Table 3.
Key characteristics and evidence base (RCTs and SEE effectiveness studies) for recommended interventions in the analyzed treatment guidelines.
| Recommended interventions | Short description | Country of origin (year) | Manual/guide for therapists | Duration of staff training | Randomized-controlled trial (RCT) evidence base | Effectiveness and/or implementation studies in SEE healthcare systems | |
|---|---|---|---|---|---|---|---|
| 1) | Art therapy | Form of psychotherapy that uses art media as its primary mode of communication. | United Kingdom (1960s) | N/A | 2–3 years | Negative (RCT indicated that group art therapy was not more effective than activity groups or standard care; (Crawford et al.35) | N/A |
| 2) | Adherence therapya | Form of counselling that is mostly focused on advising the patient on how to take his/her medication properly. | United Kingdom (1998) | Gray et al.36 | 3–4 days | Mixed (Meta-analysis of six RCTs indicated that Adherence therapy was more effective in reducing psychiatric symptoms than usual treatment) (Gray et al.37) | N/A |
| 3) | Assertive community treatment (ACT) | A person-centered form of community-based mental health care that includes support services for people with serious mental health illness. | USA (1970s) | Blokdyk38 | 2 days | Mixed (Meta-analysis of 6 RCTs and 11 observational studies showed that ACT yielded medium to large effects on symptoms, functioning, and well-being) (Norden, Malm, & Norlander39) | N/A |
| 4) | Case management | Adjusting the course, form, and contents of mental health treatment to the patient’s needs. | USA (1980s) | Powell and Tahan40 | N/A | Mixed (Meta-analysis of 40 RCTs showed that intensive case management may be valuable to individuals with high level of hospitalization in reducing hospitalization and increasing retention in care); Dietrich et al.41) | N/A |
| 5) | Cognitive-behavioral therapy (CBT) | Form of psychological treatment which involves efforts to change thinking and behavioral patterns. | USA (1960s) | Smith et al.42 | 1–3 years | Mixed (Meta-analysis of 60 RCTs indicated that CBT may improve schizophrenia symptoms) (Jones et al.43) | N/A |
| 6) | Cognitive remediation | This approach aims at improving neurocognitive functioning which could have a positive impact to psychosocial (everyday life) functioning. | Germany (1910s) | Haskins et al.44 | 3 months | Mixed (Meta-analysis of 26 RCTs indicated that Cognitive remediation produces moderate cognitive improvements); (McGurk et al.45). | Cognitive remediation linked with less negative symptoms and better quality of life, no effect on positive symptoms and social functioning (Trial data from Greece) (Rakitzi, et al.28) |
| 7) | Compliance therapy | Form of counselling that is similar to the adherence therapy. It is more focused on making sure that the patient comes to appointments with the medical professional, as well as on lifestyle and dietary changes. | Australia & United Kingdom (1996) | Kemp & David46 | N/A | Negative (single RCT;indicated that Complience therapy was not effective when compared to non-specific counselling, O’Donnell et al.47) | N/A |
| 8) | Family interventions | A set of interventions that help family members to improve their mutual communication and resolve their conflicts in more adequate ways than before. | UK and USA (mid-20th century) | Healios Ltd48 | 2 years | Mixed (meta-analysis of 25 intervention studies indicated that Family interventions can reduce the relapse rate by 20%) (Pitschel-Walz, et al.32). | N/A |
| 9) | Occupational therapy (Ergotherapy) | Patients are involved in various activities, preferably designed by taking into account their abilities, interests, and needs. | USA (1910s) | American Occupational Therapy Association49 | 3 years (at least) | Negative (Pilot RCT indicating Occupational therapy appears to reduce positive and negative symptomatology) (Foruzandeh & Parvin50) | N/A |
| 10) | Peer to peer support groups (including self-help groups and organizations) | Users of mental health services gather in order to support each other, because all of them went through some sort of mental health treatment as well as have experienced mental health issues. | France (late 18th century) | N/A | N/A | Negative (No effects were found on reducing psychiatric symptoms, based on meta-analysis that included 18 trials) (Lloyd-Evans et al.51) | N/A |
| 11) | Professional (vocational) rehabilitation | Its main aim is to train people for a suitable job, taking into account their disability. Other aims include helping them to maintain their jobs, as well as to develop professionally. | USA (early 1900s) | N/A | N/A | N/A | N/A |
| 12) | Psychodynamic/ psychoanalytic therapy | Various forms of depth psychotherapy originated from the theory and practice of S. Freud. | Austria (1890s) | McWilliams52 | 2–4 years | Negative (no trials for psychoanalytic therapy and scarce data for psychodynamic approach) (Malmberg & Fenton53) | N/A |
| 13) | Psychoeducation | Form of counselling where the patient is provided with information on the symptoms of his/her disease along with treatment options. | USA (1980) | Available manuals do not specifically refer to psychoeducation | N/A | Mixed (Systematic review of 44 trials indicated psychoeducation appears to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stay); (Xia, Merinder & Belgamwar33) | Psychoeducation of patients’ family members was associated with greater compliance and reduction in hospitalization (Trial data from Greece) (Palli et al.54) |
| 14) | Psychosocial interventions for maintaining optimal body weight | A set of interventions aimed at encouraging patients to change positive health behavior and lifestyle in a positive direction. | United Kingdom (2008) | Mooney at al,55 | N/A | N/A | N/A |
| 15) | Psychosocial interventions dealing with addiction problems as comorbid disorders | This kind of intervention is designed to address and treat substance-related issues that could also be detected in people with severe mental illness. It includes56: behavioral therapy approaches, family interventions, community reinforcement therapy, motivational enhancement therapy (MET), and CBT. | USA (2003) | N/A | N/A | N/A | N/A |
| 16) | Psychosocial interventions focused on social inclusion (e.g. social recovery therapy) | The approach is focused on deinstitutionalization, stigma-reduction, and social (re)integration. Social inclusion is a broad term and can, for example, include supported employment. | EU (1990s) | Fowler et al.57 | N/A | Positive (RCT indicated social recovery therapy plus early intervention services was associated with an increase in structured activity compared with early intervention services alone) (Fowler et al.58) | Social rehabilitation improved social functioning, self-esteem, and quality of life: case-controlled study from Croatia (Štrkalj-Ivezić et al.29) |
| 17) | Psychomotor (body) therapyb | This is a holistic approach focused on the body expression which included not only physical, but also cognitive and emotional aspects. | Belgium, Germany, and Netherlands (1960) | N/A | 500 h | N/A | N/A |
| 18) | Social skills training | This kind of training includes the development of skills that are relevant for communication and interaction with the social environment (e.g., assertiveness, self-regulation, and empathy). | USA (1970) | Bellack et al.59 | 2 days | Mixed (Meta-analysis of 27 RCTs indicated that social skills training was associated with improvements in negative symptoms and general psychopathology (Turner et al.60) | N/A |
| 19) | Supportive therapy | This technique overlaps with psychological/psychiatric counselling. | Europe and USA (mid-20th century) | Novalis, Singer, & Peele61 | It depends on the duration of training in other psychotherapies (e.g., CBT, psychoanalytic therapy, etc.) | Negative (Review of 24 trials indicated no difference compared to standard care) (Buckley et al.62) | N/A |
| 20) | Supported employment | A form of employment for people with various disabilities, where an employment specialist, coworkers or other people help the person during his/her work engagement. | USA (1970s) | A manual specifically covering supported employment for people with schizophrenia does not exist. | N/A | Mixed (Review of 14 trials indicated supported employment was effective in improving several vocational outcomes, e.g. increasing length of competitive employment) (Kinoshita et al.30) |
N/A not available (data or relevant study).
aThe terms “adherence therapy” and “compliance therapy” are sometimes used interchangeably, referring to the same or similar psychosocial approach (as was the case in the expert survey). However, it seems their levels of effectiveness are not the same which is the reason they are presented separately in the table.
bCould be considered as a form of occupational therapy.