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New Cochrane Review on Group CBT for Schizophrenia

Dr. Tania Lecomte provides a digest of the most recent Cochrane Review on Group-Administered Cognitive Behavioral Therapy for Schizophrenia.

What is a Cochrane Review?

A Cochrane Review is a systematic review of research in health care and health policy that is published in the Cochrane Database of Systematic Reviews.

What did this review set out to do?

The recent Cochrane review: Cognitive behavioural therapy (group) for schizophrenia (Cognitive behavioural therapy (group) for schizophrenia - Guaiana, G - 2022 | Cochrane Library), aimed at synthesizing the literature regarding the effects of group-administered CBT for schizophrenia on clinical aspects as well as on quality of life and functioning. The review included 24 papers (1900 participants).

What were the major findings?

The results suggest that, when compared to standard care or other psychosocial treatments, group CBT for schizophrenia is mostly effective for overall mental state and global functioning. No important differences between treatments were found for specific symptoms, quality of life, or for service use.

What were the limitations?

Although this is the first meta-analysis to specifically focus on the group format of CBT, it is limited by the fact that it targeted solely schizophrenia, whereas most studies offer CBT for psychotic symptoms more broadly. As such, some of the biggest and most rigorous studies in group CBT for psychosis were not included, because they targeted schizophrenia-spectrum diagnoses (and not just schizophrenia) or early psychosis. This is unfortunate, as this review is only relevant for people with longer course of the illness. Still, the review does confirm that group CBT has a general positive effect on one’s mental health and functioning, above and beyond other treatments, and its use is therefore strongly recommended for adult psychiatry clinics offering services to people with a diagnosis of schizophrenia.

Notably, the Cochrane review also omitted certain important outcomes to both the individual service user and the system. With regard to the former, previous studies have observed social benefits to the service user, such as increased social connections, return to work, and peer support. With regard to the latter, group-administered treatment permits the healthcare system to conserve limited resources and, as such, can be particularly beneficial when included as part of a stepped care approach.

Have any systematic reviews of Group CBTp been conducted in North America?

The Agency for Health Quality Research (AHRQ) conducted a systematic review of pharmacologic and psychosocial interventions for schizophrenia spectrum disorders in 2017. A digest of the psychological interventions, including CBT, was published in the journal Psychiatric Services, in 2021. Although findings were not limited to group-administered CBT, the review noted beneficial effects of CBT for psychosis on core illness symptoms, quality of life, and functioning.

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