Cognitive Behavioral Therapy for Prodromal Stage of Psychosis—Outcomes for Transition,Functioning, Distress,and Quality of Life: A Systematic Review and Meta-analysis |
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Authors: | Yuchen Zheng Tingting Xu Yikang Zhu Chunbo Li Jijun Wang Steven Livingstone Tianhong Zhang |
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Institution: | 1. Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China;3. Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK |
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Abstract: | ObjectiveThis study aimed to provide insight into the efficacy of cognitive-behavioral therapy for psychosis (CBTp) in patients with “clinical high risk of psychosis (CHR-P)”.MethodsMajor scientific databases were searched up to April 17, 2020. Randomized controlled trials in CHR-P individuals, comparing CBTp with needs-based interventions (NBI, including treatment as usual or nonspecific control treatment) were included, following PRISMA guidelines. The primary outcome (efficacy) was transition to psychosis by 6 months, 12 months, 24 months, and over 24 months. Secondary outcomes were change in attenuated psychotic symptoms, depression, distress, improvements in functioning, and quality of life.ResultsTen randomized controlled studies met inclusion criteria. The comparisons included 1128 participants. CBTp was significantly more efficacious in reducing rate of transition to psychosis by 6 months (after post-hoc sensitivity analysis) (relative risk RR] = 0.44, 95% confidence interval CI]: 0.26, 0.73), 12 months (RR = 0.44, 95% CI: 0.30, 0.64), 12 months (RR = 0.46, 95%CI: 0.30, 0.69), and over 24 months (RR = 0.58, 95% CI: 0.35, 0.95) after treatment, compared with those receiving NBI. CBTp was also associated with more reduced attenuated psychotic symptoms by 12 months (SMD = −0.17, 95% CI: −0.33, −0.02) and by 24 months (SMD = −0.24, 95% CI: −0.43, −0.06). No beneficial effects on functioning, depression, quality of life, or distress were observed favoring CBTp.ConclusionsCBTp is effective in reducing both psychosis transition rates and attenuated psychotic symptoms for the prodromal stage of psychosis. It is a promising intervention at the preventative stage. |
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Keywords: | psychosis CBTp cognitive-behavioral therapy meta-analysis systematic review clinical high risk distress quality of life functioning |
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