Review of CBT for Schizophrenia - taking account of research biases

[Bob]

This all sounds very familiar...

Keith Laws and colleagues have carried out a review of CBT meta-analyses for schizophrenia.
They found that there was only only a small improvement in symptoms, but when the best quality studies were analysed (when the researchers were blinded), there was no significant improvement.

Schizophrenia: talking therapy offers 'little benefit'
BBC news
2 January 2014
http://www.bbc.co.uk/news/health-25574773
...
A University of Hertfordshire team analysed over 50 studies on the use of cognitive behavioural therapy (CBT) from around the world.
...
It found that CBT did have a small benefit in treating delusions and hallucinations - which is what the therapy was was originally developed to target.

But the researchers said even this small effect disappeared when only studies using 'blind testing' were taken into account - this is where researchers do not know which group of patients are receiving the therapy.

Keith Laws, professor of cognitive neuropsychology at the University of Hertfordshire who led the study, questioned the use of CBT.

He said: "With this evidence, the current government policy which mandates this treatment for all patients with schizophrenia in England and Wales needs to be reconsidered."

The National Institute for Health and Care Excellence (NICE) argues CBT is effective, and recommend it for all people with the disorder.

...
But Paul Jenkins, chief executive of the charity Rethink Mental Illness, said: "There's a significant amount of anecdotal evidence from our members who have schizophrenia that talking therapies, like CBT, are an invaluable tool for helping them manage their illness and improve their quality of life.

"We have found that CBT can help people understand and respond better to voices in their head and to hallucinations, tackle the underlying causes of their condition and give them a more optimistic outlook."

CBT tackles the 'underlying causes' of schizophrenia? Er, right.

I can understand how CBT might help some people with mild symptoms of schizophrenia to cope, to manage the illness, and to help them recognise symptoms etc. But to say that CBT tackles the underlying cause suggests a worrying level of ignorance.

Familiar?

 

[Bob]

The Study.

Interestingly, this review was designed to examine possible biases.

This is something we've noticed in meta-analyses of CBT/GET for CFS: "Cognitive-behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias."

(Note: I've omitted the 'results' section from the abstract, below. See the weblink for full details.)

Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias
S. Jauhar, P. J. McKenna, J. Radua, E. Fung, R. Salvador and K. R. Laws
The British Journal of Psychiatry (2014) 204: 20-29
doi: 10.1192/bjp.bp.112.116285
http://bjp.rcpsych.org/content/204/1/20

Abstract

Background

Cognitive-behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias.

Aims

To conduct a systematic review and meta-analysis of the effectiveness of CBT for schizophrenic symptoms that includes an examination of potential sources of bias.

Method

Data were pooled from randomised trials providing end-of-study data on overall, positive and negative symptoms. The moderating effects of randomisation, masking of outcome assessments, incompleteness of outcome data and use of a control intervention were examined. Publication bias was also investigated.

...

Conclusions

Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the ‘small’ range. This reduces further when sources of bias, particularly masking, are controlled for.

 

[A.B.]

I think CBT will be discredited just like psychoanalysis and turn out to be nonsense that was only believed due to lots of hype and deception.

 

[Esther12]

Thanks Bob. The drippy response from Rethink Mental Illness was embarrassing... it is just like defenses of homeopathy. People classed as being mentally ill really do get shat upon. There needs to be a dramatic change.

 

[biophile]

Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the ‘small’ range. This reduces further when sources of bias, particularly masking, are controlled for.

The effect sizes of CBT for schizophrenic symptoms, described above as in the "small" range, are similar to those arbitrarily described by proponents as "moderate" for CFS. Masking would almost certainly dwindle it further. Not to mention the objective evidence disputing the functional benefit or behavioural changes that supposedly occur after CBT for CFS.

 

[taniaaust1]

Thanks Bob. The drippy response from Rethink Mental Illness was embarrassing...

To me it sounded like the kind of crap stuff some of our poorer orgs give when confronted with something like that.

 

[IreneF]

When I was healthier I used to talk with the local Crazy Lady when I met her on the street. I don't think she could tell the difference between me and the voices in her head. I can't imagine how CBT could possibly have made a difference to her. She needed a lot more care than she was getting, but in California a person can't be forced into treatment unless they are unequivocally a danger to themselves or others.