Summary of Findings Table 1.
CBT Compared to all Other Psychological Therapies for Schizophrenia
| CBT Compared to “Other Psychosocial Therapies” for People With Schizophrenia | ||||||
|---|---|---|---|---|---|---|
| Patient or Population: People With Schizophrenia Setting: Inpatients and Outpatients Intervention: CBT + Standard Care Comparison: Other Psychological Therapies + Standard Care |
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| Outcomes | Anticipated Absolute Effectsa (95% CI) | Relative Effect (95% CI) | No. of Participants (Studies) | Quality of the Evidence (GRADE) | Comments | |
| Risk With All Other Psychological Therapies | Risk With CBT | |||||
| Global state: relapse follow-up: range 8 weeks to 12 months | Study population | RR 1.05 (0.85 to 1.29) | 375 (5 RCTs) | ⊕⊕⊝⊝ LOWb,c | ||
| 463 per 1000 | 486 per 1000 (393 to 597) | |||||
| Global state: rehospitalizationa follow-up: range 70 days to 5 years | Study population | RR 0.96 (0.82 to 1.14) | 943 (8 RCTs) | ⊕⊕⊝⊝ LOWb,c | Data for pre-defined outcome “clinically important change” not reported. | |
| 375 per 1000 | 360 per 1000 (307 to 427) | |||||
| Mental state: General—clinically important change (no improvement) follow-up: range 12 months to 5 years | Study population | RR 0.82 (0.67 to 1.01) | 249 (4 RCTs) | ⊕⊕⊝⊝ LOWb,c | ||
| 636 per 1000 | 522 per 1000 (426 to 643) | |||||
| Adverse effect/event: death—any cause follow-up: range 70 days to 24 months | Study population | RR 1.57 (0.62 to 3.98) | 627 (6 RCTs) | ⊕⊕⊝⊝ LOWd,e | ||
| 16 per 1000 | 25 per 1000 (10 to 64) | |||||
| Functioning—average scores (Social Functioning Scale, high = good) follow-up: mean 12 monthsa | The mean functioning— average scores (Social Functioning Scale, high = good, long-term) was 128.5 | MD 8.80 higher (4.07 lower to 21.67 higher) | - | 65 (1 RCT) | ⊕⊝⊝⊝ VERY LOWc,f,g | Data for pre-defined outcome “clinically important change” not reported. |
| Quality of life: average scores (MSQOL, high = good, medium term) follow-up: mean 6 monthsa | The mean quality of life: average scores (MSQOL, high = good, medium-term) was 60.9 | MD 4.50 lower (15.66 lower to 6.66 higher) | - | 64 (1 RCT) | ⊕⊝⊝⊝ VERY LOWc,g,h | Data for pre-defined outcome “clinically important change” not reported. |
| Satisfaction with treatment—leaving the study early for any reason | Study population | RR 0.86 (0.75 to 0.99) | 2392 (26 RCTs) | ⊕⊕⊝⊝ LOWb,j | ||
| 247 per 1000 | 217 per 1000 (192 to 256) |
Note: CBT, cognitive behavioral therapy; RCT, randomized controlled trial; MSQOL, Modular System for Quality of Life; MD, mean difference; RR, Risk ratio; GRADE, Working Group grades of evidence; High quality: We are very confident that the true effect lies close to that of the estimate of the effect; Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect; Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
aThe risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
bDowngraded by 1 level due to risk of bias: some studies had unclear or high risk of bias with blinding of participants and outcome assessments, as well as attrition issues.
cDowngraded by 1 level due to imprecision: small sample size and wide CI.
dDowngraded by 1 level due to risk of bias: majority of the included studies had unclear risk of blinding of participants and outcome assessments.
eDowngraded by 1 level due to imprecision: small event rate and wide CI around effect estimate.
fDowngraded by 1 level due to risk of bias: high risk of detection bias due to unblinded assessment.
gDowngraded by 1 level due to indirectness: scores from scale were employed as a surrogate index of the intended outcome.
hDowngraded by 1 level due to risk of bias: high risk of allocation concealment bias, and unclear risk around blinding.
iDowngraded by 1 level due to imprecision: small sample size and wide CI which included appreciable benefit and no effect.
jDowngraded 1 level due to indirectness: leaving the study early used to predict satisfaction with treatment.