Efficacy of cognitive behavioural therapy in the treatment of psychosis: a meta-review

Introduction. Although cognitive behavioural therapy (CBT) for psychosis is recommended by the main international guidelines, its effective efficacy in the treatment of schizophrenia and psychosis is still debated. Aims. To evaluate the effectiveness of cognitive behavioural therapy in the treatment of psychosis. Method. A systematic research was carried out for systematic reviews and meta-analysis on the effectiveness of CBT in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis. Results. 20 meta-analysis were selected: 2 of high quality, 5 of moderate quality, 6 of low quality, 7 of critically low quality. Discussion and conclusion. CBT is an effective therapy compared to treatment as usual, for positive, negative and general symptoms of psychosis (with a particularly large number of studies in favour of positive symptoms), with effects of medium-small size. On the other hand, there is no clear and convincing advantage for CBT over other psychological and psychosocial therapies for symptoms, relapses, social functioning and quality of life in people with psychosis even if today the quality of the trials available is mostly of low or very low quality and further research is needed to reach reliable conclusions. Further and more rigorous research is certainly needed also to establish the effective efficacy of CBT on secondary symptoms, insight and non-symptomatic outcomes. CBT does not seem to produce significant effects in the prevention of psychotic relapses.