capacity and quality of life in patients with schizophrenia: a randomized controlled study. Clin Rehab 2015; 29: 882–91.
97 Cassilhas, RC, Cassilhas, RC, Attux, C, Cordeiro, Q, Gadelha, AL, Telles, BA, et al. A 20-week program of resistance or concurrent exercise improves symptoms of schizophrenia: results of a blind, randomized controlled trial. Rev Bras Psiquiatr 2015; 37: 271–9.
98 Crawford, MJ, Killaspy, H, Barnes, TR, Barrett, B, Byford, S, Clayton, K, et al. Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial. BMJ 2012; 344: e846.
99 Montag, C, Haase, L, Seidel, D, Bayerl, M, Gallinat, J, Herrmann, U, et al. A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes: feasibility, impact on symptoms and mentalising capacity. PloS One 2014; 9: e112348.
100 Talwar, N, Crawford, MJ, Maratos, A, Nur, U, McDermott, O, Procter, S. Music therapy for in-patients with schizophrenia. Br J Psychiatry 2006; 189: 405–9.
101 Gold, C, Mössler, K, Grocke, D, Heldal, TO, Tjemsland, L, Aarre, T, et al. Individual music therapy for mental health care clients with low therapy motivation: Multicentre randomised controlled trial. Psychoth Psychosom 2013; 82: 319–31.
102 Ulrich, G, Houtmans, T, Gold, C. The additional therapeutic effect of group music therapy for schizophrenic patients: a randomized study. Acta Psychiatr Scand 2007; 116: 362–70.
103 Tang, W, Yao, X, Zheng, Z. Rehabilitative effect of music therapy for residual schizophrenia: A one-month randomised controlled trial in Shanghai. Br J Psychiatry 1994; 164 (suppl 24): 2834.
104 Lu, SF, Lo, CH, Sung, HC, Hsieh, TC, Yu, SC, Chang, SC. Effects of group music intervention on psychiatric symptoms and depression in patient with schizophrenia. Complement Ther Med 2013; 21: 682–8.
105 Bradley, GM, Couchman, GM, Perlesz, A, Nguyen, AT, Singh, B, Riess, C. Multiple-family group treatment for English-and Vietnamese-speaking families living with schizophrenia. Psychiatr Serv 2006; 57: 521–30.
106 Wang, L, Zhou, J, Yu, X, Qiu, J, Wang, B. Psychosocial rehabilitation training in the treatment of schizophrenia outpatients: a randomized, psychosocial rehabilitation training–and monomedication-controlled study. Pak J Med Sci 2013; 29: 597600.
107 Dyck, DG, Short, RA, Hendryx, MS, Norell, D, Myers, M, Patterson, T, et al. Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Psychiatr Serv 2000; 51: 513–9.
108 Calvo, A, Moreno, M, Ruiz-Sancho, A, Rapado-Castro, M, Moreno, C, Sánchez-Gutiérrez, T, et al. Intervention for adolescents with early-onset psychosis and their families: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2014; 53: 688696.
109 Buchkremer, G, Klingberg, S, Holle, R, Schulze Mönking, H, Hornung, WP, et al. Psychoeducational psychotherapy for schizophrenic patients and their key relatives or care-givers: results of a 2-year follow-up. Acta Psychiatr Scand 1997; 96: 483–91.
110 Cai, J, Zhu, Y, Zhang, W, Wang, Y, Zhang, C. Comprehensive family therapy: an effective approach for cognitive rehabilitation in schizophrenia. Neuropsychiatr Dis Treat 2015; 11: 1247–53.
111 Cai, C, Yu, L, Rong, L, Zhong, H. Effectiveness of humor intervention for patients with schizophrenia: a randomized controlled trial. J Psychiatr Res 2014; 59: 174–8.
112 Gelkopf, M, Gonen, B, Kurs, R, Melamed, Y, Bleich, A. The effect of humorous movies on inpatients with chronic schizophrenia. J Nerv Ment Dis 2006; 194: 880–3.
113 Thorup, A, Petersen, L, Jeppesen, P, Ohlenschlaeger, J, Christensen, T, Krarup, G, et al. Integrated treatment ameliorates negative symptoms in first episode psychosis—results from the Danish OPUS trial. Schizophr Res 2005; 79: 95105.
114 Garety, PA, Craig, TKJ, Dunn, G, Fornells-Ambrojo, M, Colbert, S, Rahaman, N, et al. Specialised care for early psychosis: symptoms, social functioning and patient satisfaction. Randomised controlled trial. Br J Psychiatry 2006; 188: 3745.
115 White, R, Gumley, A, McTaggart, J, Rattrie, L, McConville, D, Cleare, S, et al. A feasibility study of acceptance and commitment therapy for emotional dysfunction following psychosis. Behav Res Therapy 2011; 49: 901–7.
116 Röhricht, F, Priebe, S. Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial. Psychol Med 2006; 36: 669–78.
117 Villalta-Gil, V, Roca, M, Gonzalez, N, Domenec, E, Ana Escallani, C, Asensio, MR, et al. Dog-assisted therapy in the treatment of chronic schizophrenia inpatients. Anthrozoös 2009 22: 149–59.
118 Anderson, KH, Ford, S, Robson, D, Cassis, J, Rodrigues, C, Gray, R. An exploratory, randomized controlled trial of adherence therapy for people with schizophrenia. Int J Ment Health Nurs 2010; 19: 340–9.
119 Gholipour, A, Abolghasemi, SH, Gholinia, K, Taheri, S. Token reinforcement therapeutic approach is more effective than exercise for controlling negative symptoms of schizophrenic patients: a randomized controlled trial. Int J Prevent Med 2012; 3: 466–70.
120 Choi, J, Medalia, A. Intrinsic motivation and learning in a schizophrenia spectrum sample. Schizophr Res 2010; 118: 12–9.
121 Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlaeger, J, le Quach, P, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 2008; 65: 762–71.
122 Singh, SP, Evans, N, Sireling, L, Stuart, H. Mind the gap: the interface between child and adult mental health services. Psychiatrist 2005; 29: 292–4.
123 Erekson, DM. Scheduled Healing: The Relationship between Session Frequency and Psychotherapy Outcome in a Naturalistic Setting (PhD). Department of Psychology, Brigham Young University, 2013 (http://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=5036&context=etd).
124 Garety, PA, Fowler, D, Kuipers, E. Cognitive-behavioral therapy for medication-resistant symptoms. Schizophr Bull 2000; 26: 7386.
125 Ayllon, T, Azrin, N. The Token Economy: A Motivational System for Therapy and Rehabilitation. Appleton-Century-Crofts, 1968.
126 Frank, AF, Gunderson, JG. The role of the therapeutic alliance in the treatment of schizophrenia: Relationship to course and outcome. Arch Gen Psychiatry 1990; 47: 228–36.
127 Bellack, AS, Mueser, KT, Gingerich, S, Agresta, J. Social Skills Training for Schizophrenia: A Step-by-Step Guide, 2nd edn. Guilford Publications, 2013.
128 Green, MF. Cognitive remediation in schizophrenia: is it time yet? Am J Psychiatry 1993; 150: 178–87.
129 Ryan, RM, Plant, RW, O'Malley, S. Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout. Addict Behav 1995; 20: 279–97.
130 Erhart, SM, Marder, SR, Carpenter, WT. Treatment of schizophrenia negative symptoms: future prospects. Schizophr Bull 2006; 32: 234–7.
131 Kirkpatrick, B, Fenton, WS, Carpenter, WT Jr, Marder, SR. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006; 32: 214–9.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 171 *
Loading metrics...

Abstract views

Total abstract views: 241 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 20th April 2018. This data will be updated every 24 hours.

Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

  • Danyael Lutgens (a1), Genevieve Gariepy (a2) and Ashok Malla (a3)
Submit a response

eLetters

Psychosocial Intervention for Negative Symptoms: a note on meta-analyses

Matteo Cella, Clinical Psychologist / Lecturer, King's College London, UK
Antonio Preti, Psychiatrist / Associate Professor, Center for Liaison Psychiatry and Psychosomatics, Cagliari University Hospital, Cagliari, Italy
24 March 2017

We read with interest the paper by Lutgens et al., 1 describing the results of their meta-analytic study on the effect of psychosocial interventions on negative symptoms for people with psychosis. Despite commending the aims of the study we have some methodological reservations on the results presented.

We believe the number of the studies included is only a partial representation of the research conducted in the therapeutic modalities considered. For example, we have recently completed a meta-analysis on the effect of cognitive remediation on negative symptoms 2. Our study had a similar time frame to Lutgens et al., 1 and the same participants’ inclusion criteria. Our search retrieved 45 eligible studies compared to only 16 retrieved by Lutgens et al., 1 in their neurocognitive therapies category. We believe this is due to the search strategy used, which included the term “negative symptom” and therefore retrieve only studies with this term in the abstracts. This has two effects. It is more likely to retrieve studies reporting positive findings, and when investigating interventions not specifically designed to target negative symptom will miss a large body of studies across all the therapies modalities considered.

The nature of the control condition is also important when considering effect sizes. In their study Lutgens et al., 1 conflate passive with active control conditions. Active control conditions for one study (e.g. cognitive remediation) were then considered active treatment condition in subsequent analyses. We also noted some overlap in therapy groups considered. Both art and music and exercise therapy included dance-based interventions. The miscellaneous category adds to the limited clarity in categories definition by considering comprehensive “care packages” such as Garety et al., 3 which include medication management and allocation to a psychosocial intervention amongst a number recommended by clinical guidelines (i.e. family therapy or CBT). These limitations, in our view, make it difficult to reliably compare effect sizes from the intervention groups considered.

We also wish to point out some methodological considerations that may limit the accuracy of the results reported. Firstly, it appears the authors considered only end of therapy data to estimate effect sizes. This does not account for relative change. In other words, this method considers a symptoms reduction of a hypothetical 3 points of a negative symptoms scale to be the same in individuals entering the study with an initial score of 5 or 23. The importance of taking into account baseline levels in meta-analysis is clear and it is considered best practice 4. There is also evidence that the DerSimonian and Laird method has limitations when compared to other methods using restricted maximum likelihood estimator 5.

Lastly, it is unclear how the authors considered the treatment participants received as part of treatment as usual (TAU). The authors stated: “Compared with TAU, 59% (10/17) of studies reported CBT to be more effective at the end of treatment”. From this statement one may assume that participants received either TAU (e.g. medication) or CBT. In all likelihood studies compared CBT + TAU to TAU only.

References

1.Lutgens D, Gariepy G, Malla A. Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. Br J Psychiatry 2017, in Press.

2.Cella M, Preti A, Edwards C, Dow T, Wykes T. Cognitive remediation for negative symptoms of schizophrenia: A network meta-analysis. Clin Psychol Rev 2017; 52: 43-51.

3.Garety PA, Craig TKJ, Dunn G, Fornells-Ambrojo M, Colbert S, Rahaman N, et al. Specialised care for early psychosis: symptoms, social functioning and patient satisfaction. Randomised controlled trial. Br J Psychiatry 2006; 188: 37–45.

4.Achana FA, Cooper NJ, Dias S, Lu G, Rice SJ, Kendrick D, Sutton AJ. Extending methods for investigating the relationship between treatment effect and baseline risk from pairwise meta-analysis to network meta-analysis. Stat Med 2013; 32: 752-71.

5.Veroniki AA, Jackson D, Viechtbauer W, Bender R, Bowden J, Knapp G, Kuss O, Higgins JP, Langan D, Salanti G. Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth Methods 2016; 7:55-79.

... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *