Table 3.
Description of interventions. (Adapted from [1], created with Microsoft Office)
| Acceptance and commitment therapy (ACT) | A manualized cognitive behavior therapy (Hayes et al. 2003, p. 79) that focuses more on the patient’s relation to distressing symptoms than on the symptoms themselves. It encourages patients to be mindful of and accept instead of try and avoid negative experiences, such as distressing voices. At the same time, it is a goal to take value-guided action to enable positive change in spite of the difficulties the patients face1 |
| Activity group ( inactive control) | Activity groups are used as control groups in the trial Crawford and colleagues conducted. They aim to control for potential effects of the group setting also used in group art therapy. Lead by a group facilitator, the patients engage together in different activities varying from watching films to visiting local cafés. Psychological techniques as well as art materials are not employed2 |
| Art therapy | In art therapy, patients express their inner experience spontaneously and freely in a creative process using different art materials. Then, they get the possibility to share and discuss their pictures helped by interventions of an art therapist2,3 |
| Befriending ( inactive control) | A manualized treatment designed to control for the therapist’s attention and the patient’s treatment expectancy. It includes conversation about everyday topics and, if conversation is too difficult to attain, neutral activities that do not provoke fear or negative emotions. For talking about symptoms and problems, the patient is referred to the treating clinician4 |
| Cognitive-behavioral social skills training ( CBT) | An intervention integrating cognitive behavioral techniques and strategies from social skills training to help patients challenge their thoughts, ask for help in an appropriate way and problem-solve, tailored to the specific needs of patients suffering from schizophrenia5 |
| Cognitive behavior therapy (CBT) | A widely spread therapy approach aimed at changing thought processes and behavior. Initially, a stable therapeutic relationship is to be built. The following treatment includes identifying dysfunctional cognitive and behavioral patterns, setting distinct and reachable therapy goals together and replacing dysfunctional patterns step by step with healthier ones. CBT for psychosis focusses especially on dealing with disturbing hallucinations and delusional thoughts as well as the identification of negative belief systems and the development of healthy coping strategies6 |
| Cognitive remediation | Applying the principles of errorless learning and immediate positive feedback, executive functioning, attention and memory are trained using techniques for structuring of information, verbalization and self-instruction7 |
| Cognitive therapy ( CBT) | An individualized goal-directed therapy approach aiming to motivate the patient to work on realistic long- and short-term goals. Dysfunctional believes are replaced by more functional ones using cognitive and behavioral strategies. Techniques introduced and practiced during the sessions are consolidated with homework for the patient to do between the sessions8 |
| Creative therapy | This term summarizes therapies that give patients the possibility to express themselves in a creative way, for example through art, music or body movement. For more detailed information about the treatments that are considered creative therapy, see their descriptions in this table |
| Dance and movement therapy and body psychotherapy | See movement therapy |
| Day treatment program ( TAU) | A psychiatric service provided for a longer period of time to persons with serious and chronic psychiatric conditions. It entails medication management and different group interventions9 |
| Family intervention | An intervention that aims at improving communication and problem-solving skills in the families of schizophrenic patients. There are psychoeducational elements to enable a better understanding of the patients. On top of that, the patient and the relatives get the possibility to discuss and resolve conflicts with the help of a professional and work through difficult emotions that arise as a consequence of the disease10 |
| Goal-focused supportive contact ( inactive control) | Designed to control for frequency and amount of contact to the therapist and other group members, this intervention gives patients the opportunity to formulate goals and work on them through group discussion without specific therapist guidance11 |
| Hallucination focused integrative treatment | This is a combination treatment containing psychoeducational, cognitive-behavioral, coping-oriented as well as family interventions and rehabilitative elements added to antipsychotic medication. The main purpose is to cope better with hallucinations12 |
| Inactive control | This term is utilized for any treatment that serves as a control condition regarding non-specific factors such as the therapist’s attention, for example “activity group”, “befriending”, “social activity therapy” or “supportive counselling” which are also described in this table13 |
| Integrated therapies | Under this term, treatments that combine multiple fundamentally different therapeutic strategies, for example music therapy, family intervention or behavioral therapy, are subsumed |
| Metacognitive training | A structured group intervention aimed at dismantling cognitive biases that contribute to psychotic exacerbations. There are multiple modules with different specific targets such as showing the importance of collecting enough information before making assumptions, strengthening theory of mind or also handling affective symptoms14 |
|
Metacognitive reflection and insight therapy (MERIT) ( metacognitive training) |
This therapy aims to stimulate the four metacognition elements (self-reflectivity, understanding the other’s mind, decentration, and mastery) and focuses on adjusting level of metacognition of the patient during the session rather than providing a step-by-step intervention28 |
| Mindfulness | A third-wave cognitive and experiential approach aimed at enabling a different pattern of relating to psychotic experiences such as thoughts, images and hallucinations. Core element are guided meditation sessions in which patients are motivated to focus on bodily sensations and their breath and bring a gentle attention to distressing symptoms. The aim is not to eliminate distressing sensations, but to alleviate distress that is generated by dysfunctional ways of relating to them. Mindfulness meditation integrated with discussion in a cognitive frame is believed to bring about metacognitive insights that enhance the process of relating more functionally to psychotic experiences15,16 |
| Mindfulness-based psychoeducation ( mindfulness) | Its aim is to increase the patient’s comprehension of schizophrenia and their illness insight as well as helping them to manage and accept their symptoms. Patients are taught to recognize and respond in a less-involved way to their emotions, cognitions and perceptions instead of seeing them as exact representations of reality17 |
| Movement therapy | Movement therapy is a therapy form that aims at alleviating psychotic symptoms using body-oriented exercises. These can focus on perception of sensation on the one hand as well as on an active and expressive bodily movement on the other hand. Feeling and moving the body are used to enable the patients to develop a more embodied sense of self, a broader range of communicative behaviors and a more differentiated understanding and expression of their emotions18 |
|
Movie therapy ( inactive control) |
A therapy that screens the 2–3-min videos on different topics showing the people interact each other and reflecting certain emotion theme such as basic emotions (fear and happiness) and complex emotions (jealousy, disappointment, etc.). This movie therapy allows the patients to follow three stages which first the video sections are watched without interruption and the group therapist will ask the patient how they interpret the scenes. In the second stage, the group therapist will pause the video sections to allow the patients to collect the social clues such as place, time, facial expressions, voice tones, etc. Finally, the patients discuss the social clues they have picked up29 |
| Music therapy | An intervention that uses music to tackle psychotic symptoms. It can take place either individually or in a group setting. Usually, patients are encouraged to express themselves spontaneously by improvising on musical instruments. Therapeutic interventions can entail accompanying the patients’ music, helping them to vary the course of the music and interpreting the music together through discussion19 |
| Narrative therapy | Narrative therapy is an intervention that helps patients to collect their life events, experiences, and memories, as well as understand other people’s thoughts and feelings to gain new insights and perspectives. There are four stages during the sessions. At the first stage, the patients will share their stories without interruption after the group therapist reviewed the narrative before the session begins. The second and third stage will be about responding to the narrative by asking several questions and it is also important to ask the patient’s emotions during the event and ensure that the patient feel accepted of what other people might have thought and felt. The last stage aims to gain an insight and perspective from other patients29 |
| PIPE (Psychoeducation, CBT, motivational intervention) | This is a combination therapy consisting of psychoeducation, individual CBT & family cognitive-motivational therapy. The aims to treat the patient’s ideas and hallucination and to ensure the family can adapt to the illness and provide the optimal support and environment for the sake of patient’s recovery30 |
| Psychotherapy not further specified | A therapy is considered not specified, if no further information is given about the specific form of psychological treatment, for example in the study undertaken by Matthews in 1981, where it was only mentioned that the patients received “psychotherapy”, but no details were given |
| Positive psychotherapy | Using different exercises, patients shall be encouraged to make positive experiences, enhance their personal strengths and interpersonal relationships and get a more meaningful perspective on their lives20 |
| Psychodynamic therapy | Patients get the opportunity to describe the narratives of their lives. By doing so, they can make sense of the timing and nature of the illness and how it is related to strong and unbearable affects in their past personal history. Furthermore, transference phenomena in the therapeutic relationship can be described and worked through24 |
| Psychoeducation | Psychoeducation is meant to teach patients about different aspects of their disease and its management. Topics vary from explanation models of disease development to the rationale for medication and different coping strategies as well as noticing and understanding warning signs for relapses21 |
| Psychosocial therapy | Psychosocial therapy is an intervention based on social skills training with the aim to give patients behavioral alternatives that enrich their existing behavioral strategies. The focus lies on five areas: occupation, economical aspects and relationships with friends, partners and family22 |
| Social activity therapy ( inactive control) | Social activity therapy has the goal to support patients in finding activities they like doing and taking steps to actually engage in them23 |
| Standard treatment ( TAU) | See “Treatment as usual” |
| Supportive therapy | In supportive therapy, a safe environment is created in which patients can talk about their problems24. The therapists support the patients emotionally without giving symptom specific interventions. More importance is given to non-specific therapeutic factors such as empathic attitude and creating a reliable therapeutic alliance25 |
| Third-wave cognitive behavioral therapy | If described as waves, the first wave of CBT consists in the strictly behavioral approach and the second is characterized by the implementation of a cognitive model. In the current third wave, an emphasis is put on metacognition and how the patient relates to thoughts and emotions. Examples for third-wave therapies are dialectical behavior therapy, acceptance and commitment therapy (ACT), mindfulness-based treatments, metacognitive therapy and several others27 |
| Treatment as usual (TAU) | Patients assigned to this group get the usual psychiatric care. What it exactly entails depends on the local guidelines. Usually, patients are offered medication and regular visits to doctors and nurses to talk about current issues13 |
| Virtual-reality exposure therapy for psychosis ( CBT) | A cognitive behavior therapy using a virtual-reality environment for exposure exercises for fear and paranoia provoking social situations26 |
| Wait-list | If patients get assigned to the wait-list, this means that they get informed that there is a possible treatment, but they cannot yet engage in it. They can only get that specific treatment after waiting some weeks13 |
1. Pankey J, Hayes SC (2003) Acceptance and commitment therapy for psychosis. Int J Psychol Psychol Ther 3(2):311–328
2. Crawford MJ, Killaspy H, Barnes TR et al (2012) Group art therapy as an adjunctive treatment for people with schizophrenia. A randomised controlled trial (MATISSE). Health Technol Assessm (Winchester, England) 16(8): iii–iv, 1–76. https://doi.org/10.3310/hta16080
3. Montag C, Haase L, Seidel D et al (2014) A pilot RCT of psychodynamic group art therapy for patients in acute psychotic episodes. Feasibility, impact on symptoms and mentalising capacity. PloS One 9(11): e112348. https://doi.org/10.1371/journal.pone.0112348
4. Shawyer F, Farhall J, Mackinnon A et al (2012) A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behav Res Ther 50(2):110–121. https://doi.org/10.1016/j.brat.2011.11.007
5. Granholm E, McQuaid JR, McClure FS et al (2005) A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry 162(3):520–529. https://doi.org/10.1176/appi.ajp.162.3.520
6. Hagen R, Turkington D, Berge T, Gråwe RW (2011) CBT for psychosis: A symptom-based approach. Routledge
7. Klingberg S, Wölwer W, Engel C et al (2011) Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy. Results of the randomized clinical TONES study. Schizophr Bull 37 Suppl 2: S98–110. https://doi.org/10.1093/schbul/sbr073
8. Grant PM, Huh GA, Perivoliotis D et al. (2012) Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Arch General Psychiatry 69(2): 121–127. https://doi.org/10.1001/archgenpsychiatry.2011.129
9. Bradshaw W (2000) Integrating cognitive-behavioral psychotherapy for persons with schizophrenia into a psychiatric rehabilitation program. Results of a three year trial. Commun Mental Health J 36(5): 491–500. https://doi.org/10.1023/a:1001911730268
10. Garety PA, Fowler DG, Freeman D et al (2008) Cognitive–behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis. Randomised controlled trial. The British journal of psychiatry: the journal of mental science 192(6): 412–423. https://doi.org/10.1192/bjp.bp.107.043570
11. Granholm E, Holden J, Link PC et al (2014) Randomized clinical trial of cognitive behavioral social skills training for schizophrenia. Improvement in functioning and experiential negative symptoms. Journal of consulting and clinical psychology 82(6): 1173–1185. https://doi.org/10.1037/a0037098
12. Jenner JA, Nienhuis FJ, Wiersma D et al (2004) Hallucination focused integrative treatment. A randomized controlled trial. Schizophr Bull 30(1): 133–145. https://doi.org/10.1093/oxfordjournals.schbul.a007058
13. Bighelli I, Salanti G, Huhn M et al (2018) Psychological interventions to reduce positive symptoms in schizophrenia. Systematic review and network meta-analysis. World psychiatry: official journal of the World Psychiatric Association (WPA) 17(3): 316–329. https://doi.org/10.1002/wps.20577
14. Roberts DL, Penn DL (2013) Social Cognition in Schizophrenia. Oxford University Press
15. Chadwick P (2006) Person-Based Cognitive Therapy for Distressing Psychosis. John Wiley & Sons Ltd, West Sussex, England
16. Chadwick P, Hughes S, Russell D et al (2009) Mindfulness groups for distressing voices and paranoia. A replication and randomized feasibility trial. Behav Cogn Psychother 37(4): 403–412. https://doi.org/10.1017/S1352465809990166
17. Chien WT, Lee IYM (2013) The mindfulness-based psychoeducation program for Chinese patients with schizophrenia. Psychiatric serv (Washington, D.C.) 64(4):376–379. https://doi.org/10.1176/appi.ps.002092012
18. Martin LAL, Koch SC, Hirjak D et al (2016) Overcoming disembodiment. The effect of movement therapy on negative symptoms in schizophrenia-a multicenter randomized controlled trial. Front Psychol 7:483. https://doi.org/10.3389/fpsyg.2016.00483
19. Talwar N, Crawford MJ, Maratos A et al (2006) Music therapy for in-patients with schizophrenia. Exploratory randomised controlled trial. The British J Psychiatry 189:405–409. https://doi.org/10.1192/bjp.bp.105.015073
20. Schrank B, Brownell T, Jakaite Z et al (2016) Evaluation of a positive psychotherapy group intervention for people with psychosis. Pilot randomised controlled trial. Epidemiol Psychiatric Sci 25(3): 235–246. https://doi.org/10.1017/S2045796015000141
21. Cather C, Penn D, Otto MW et al (2005) A pilot study of functional Cognitive Behavioral Therapy (fCBT) for schizophrenia. Schizophr Res 74(2–3): 201–209. https://doi.org/10.1016/j.schres.2004.05.002
22. Valencia M, Murow E, Rascon ML (2006) Comparación de tres modalidades de intervención en esquizofrenia: terapia psicosocial, musicoterapia y terapias múltiples. [Comparison of three types of treatment for schizophrenia: Psychosocial therapy, music therapy, and multiple therapies]. Revista Latinoamericana de Psicologia 38(3):535–549
23. Haddock G, Barrowclough C, Shaw JJ et al (2009) Cognitive-behavioural therapy v. social activity therapy for people with psychosis and a history of violence. Randomised controlled trial. British J Psychiatry 194(2):152–157. https://doi.org/10.1192/bjp.bp.107.039859
24. Durham RC, Guthrie M, Morton RV et al (2003) Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. Results to 3-month follow-up. British J Psychiatry 182:303–311. https://doi.org/10.1192/bjp.182.4.303
25. Penn DL, Meyer PS, Evans E et al (2009) A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations. Schizophr Res 109(1–3):52–59. https://doi.org/10.1016/j.schres.2008.12.009
26. Pot-Kolder RMCA, Geraets CNW, Veling W et al (2018) Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders. A single-blind randomised controlled trial. Lancet Psychiatry 5(3):217–226. https://doi.org/10.1016/S2215-0366(18)30053-1
27. Hayes SC, Hofmann SG (2017)The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry16(3):245–246. https://doi.org/10.1002/wps.20442
28. de Jong S, van Donkersgoed RJM, Timmerman M E et al (2019) Metacognitive reflection and insight therapy (MERIT) for patients with schizophrenia. Psychol Med 49(2):303–313. https://doi.org/10.1017/S0033291718000855
29. Gürcan MB, Yildiz M, Patir K, Demir Y (2021) The effects of narrative and movie therapy on the theory of mind and social functioning of patients with schizophrenia. Noro Psikiyatri Arsivi 58(2):108–114. https://doi.org/10.29399/npa.27291
30. Palma C, Farriols N, Frías A, Cañete J, Gomis O, Fernández M, Alonso I, Signo S (2019) Randomized controlled trial of cognitive-motivational therapy program (PIPE) for the initial phase of schizophrenia: Maintenance of efficacy at 5-year follow up.✰. Psychiatry Res 273:586–594. https://doi.org/10.1016/j.psychres.2019.01.084