Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis

Clinical equipoise regarding preventative treatments for psychosis has encouraged the development and evaluation of psychosocial treatments, such as cognitive behavioural therapy (CBT). A systematic review and meta-analysis was conducted, examining the evidence for the effectiveness of CBT-informed...

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Published in:	Psychological medicine 2014-02, Vol.44 (3), p.449-468
Main Authors:	Hutton, P., Taylor, P. J.
Format:	Article
Language:	eng
Subjects:	Anxiety Disorders - epidemiology Behavior therapy. Cognitive therapy Behavioral psychology Bias Biological and medical sciences Cognitive behaviour therapy Cognitive psychology Cognitive Therapy Depressive Disorder - epidemiology Disease Progression Heterogeneity Humans Medical sciences Meta-analysis Neuroses Numbers Needed To Treat Prodromal Symptoms Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychoses Psychosis Psychotic Disorders - epidemiology Psychotic Disorders - prevention & control Psychotic Disorders - psychology Quality of Life Randomized Controlled Trials as Topic Relative risks Risk Social Adjustment Symptoms Systematic review Therapeutic Equipoise Time Factors Treatment Outcome Treatments
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Summary:	Clinical equipoise regarding preventative treatments for psychosis has encouraged the development and evaluation of psychosocial treatments, such as cognitive behavioural therapy (CBT). A systematic review and meta-analysis was conducted, examining the evidence for the effectiveness of CBT-informed treatment for preventing psychosis in people who are not taking antipsychotic medication, when compared to usual or non-specific control treatment. Included studies had to meet basic quality criteria, such as concealed and random allocation to treatment groups. Our search produced 1940 titles, out of which we found seven completed trials (six published). The relative risk (RR) of developing psychosis was reduced by more than 50% for those receiving CBT at every time point [RR at 6 months 0.47, 95% confidence interval (CI) 0.27-0.82, p = 0.008 (fixed-effects only: six randomized controlled trials (RCTs), n = 800); RR at 12 months 0.45, 95% CI 0.28-0.73, p = 0.001 (six RCTs, n = 800); RR at 18-24 months 0.41, 95% CI 0.23-0.72, p = 0.002 (four RCTs, n = 452)]. Heterogeneity was low in every analysis and the results were largely robust to the risk of an unpublished 12-month study having unfavourable results. CBT was also associated with reduced subthreshold symptoms at 12 months, but not at 6 or 18-24 months. No effects on functioning, symptom-related distress or quality of life were observed. CBT was not associated with increased rates of clinical depression or social anxiety (two studies). CBT-informed treatment is associated with a reduced risk of transition to psychosis at 6, 12 and 18-24 months, and reduced symptoms at 12 months. Methodological limitations and recommendations for trial reporting are discussed.
ISSN:	0033-2917 1469-8978