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. 2018 Dec 20;2018(12):CD007964. doi: 10.1002/14651858.CD007964.pub2

Naeem 2015.

Methods Allocation: randomised
Blinding: Assessors were blind to allocation and were based in a separate location.
Location: 2 hospitals, Pakistan
Length of follow‐up: 4 months
Participants Diagnosis: schizophrenia or a related disorder (ICD‐10, RDC)
N = 116
Sex: 70 M, 46 F
Age: 18 ‐ 65 years, mean ˜ 31.1 years, SD ˜ 7.4 years
Included: length of illness: mean ˜ 5.8 years, SD ˜ 3.7 years; living within travelling distance of the hospital; having at least 5 years of education or living with a carer with at least 5 years of education
Excluded: comorbid alcohol or substance dependence; severe learning impairment; problems due to an organic condition; high levels of disturbed behaviour, or high risk of suicide or homicide
Interventions 1. CBT group*: N = 59
Content: A spiritual dimension was included in formulation, understanding and in therapy plan; equivalents of CBT jargons were used in the therapy; culturally appropriate home work assignments were selected and participants were encouraged to attend even if they were unable to complete their homework; folk stories and examples relevant to the religious beliefs of the local population were used to clarify issues.
Delivered by: psychology graduates with more than 5 years experience of working in mental health
Frequency: 6 to 10 sessions
Treatment duration: 4 months
2. Standard care group: N = 57
Content: This normally consists of prescribing antipsychotic medication as considered suitable by the treating psychiatrist and nursing care.
Delivered by: not reported
Frequency: not reported
Treatment duration: 4 months
Outcomes Mental state: positive symptoms, negative symptoms, affective symptoms (PANSS scores); delusion, hallucination (PSYRATs scores), insight (SAI scores)
Satisfaction with treatment: leaving the study early
Notes *Participants in the CBT group also received the standard care intervention.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "...randomly assigned, allocation lists were generated by a web‐based automated randomisation system..." (p.145).
Comments: The investigators described a random component in the sequence generation process.
Allocation concealment (selection bias) Unclear risk Comments: The method of concealment was not described.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Comments: The author did not address this information. However, participants and personnel were not likely to be blinded because participants in the treatment group received CBT, and the control group only received standard care.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Quote: "Assessors were blind to allocation and were based in a separate location." (p.144)
Comments: The outcome assessor could not foresee assignment.
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Comments: Six participants from CBT group and eight participants from control group left the study early. No reason was reported.
Selective reporting (reporting bias) Low risk Comments: All measured outcomes were reported.
Other bias Low risk Comments: none obvious