Table 2.
Characteristics of included studies. Arrows indicate under which term the intervention was considered for the analysis when applicable. (Adapted from [1], created with Microsoft Office)
| Overall study characteristics | Characteristics of patients | |
|---|---|---|
| Ahuir et al [83] |
Country: Spain Study treatments (number of patients): Meta Cognitive Therapy (n = 14), Psychoeducation (n = 14) Trial duration: 8 weeks Treatment setting: group Number of sessions: 8 Study design: open label Risk of bias*: moderate Functioning scale: Personal and Social Performance scale (PSP) |
Diagnosis: psychotic disorder (DSM-IV) Baseline severity: Positive and Negative Syndrome Scale (PANSS) positive symptoms 9.85 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Barrowclough et al [39] |
Country: UK Study treatments (number of patients): cognitive behavior therapy (CBT) (n = 57), treatment as usual (TAU) (n = 56) Trial duration: 26 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 10.4 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Gender: 82 (73%) men, 31 women (27%) Mean age: 38.83 years Baseline severity: Positive and Negative Syndrome Scale (PANSS) total score: 63.8, positive symptoms 17.4, negative symptoms 14.1; Duration of illness: 13.67 years Only treatment resistant patients included: no |
| Bradshaw [40] |
Country: not available (author’s affiliation in the USA) Study treatments (number of patients): CBT (n = 12), day treatment program (n = 12) Trial duration: 156 weeks Treatment setting: individual Number of sessions: not available Study design: single blind Risk of bias: high Functioning scale: Role Functioning Scale |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Mean age: 32 years Duration of illness: 11 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Bozzatello et al [84] |
Country: Italy Study treatments (number of patients): Art therapy (n = 30), Befriending (n = 32) Trial duration: 24 weeks Treatment setting: group Number of sessions: 24 Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) & Personal and Social Performance scale (PSP) |
Diagnosis: schizophrenia spectrum disorder (DSM-V) Setting: outpatients Gender: 29 men, 25 women Mean age: 46.9 years Duration of illness: 18.8 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Cather et al [41] |
Country: USA Study treatments (number of patients): CBT (n = 16), psychoeducation (n = 14) Trial duration: 16 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 15 Study design: single blind Risk of bias: high Functioning scale: Social Functioning Scale (SFS) |
Diagnosis: schizophrenia or schizoaffective disorder, depressed type (DSM-IV) Setting: outpatients Gender: 17 (57%) men, 13 (43%) women Mean age: 40.4 years Baseline severity: PANSS total score 51.1, positive symptoms factor 13.53, negative symptoms factor 14.32; Duration of illness: 18 years Medication: 100% of CBT arm taking antipsychotics Only treatment resistant patients included: no |
| Chadwick et al [42] |
Country: UK Study treatments (number of patients): mindfulness (n = 11), wait-list (n = 11) Trial duration: 10 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 10 Study design: open label Risk of bias: high Functioning scale: Clinical Outcomes in Routine Evaluation |
Diagnosis: psychotic disorder (criteria not available) Mean age: 41.6 years Duration of illness: 17.7 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Chien and Lee [43] |
Country: Hongkong Study treatments (number of patients): mindfulness-based psychoeducation (n = 48), TAU (n = 48) Trial duration: 36 weeks Treatment setting: group Number of sessions: 12 Study design: single blind Risk of bias: high Functioning scale: Specific Levels of Functioning (SLOF) |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 53 (55%) men, 43 (45%) women Mean age: 25.9 years Baseline severity: Brief Psychiatric Rating Scale (BPRS) total score 63.35 Duration of illness: 3.1 years Medication: 84.375% taking antipsychotics Only treatment resistant patients included: no |
| Chien and Thompson [44] |
Country: Hongkong Study treatments (number of patients): mindfulness-based psychoeducation (n = 36), TAU (n = 35), psychoeducation (n = 36) Trial duration: 27 weeks Treatment setting: group Number of sessions: 12 Study design: single blind Risk of bias: high Functioning scale: Specific Levels of Functioning (SLOF) |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 61 (57%) men, 46 (43%) women Mean age: 25.63 years Baseline severity: BPRS-18 total score 31.40 Duration of illness: 2.6 years Medication: 87.85% taking antipsychotics Only treatment resistant patients included: no |
| Chien et al [45] |
Country: Hongkong Study treatments (number of patients): mindfulness-based psychoeducation (n = 114), TAU (n = 114), psychoeducation (n = 114) Trial duration: 24 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 12 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning (SLOF) |
Diagnosis: schizophrenia and other psychotic disorders (DSM-IV) Setting: outpatients Gender: 216 (63%) men, 126 (37%) women Mean age: 25.63 years Baseline severity: PANSS total score 80.77, positive symptoms 20.23, negative symptoms 19.83 Duration of illness: 2.6 years Medication: 89.77% taking antipsychotics Only treatment resistant patients included: no |
| Chien et al [85] |
Country: China & Hong Kong Study treatments (number of patients): Mindfulness-based Psychoeducation Group Programme (MPGP) (n = 60), Conventional Psychoeducation Group Programme (CPGP) (n = 60), TAU (n = 60) Trial duration: 24 weeks Treatment setting: group Therapist expertise: experts only Number of sessions:12 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning (SLOF) |
Diagnosis: Schizophrenia or its subtypes according to DSM-IV-TR Setting: outpatients Gender: 100 men, 80 women Mean age: 25–28 years Baseline severity: PANSS total score: 94.73, positive symptoms 27.67, negative symptoms 23.6 Duration of illness: 2.1–2.5 years Medication: 51.6% taking first generation antipsychotics, 28.3% taking second generation antipsychotics Only treatment resistant patients included: no |
| Crawford et al [46] |
Country: UK Study treatments (number of patients): art therapy (n = 140), activity group (n = 140), TAU (n = 137) Trial duration: 52 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 52 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia (clinical diagnosis) Setting: outpatients Gender: 279 (67%) men, 138 (33%) women Mean age: 41 years Baseline severity: PANSS total score 74.08, positive symptoms 17.84, negative symptoms 18.63 Duration of illness: 19.33 years Medication: 96% taking antipsychotics Only treatment resistant patients included: no |
| De Jong et al. 2018 |
Country: Netherlands Study treatments (number of patients): Metacognitive reflection and insight therapy (MERIT) (n = 35), treatment as usual (TAU) (n = 35) Trial duration: 40 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 40 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) |
Diagnosis: Schizophrenia or schizoaffective disorder (DSM-IV-TR) Setting: NA Gender: 49 men, 21 women Mean age: 40 years Baseline severity: PANSS total score: 66.23 Duration of illness: 13.76 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| De Pinho et al. 2020 |
Country: Portugal Study treatments (number of patients): Meta Cognitive Training (n = 27), treatment as usual (TAU) (n = 29) Trial duration: 4 weeks Treatment setting: group Therapist expertise: NA Number of sessions: 8 Study design: single blind Risk of bias: low Functioning scale: Personal and Social Performance scale (PSP) |
Diagnosis: Schizophrenia (clinical diagnosis) Setting: unclear Gender: 30 men, 26 women Mean age: 50.48 years Baseline severity: NA Duration of illness: NA Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Durham et al [47] |
Country: Scotland Study treatments (number of patients): CBT (n = 22), supportive therapy (n = 23), TAU (n = 21) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 20 Study design: single blind Risk of bias: high Functioning scale: Global Assessment Scale (GAS) |
Diagnosis: schizophrenia, schizoaffective disorder, delusional disorder (ICD-10 and DSM-IV) Setting: inpatients and outpatients Gender: 45 (68%) men, 21 women (32%) Mean age: 36.3 years Baseline severity: PANSS total score 96.63, PSYRATS total 35.57 Duration of illness: 13 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Farhall et al [48] |
Country: Australia Study treatments (number of patients): CBT (n = 45), TAU (n = 49) Trial duration: 52 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 17.05 Study design: open label Risk of bias: high Functioning scale: Life Skills Profile |
Diagnosis: schizophrenia, schizoaffective disorder, delusional disorder, or mood disorder with psychotic features (DSM-IV) Setting: outpatients Gender: 54 (59%) men, 38 (41%) women Mean age: 32.85 years Baseline severity: PANSS total score 59.31, positive symptoms 14.63; negative symptoms 14.78 Medication: 90.43% taking antipsychotics Only treatment resistant patients included: no |
| Fujii et al [95] |
Country: Japan Study treatments (number of patients): Meta Cognitive Training (n = 11), Occupational Therapy (n = 11) Trial duration: 16 weeks Treatment setting: group Therapist expertise: NA Number of sessions: 16 Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: Schizophrenia according to DSM-V Setting: inpatients Gender: 10 men, 7 women Mean age: 54.25 years Baseline severity: PANSS total score 107.8, positive symptoms 25.75; negative symptoms 28.04 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
|
Garety et al [49] (total sample) |
Country: UK Study treatments (number of patients): CBT (n = 133), family intervention (n = 28), TAU (n = 140) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 14.3 (CBT), 13.9 (FI) Study design: single blind Risk of bias: moderate Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) |
Diagnosis: non-affective psychosis (ICD-10 and DSM-IV) Setting: inpatients and outpatients Gender: 211 (70%) men, 90 (30%) women Mean age: 37.54 years Baseline severity: PANSS total score 65.16, positive symptoms 18.15, negative symptoms 13.27 Duration of illness: 10.8 years Only treatment resistant patients included: no |
|
Garety et al [49] (sample a) |
Country: UK Study treatments (number of patients): CBT (n = 27), family intervention (n = 28), TAU (n = 28) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 13.9 Study design: single blind Risk of bias: moderate Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) |
Diagnosis: non-affective psychosis (DSM-IV and ICD–10) Setting: inpatients and outpatients Gender: 60 (72%) men, 23 (28%) women Mean age: 36.4 years Baseline severity: PANSS total score 67.31, positive symptoms 17.16, negative symptoms 15.58 Duration of illness: 11.57 years Only treatment resistant patients included: no |
|
Garety et al [49] (sample b) |
Country: UK Study treatments (number of patients): CBT (n = 106), TAU (n = 112) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 14.3 Study design: single blind Risk of bias: moderate Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) |
Diagnosis: non-affective psychosis (DSM-IV and ICD–10) Setting: inpatients and outpatients Gender: 151 (69%) men, 67 (31%) women Mean age: 38.1 years Baseline severity: PANSS total score 64.29, positive symptoms 18.51, negative symptoms 12.38 Duration of illness: 10.4 years Only treatment resistant patients included: no |
| Gottlieb et al [50] |
Country: USA Study treatments (number of patients): CBT (n = 19), TAU (n = 18) Trial duration: 24 weeks Treatment setting: individual Number of sessions: 10 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning |
Diagnosis: schizophrenia, schizoaffective disorder, or psychosis not otherwise specified diagnosis (NA) Setting: outpatients; 23 (62%) men, 14 women (38%) Mean age: 42.04 years Baseline severity: BPRS-24 total score 54.92, Psychotic Symptom Rating Scales (PSYRATS) 53.06, BPRS negative symptoms 6.23 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Granholm et al [51] |
Country: USA Study treatments (number of patients): cognitive behavioural social skills training (CBSST) (n = 37), TAU (n = 39) Trial duration: 24 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 24 Study design: single blind Risk of bias: moderate Functioning scale: Independent Living Skills Survey (ILSS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 56 (74%) men, 20 (26%) women Mean age: 53.78 years Baseline severity: PANSS total score 53.37, positive symptoms 12.73, negative symptoms 14.66 Duration of illness: 29.23 years Medication: 87.5% taking antipsychotics Only treatment resistant patients included: no |
| Granholm et al [52] |
Country: USA Study treatments (number of patients): CBSST (n = 41), goal-focused supportive contact (n = 38) Trial duration: 36 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 30.3 (CBSST), 29.6 (goal-focused supportive contact) Study design: single blind Risk of bias: high Functioning scale: Independent Living Skills Survey (ILSS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 44 (56%) men, 35 (44%) women Mean age: 55 years Baseline severity: PANSS total score 64.63, positive symptoms 18.06 Medication: 94.94% taking antipsychotics Only treatment resistant patients included: no |
| Granholm et al [53] |
Country: USA Study treatments (number of patients): CBSST(n = 73), goal-focused supportive contact (n = 76) Trial duration: 36 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 12.2 (CBSST), 15.6 (goal-focused supportive contact) Study design: single blind Risk of bias: high Functioning scale: Independent Living Skills Survey (ILSS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 99 (66%) men, 50 (34%) women Mean age: 41.36 years Baseline severity: PANSS total score 72.42, positive symptoms 19.81 Duration of illness: 21.35 years Medication: 97.32% taking antipsychotics Only treatment resistant patients included: no |
| Granholm et al [87] |
Country: United States of America Study treatments (number of patients): Mobile-assisted CBSST (MA-CBSST) (n = 17), Cognitive-behavioral social skills training (CBSST) (n = 26), device contact-only (DC-only) (n = 14) Trial duration: 24 weeks Treatment setting: group Number of sessions: 24 Study design: single blind Risk of bias: high Functioning scale: Independent Living Skills Survey (ILSS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV-TR) per the Structured Clinical Interview for DSM-IV (SCID-I/P) Setting: outpatients Gender: 47 men, 10 women Mean age: 56.1 years Baseline severity: PANSS total score: 70.64, positive symptoms 18.39 Only treatment resistant patients included: no |
| Grant et al [54] |
Country: USA Study treatments (number of patients): cognitive therapy (n = 31), standard treatment (n = 29) Treatment setting: individual Trial duration: 18 months Number of sessions: 50.5 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment Scale (GAS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 40 (67%) men, 20 (33%) women Mean age: 38.46 years Baseline severity: Scale for the Assessment of Positive Symptoms (SAPS) score 17.33 Duration of illness: 15.52 years Only treatment resistant patients included: no |
| Gurcan et al 2021 |
Country: Turkey Study treatments (number of patients): Narrative therapy (n = 14), movie therapy (n = 14) Trial duration: 14 weeks Treatment setting: group Therapist expertise: trainee therapist allowed Number of sessions: 28 Study design: single blind Risk of bias: moderate Functioning scale: Social Functioning Scale (SFS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-V) Setting: outpatients Gender: 71,4% men, 28,6% women Mean age: 40.75 years Baseline severity: PANSS total score: 74.74, positive symptoms 16.06; negative symptoms 20.31 Duration of illness: 18.17 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Haddock et al [55] |
Country: UK Study treatments (number of patients): CBT (n = 38), social activity therapy (n = 39) Trial duration: 26 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 17 (CBT), 17.4 (social activity therapy) Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-VI) Setting: inpatients and outpatients Gender: 66 (86%) men, 11 (14%) women Mean age: 34.8 years Baseline severity: PANSS total score 63.81, positive symptoms 27.6, negative symptoms 13.04 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Ishikawa et al 2019 |
Country: Japan Study treatments (number of patients): TAU + MCT (Meta Cognitive Training) (n = 24), treatment as usual (TAU) (n = 26) Trial duration: 10 weeks Treatment setting: group Number of sessions: 10 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, schizotypal, and delusional disorders (ICD 10) Setting: inpatients & outpatients Gender: 25 men, 25 women Mean age: 47.5 years Baseline severity: positive symptoms 23.78 Duration of illness: 21.04 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Jenner et al [20] |
Country: Netherlands Study treatments (number of patients): hallucination focused integrative treatment (n = 39), TAU (n = 39) Trial duration: 39 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 11 Study design: open label Risk of bias: high Functioning scale: Groningen Social Disabilities Schedule |
Diagnosis: non-affective psychosis, including schizophrenia, schizoaffective or psychotic disorder not otherwise specified (DSM-IV) Setting: outpatients Gender: 41 (54%) men, 35 (46%) women Mean age: 36.35 years Baseline severity: PANSS total score 60.2, positive symptoms 16.05, negative symptoms 13.25 Only treatment resistant patients included: no |
| Klingberg et al [57] |
Country: Germany Study treatments (number of patients): CBT (n = 99), cognitive remediation (n = 99) Trial duration: 36 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 16.6 (CBT), 13.7 (cognitive remediation) Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 87 women (43.94%), 111 men (56.06%) Mean age: 36.9 years Baseline severity: PANSS total score 59.45, positive symptoms 10.5, negative symptoms 18.55 Duration of illness: 12.5 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Kråkvik et al [58] |
Country: Norway Study treatments (number of patients): CBT (n = 23), wait-list (n = 22) Trial duration: 26 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 20 Study design: open label Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, schizoaffective disorder, or persistent delusional disorder (ICD-10) Setting: inpatients and outpatients Gender: 29 (64%) men, 16 (36%) women Mean age: 36.36 years Baseline severity: BPRS-24 score 49.49 Duration of illness: 10.9 years Only treatment resistant patients included: no |
| Kuipers et al [59] |
Country: UK Study treatments (number of patients): CBT and family intervention (n = 32), TAU (n = 27) Trial duration: 39 weeks Number of sessions: not available Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: any functional psychosis (OPCRIT) Setting: outpatients Gender: 45 (76%) men, 14 (24%) women Mean age: 27.8 years Baseline severity: PANSS total score 73.11, positive symptoms 17.39, negative symptoms 16.86 Only treatment resistant patients included: no |
| Lee et al [60] |
Country: Korea Study treatments (number of patients): group music therapy (n = 12), control (n = 12) Trial duration: 12 weeks Treatment setting: group Number of sessions: 18 Study design: not available Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 25 (75%) men, 5 (25%) women Mean age: 40.55 years Baseline severity: PANSS total score 94.5, positive symptoms 21.25, negative symptoms 23.2 Only treatment resistant patients included: no |
| Li et al 2015 |
Country: China Study treatments (number of patients): CBT (n = 96), supportive therapy (n = 96) Trial duration: 24 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 15 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) |
Diagnosis: schizophrenia (DSM-IV) Setting: inpatients and outpatients Gender: 72 (38%) men, 120 (63%) women Mean age: 31.36 years Baseline severity: PANSS total score 72.6, positive symptoms 23.43, negative symptoms 20.4 Duration of illness: 8.21 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Lincoln et al [62] |
Country: Germany Study treatments (number of patients): CBT (n = 40), TAU (n = 40) Trial duration: 38 weeks Treatment setting: individual Therapist expertise: trainees allowed Number of sessions: 28.9 (CBT), 2 (TAU) Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, schizoaffective disorder, delusional disorder, or brief psychotic disorder (DSM-IV) Setting: outpatients Gender: 45 (56%) men, 35 (44%) women Mean age: 33.15 years Baseline severity: PANSS total score 63.15, positive symptoms 14.95, negative symptoms 14.15 Duration of illness: 10.4 years Medication: 96.25% taking antipsychotics Only treatment resistant patients included: no |
| Martin et al [63] |
Country: Germany Study treatments (number of patients): dance and movement therapy and body psychotherapy (n = 44), TAU (n = 24) Trial duration: 10 weeks Treatment setting: group Therapist expertise: trainees allowed Number of sessions: 20 Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia spectrum disorder (ICD-10) Setting: outpatients Gender: 36 (53%) men, 32 (47%) women Mean age: 39.8 years Baseline severity: BPRS total score 38.16, SANS 25.03 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Matthews [64] |
Country: USA Study treatments (number of patients): psychotherapy (n = 28), TAU (n = 14) Trial duration: 8 weeks Therapist expertise: experts only Number of sessions: 8 Study design: not available Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia (NA) Setting: outpatients Gender: 21 (50%) men, 21 (50%) women Mean age: 24.95 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Montag et al [65] |
Country: Germany Study treatments (number of patients): psychodynamic art therapy (n = 29), TAU (n = 29) Trial duration: 6 weeks Number of sessions: 12 Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia (DSM-IV) Setting: inpatients Gender: 38 (72%) men, 15 (28%) women Mean age: 38.1 years Baseline severity: SAPS total score 60.15, Scale for the Assessment of Negative Symptoms (SANS) 45.6 Duration of illness: 12.6 years Only treatment resistant patients included: no |
| Morrison et al [66] |
Country: UK Study treatments (number of patients): cognitive therapy (n = 37), TAU (n = 37) Trial duration: 39 weeks Therapist expertise: experts only Number of sessions: 13.3 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) |
Diagnosis: schizophrenia, schizoaffective disorder, or delusional disorder; diagnostic uncertainty in early phases of psychosis (Early intervention for psychosis service) (ICD-10 or PANSS) Gender: 39 (53%) men, 35 (47%) women Mean age: 31.32 years Baseline severity: PANSS total score 71.76, positive symptoms 20.98, negative symptoms 14.52; Medication: 0% taking antipsychotics Only treatment resistant patients included: no |
| Morrison et al [90] |
Country: United Kingdom Study treatments (number of patients): cognitive behavior therapy (CBT) (n = 242), treatment as usual (TAU) (n = 245) Trial duration: 39 weeks Treatment setting: individual Therapist expertise: only expert therapists Number of sessions: 26 Study design: single blind Risk of bias: moderate Functioning scale: Personal and Social Performance scale (PSP) |
Diagnosis: schizophrenia, schizoaffective disorder, or delusional disorder, or criteria for an Early Intervention for Psychosis service to allow for diagnostic uncertainty in early phases (ICD-10) Setting: inpatients and outpatients Gender: 349 men, 138 women Mean age: 42.5 years Baseline severity: PANSS total score: 83.05; positive symptoms 24.95; negative symptoms 19.35 Duration of illness: 19 years Medication: 91% taking antipsychotics Only treatment resistant patients included: yes |
| Naeem et al [67] |
Country: Canada Study treatments (number of patients): CBT (n = 18), TAU (n = 15) Trial duration: 16 weeks Treatment setting: individual Number of sessions: 14 Study design: single blind Risk of bias: low Functioning scale: (World Health Organization Disability Assessment Schedule) WHODAS 2.0 |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 17 (52%) men, 16 (48%) women Mean age: 40.45 years Baseline severity: PANSS total score 50.24, positive symptoms 13.54, negative symptoms 12.18 Only treatment resistant patients included: no |
| Ochoa et al [68] |
Country: Spain Study treatments (number of patients): metacognitive training (n = 65), psychoeducation (n = 57) Trial duration: 8 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 5.53 (metacognitive training), 4.95 (psychoeducation) Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, psychotic disorder not otherwise specified, delusional disorder, schizoaffective disorder, brief psychotic disorder, or schizophreniform disorder (DSM-IV-TR) Setting: outpatients Gender: 85 (70%) men, 37 (30%) women Mean age: 27.59 years Baseline severity: PANSS total score 54.33, positive symptoms 12.22, negative symptoms 14.63 Duration of illness: 2.29 years Only treatment resistant patients included: no |
| Ozdemir and Budak 2022 |
Country: Turkey Study treatments (number of patients): mindfulness-based stress reduction (MBSR) (n = 50), psychoeducation group (n = 50), control group (n = 56) Trial duration: 8 weeks Treatment setting: group Therapist expertise: only expert therapists Number of sessions: 8 Study design: open label Risk of bias: high Functioning scale: Functional Remission of General Schizophrenia (FROGS) scale |
Diagnosis: schizophrenia (DSM-V) Setting: outpatients Gender: 106 men, 31 women Mean age: 43.77 years Duration of illness: 16.36 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Palma et al [22] |
Country: Spain Study treatments (number of patients): Cognitive-Motivational Therapy (PIPE) (n = 35), Routine Care (n = 27) Trial duration: 52 weeks Treatment setting: individual & family Therapist expertise: expert only Number of sessions: 34 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: initial phase of schizophrenia (DSM-IV) Setting: inpatients & outpatients Gender: 46 men, 16 women Mean age: 25.5 years Baseline severity: PANSS total score: 104, positive symptoms 38,8, negative symptoms 30,7 Duration of illness: 1 year Only treatment resistant patients included: no |
| Penadés et al [69] |
Country: Spain Study treatments (number of patients): CBT (n = 20), cognitive remediation (n = 20) Trial duration: 16 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 40 Study design: single blind Risk of bias: moderate Functioning scale: Life Skills Profile |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 23 men (57.5%), 17 women (42.5%) Mean age: 35.1 years Baseline severity: PANSS score 66.99, positive symptoms 11.27, negative symptoms 20.17 Duration of illness: 13.8 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Penn et al [70] |
Country: USA Study treatments: CBT (n = 32), supportive therapy (n = 33) Trial duration: 12 weeks Treatment setting: group Number of sessions: 8.3 Study design: single blind Risk of bias: low Functioning scale: Social Functioning Scale (SFS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 33 (51%) men, 32 (49%) women Mean age: 40.65 years Baseline severity: PANSS total score 61.75, positive symptoms 17.55, negative symptoms 13.9 Duration of illness: 15.4 years Only treatment resistant patients included: no |
| Pos et al [92] |
Country: Netherlands Study treatments (number of patients): CBTsa (Social Activation) (n = 49), TAU (n = 50) Trial duration: 12 weeks Treatment setting: group & individual Therapist expertise: experts only Number of sessions: 14 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia or a related disorder with onset of their first psychotic episode 4 years prior to inclusion (DSM-IV-TR) Setting: inpatients & outpatients Gender: male 80, female 19 Mean age: 25.43 years Baseline severity: NA Duration of illness: NA Medication: 91.7% taking antipsychotics Only treatment resistant patients included: no |
| Pot-Kolder et al [26] |
Country: Netherlands Study treatments (number of patients): virtual-reality exposure therapy for psychosis (n = 58), wait-list (n = 58) Trial duration: 12 weeks Number of sessions: 16 Study design: single blind Risk of bias: low Functioning scale: Social and Occupational Functioning Assessment Scale (SOFAS) |
Diagnosis: psychotic disorder (DSM-IV) Gender: 82 (71%) men, 34 (29%) women Mean age: 38 years Duration of illness: 14.1 years Medication: 95.5% taking antipsychotics Only treatment resistant patients included: no |
| Richardson et al [72] |
Country: UK Study treatments (number of patients): art therapy (n = 43), TAU (n = 47) Trial duration: 12 weeks Treatment setting: group Number of sessions: 12 Study design: open label Risk of bias: high Functioning scale: Social Functioning Scale (SFS) |
Diagnosis: chronic schizophrenia (NA) Setting: outpatients Gender: 59 (66%) men, 31 (34%) women Mean age: 41.17 years Baseline severity: BPRS total score 15.57, SANS 8.44 Only treatment resistant patients included: no |
| Schrank et al [73] |
Country: UK Study treatments (number of patients): group psychotherapy (n = 47), TAU (n = 47) Trial duration: 11 weeks Treatment setting: group Number of sessions: 7 Study design: open label Risk of bias: high Functioning scale: Health of the Nation Outcome Scale |
Diagnosis: diagnosis of psychosis defined as schizophrenia and other psychoses including schizoaffective and delusional disorder but not depressive psychosis or psychosis due to substance misuse (clinical diagnosis) Setting: inpatients and outpatients Gender: 56 (60%) men, 38 (40%) women Mean age: 42.5 years Baseline severity: BPRS-18 total score 32.14 Duration of illness: 13.5 years Only treatment resistant patients included: no |
| Shawyer et al [74] |
Country: Australia Study treatments (number of patients): CBT (n = 21), befriending (n = 22) Trial duration: 15 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 14.3 (CBT), 14.4 (Befriending) Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia or related condition (DSM-IV) Gender: 24 (56%) men, 19 (44%) women Mean age: 39.8 years Baseline severity: PANSS total score 62.89, positive symptoms 15.99, negative symptoms 14.15 Duration of illness: 14.71 years Only treatment resistant patients included: no |
| Shawyer et al [75] |
Country: Australia Study treatments (number of patients): acceptance and commitment therapy (n = 49), befriending (n = 47) Trial duration: 13 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 7 Study design: single blind Risk of bias: low Functioning scale: Social Functioning Scale (SFS) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV-TR) Setting: outpatients Gender: 59 (61%) men, 37 (39%) women Mean age: 34.3 years Baseline severity: PANSS total score 78.25, positive symptoms 21.8, negative symptoms 18 Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
| Startup et al [76] |
Country: UK Study treatments (number of patients): CBT (n = 47), TAU (n = 43) Trial duration: 26 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 12.9 Study design: open label Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, schizophreniform, schizoaffective (DSM-IV) Setting: inpatients Gender: 68 (76%) men, 22 (24%) women Mean age: 30.8 years Baseline severity: BPRS-16 total score 45.75, SAPS positive symptoms 10.7, SANS negative symptoms 8.9; Duration of illness: 6.95 years Only treatment resistant patients included: no |
| Talwar et al [77] |
Country: UK Study treatments (number of patients): music therapy (n = 33), TAU (n = 48) Trial duration: 12 weeks Treatment setting: individual Number of sessions: 8 Study design: single blind Risk of bias: low Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, or schizophrenia-like psychoses (ICD-10) Setting: inpatients Gender: 60 (74%) men, 21 (26%) women Mean age: 37.36 years Baseline severity: PANSS total score 71.72, positive symptoms 16.36, negative symptoms 19.20 Only treatment resistant patients included: no |
| Tarrier et al [78] |
Country: UK Study treatments: CBT (n = 25), TAU (n = 24) Trial duration: 16 weeks Treatment setting: individual Therapist expertise: experts only Number of sessions: 24 Study design: single blind Risk of bias: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder or psychotic disorder not otherwise specified (DSM-IV) Gender: 31 (63%) men, 18 (37%) women Mean age: 34.9 years Baseline severity: PANSS total score 60.12, positive symptoms 15.44, negative symptoms 13.29 Medication: 100% taking antipsychotics O Only treatment resistant patients included: no |
| Valencia et al]. [79] |
Country: Mexico Study treatments (number of patients): music therapy (n = 18), psychosocial therapy (n = 18), multiple therapies (n = 18) Trial duration: 26 weeks Number of sessions: 44 (MT), 44 (PST), 108 (MultipleT) Study design: single blind Risk of bias: high Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 33 (77%) men, 10 (23%) women Mean age: 30.5 years Duration of illness: 8.13 years Medication: 100% taking antipsychotics Only treatment resistant patients included: yes |
| van der Gaag et al [80] |
Country: Netherlands Study treatments (number of patients): CBT (n = 110), TAU (n = 106) Treatment setting: individual Trial duration: 26 weeks Number of sessions: 13 Study design: single blind Risk of bias: high Functioning scale: Social Functioning Scale (SFS) |
Country: schizophrenia or schizoaffective disorder (DSM-IV-TR) Gender: 153 (71%) men, 63 (29%) women Mean age: 36.99 years Baseline severity: PANSS total score 69.3, PSYRATS total 31.35 Duration of illness: 10.58 years Only treatment resistant patients included: no |
| Wang et al [81] |
Country: Hong Kong Study treatments (number of patients): mindfulness-based psychoeducation (n = 46), psychoeducation (n = 46), TAU (n = 46) Trial duration: 26 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 12 Study design: single blind Risk of bias: moderate Functioning scale: Specific Levels of Functioning (SLOF) |
Diagnosis: schizophrenia or its subtypes (DSM-IV-TR) Setting: outpatients Gender: 72 (52%) men, 66 (48%) women Mean age: 24.3 years Baseline severity: PANSS total score 87.93, positive symptoms 26.57, negative symptoms 18.3 Duration of illness: 2.03 years Medication: 85.51% taking antipsychotics Only treatment resistant patients included: no |
| Wykes et al [82] |
Country: UK Study treatments (number of patients): CBT (n = 45), TAU (n = 40) Trial duration: 10 weeks Treatment setting: group Therapist expertise: experts only Number of sessions: 7 Study design: open label Risk of bias: high Functioning scale: Social Behaviour Schedule |
Diagnosis: schizophrenia (DSM-IV) Setting: outpatients Gender: 50 (59%) men, 35 (41%) women Mean age: 39.7 years Baseline severity: PSYRATS hallucination score 27.95 Only treatment resistant patients included: no |
| Yildiz et al. [93] |
Country: Turkey Study treatments (number of patients): Psychosocial Skills Training (PST) (n = 10), Meta Cognitive Training (MCT) (n = 10) Trial duration: 20 weeks Treatment setting: group Therapist expertise: only expert Number of sessions: 40 Study design: single blind Risk of bias*: moderate Functioning scale: Global Assessment of Functioning (GAF) |
Diagnosis: schizophrenia or schizoaffective disorder (DSM-IV) Setting: outpatients Gender: 13 men, 7 women Mean age: 35.25 years Baseline severity: PANSS total score: 81.85 Duration of illness: 13.4 years Medication: 100% taking antipsychotics Only treatment resistant patients included: no |
*The overall risk of bias was calculated using the Cochrane risk of bias tool (Higgins et al. [30]) and the approach described by Furukawa [31]. For this evaluation, the domain “blinding of participants and personnel” was not considered as patients and therapists usually cannot be blinded in psychological interventions